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New to group, Pre biopsy testing
I'm new here to this discussion group. I have been following with interest many of the topics here.
I am 67, have had on and off BPH issues since my 40's. For which I chose to do nothing with besides monitor.
Over the past year though things changed after taking antihistamines / antibiotics for a case of pneumonia. My prostate didn't like that and made urinating very difficult. Family Doc prescribes flomax and refers me to a Urology group.
A PSA was run at the time indicating 15.2.
Since going to the Urology group (after a few months of waiting to get in) a number of tests and an MRI have been performed. I've listed them here:
Labs/Imaging
- PSA (04/2025): 15.229
- PSA (08/19/2025): 5.24
- ExoDx (11/24/2025): 72.91
- ISO PSA (04/14/2026): Total PSA 8.3, risk result 8.
- Prostate MRI (09/02/2025): Prostate volume 70cc. 10x4 mm PIRADS 3 lesion in left transitional zone of mid-gland. No extracapsular extension or lymphadenopathy. BPH, mild bladder wall thickening noted.
- CarePath (03/15/2026): Average Qmax 8 mL/sec (obstructed, < 10 mL/sec).
The results seem to be leading down the path to a biopsy. Is this a correct assumption given what is listed here? Or are there other non invasive tests that can be done?
Thanks in advance for your opinions and advise.
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Well...results are in and yes, you have cancer. Now what? The nature of the beast is:
1) Urology will want an RP...that's what they do.
2) Radiology will want IMRT or the like...that's what they do.
3) You want a care team to evaluate all possibilities at a respected cancer center, or you want a respected GUO (Genito-urinary oncologist) to guide you through, so you can make the most informed decision possible, and quarterback your care.
One thing to remember...second opinions are not insults to your doctor and if they are, find a new doctor.
I had a urologist a little over a year ago who, when some somatic testing came back said, "Wow, I've never seen that before."
My reply, "Well then, I'm not talking to the right doctor, am I? How about you find me someone that has seen it before."
He did.
Best wishes! 👍
@mjp0512 I have been fortunate in my life to never have needed more than the family physician to handle the coughs, colds and sniffles.
I'd like to go straight to #3! Where do you find these "care teams"? The nearest place to me would be Duke University Medical (about 4 hours away). How do you get to these teams as opposed to individual doctors? What do you ask for?
@corsair
My recommendation is to start making calls to the best Doctors/Centers in your area.
Last October, I was in your situation post MRI/Biopsy at local Urologist/Hospital.
I started asking friends and friends of friends who they recommended. I called City of Hope and asked to meet with the best Urologist (that had been recommended to me). From that initial call, everything has gone very well. Within two weeks, I was meeting with Surgeon and Radiation Oncologist. Have continued to work thru the process of gathering info and additional tests.
You may need a referral, but from my experiences, best just to start making phone calls and ask to be seen by their best Surgeon/Urologist and Radiation Onvologist.
Based on Biopsy and MRI, appears you want to be meeting with a great Surgeon and Radiation Oncologist and ask, “Why is Active Surveillence not appropriate at this time?”
I would want a center and Radiation Oncologist very capable of HDR. I think you want that as an option, if treatment is desired/needed.
Your BHP will be part of the treatment discussions (when treatment is determined to be necessary).
Best Wishes on finding excellent doctors and facility. Best Wishes on being able to delay treatment, if possible.
@corsair
Need to discuss Decipher testing and PET imaging. Your 7 (3+4) is considered a favorable 7. AS is becoming more common with a favorable 7, especially one core. You do have time to discuss with Duke. Call them direct and say your biopsy came back positive. They will get you set up for an appointment. It might be good to let them order your decipher and Pet. They will need to direct who has your biopsy tissue to forward for testing. I am sure they will go over required vigilance and routine regular testing if you were to go AS. Your ExoDx is high and maybe a PSE might confirm liklihood of actually more aggressive than a 7. One discussion of the RP, is certainly it is out, and in likely two weeks you are fairly recovered from surgery. Duke probably has capabilities of single port DaVinci and Retzius sparing technique for you to discuss with them if surgery becomes an option. Studies are showing quicker recovery, lesser incontinence, often immediate continence and improved ED. It is worth discussing surgery options.
@corsair -- I haven't used Duke nor am I an expert in this generally, so maybe someone else can weigh in with more specifics. That said, I'd suggest asking for a second opinion for a prostate cancer diagnosis and ask for a multidisciplinary evaluation. That should trigger a review by multiple specialties. Also make sure you consider with your insurance first as some will require the 2nd opinion request to come from your doctor. I have original medicare with a supplement so I didn't need a referral when I went to a CCOE. Assuming your insurance doesn't require a referral from your doctor, then I believe you can either call Duke to make the appointment or use their portal. You'll have to make sure your test results are sent to Duke. Best wishes.
@corsair - Looks like your questions have been answered above. One thought since you said you were 4 hours away from Durham, maybe another cancer center is closer. I don't know where you are so here's a couple links to check.
https://www.cancer.gov/research/infrastructure/cancer-centers/find
https://www.nccn.org/home/member-institutions
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