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Newly Diagnosed and Need Help
First, I would like to extend my appreciation to all those who contribute to this site. I have been an observer ever since I was diagnosed and now have to decide what to do. I would appreciate your insights. I am 75, my wife died from glioblastoma and I moved to PA from FL to help my daughter who is paralyzed on the left side from 2 strokes (genetic veinous interference.) So I have a reason to live. I’m in great shape and work out 4 times a week. No co-morbidities.
This all started sort of cavalierly I insisted on a PSA test with my PCP on 3/15/26. 2 years prior is was 3.7, most recently it was 6.1. His comment was “what would you do if you had PC?” My response was “depends on the score.” Referred to a urologist, insisted on an MRI and that came back PiRads-4 on 4/12/26. Results below. The urologist recommended a biopsy, got it on 5/10/26.) Results on 6/1/26. See below:
My question is, what should I do from here? I plan on a second opinion on the pathology, most likely from John Hopkins, but assuming the initial pathology is correct, what do people think is my best path forward?
I have access to John’s Hopkins, UPMC and UPENN. They are all commutable.
Biopsy:
1. Prostate, right posterior medial, biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group: 1), involving 2 of 3 core biopsies.
The carcinoma involves the cores with total linear lengths of 1 mm (10%), and 4 mm (20%), respectively (approximately 10% of the entire tissue submitted).
2. Prostate, right posterior lateral, biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group: 1), involving 3 of 4 core biopsies.
The carcinoma involves the cores with total linear lengths of 5 mm (30%), 6 mm (60%), and 1 mm (10%), respectively (approximately 20% of the entire tissue submitted).
3. Prostate, right base, biopsy:
Benign prostatic tissue, no tumor present.
4. Prostate, right anterior medial, biopsy:
Benign prostatic tissue, no tumor present.
5. Prostate, right anterior lateral, biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group: 1), involving 2 of 4 core biopsies.
The carcinoma involves the cores with total linear lengths of 1 mm (10%), and <1 mm (5%), respectively (approximately 10% of the entire tissue submitted).
6. Prostate, left posterior medial, biopsy:
Benign prostatic tissue, no tumor present.
7. Prostate, left posterior lateral, biopsy:
Benign prostatic tissue, no tumor present.
8. Prostate, left base, biopsy:
Benign prostatic tissue, no tumor present.
9. Prostate, left anterior medial, biopsy:
Benign prostatic tissue, no tumor present.
10. Prostate, left anterior lateral, biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group: 1), involving 20% of 1 of 3 core biopsies.
The total linear length of carcinoma is 2 mm in the core.
11. Prostate,Right middle prostate sole left, biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (Grade Group: 1), involving 4 of 4 core biopsies.
The carcinoma involves the cores with total lengths of 10 mm (80%), 12 mm (discontinuous, 80%), 2 mm (20%), and 5 mm (50%) (approximately 60% of the entire tissue submitted).
MRI:
Impression
PI-RADS version 2.1 Score: 4 , high probability of prostate
cancer in the right posterolateral peripheral zone midgland.
No evidence of extraprostatic extension. Differential
diagnosis also includes sequelae of infectious/inflammation.
Findings to be relayed and documented by Teleradiology
assistant to the referring physician. A notice that an
imaging finding is present on this exam which may require
follow up will be sent to the patient.
Narrative
EXAM:
MRI PROSTATE WITHOUT AND WITH CONTRAST
HISTORY:
Elevated prostate specific antigen (PSA).
PSA value: 6.4 ng/mL
COMPARISON:
CT abdomen and pelvis May 2024
TECHNIQUE:
Multiparametric prostate MRI utilizing standard sequences
in three orthogonal planes without and with intravenous
contrast.
CONTRAST: 8.2 mL Vueway intravenously.
FINDINGS:
PROSTATE:
Volume: 3.1 x 4.4 x 4.5 cm for a volume of 32.1 mL, PSA
density is 0.2 ng/mL/cc based on ellipsoid calculations.Quality: Good
Hemorrhage: None
Peripheral zone: Diffuse linear and wedge-shaped hypo
intensities.
Transition zone: Moderate heterogeneity consistent with
prostatic hyperplasia.
Lesion 1:
Location: Right posterolateral peripheral zone midgland
image 15 series 1007, 1008, image 17 series 801
Size: 5 mm
T2: Moderate T2 hypointense area
DWI: Focus of positive restricted diffusion
DCE: Mildly positive
Prostate margin: Abuts the prostate margin for less than 2
cm.
Lesion overall PI-RADS 2.1 category: 4
PELVIS:
Neurovascular bundles: No evidence of involvement is
identified.
Seminal Vesicles: Unremarkable.
Lymph Nodes: No lymphadenopathy.
Urinary Bladder: Unremarkable.
Osseous Structures: Unremarkable.
Other: Trace bilateral fat containing inguinal hernias.
I greatly appreciate your feedback.
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HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
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I greatly appreciate the input everyone has provided and will be seeking additional expert evaluations from Cancer Centers of Excellence.
Genetic test of biopsy sample: DECIPHER
AI comparison of biopsy slides: ARTERA
Analog review of MRI: Second look by eyeballs at Cancer Centers of Excellence (CCOE)
AI digital review of MRI: $258.00 if no approval of insurance DeepViewImaging.com
PROSTOX oral swab genetic test: $900 if ins neg. If contemplating external beam radiation ['EBRT']('types: SBRT 5 (-7) visits, IMRT: Mod. hypofraction..20x, Conventional fract...30-40 visits. The test determines the risk of DELAYED (months to yrs.) of urinary symptoms. Acute symptoms post EBRT appear similarly and resolve over time w or w/o symptomatic drugs.
External beams have to be at suboptimal doses as they go through healthy adjacent tissues. By contrast Internal radiation sources in the form of brachytherapy is not so limited. Low dose interstitial radiotherapy/ permanent 'seeds'/ LDR brachytherapy provide a low dose but over time has a higher effective dose. The seeds work for weeks to months. All that is left are inert titanium cylinders the size of rice. They will show up on x-rays like surgical clips and dental implants. Given it's lower reimbursement 'LDR-B' has dropped in USA usage from 17% to 7%; whereas it is increasing in Europe. The data show it is superior than surgery and external radiation 10-15 years out in appropriately selected gland contained disease. To give you a background on LDR-brachytherapy see the You-Tube videos on the subject; Brachytherapy-101 and a later one too.
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Hug
1 ReactionIt's pretty easy now days to get a second opinion on biopsy slides from a center of excellence. You should do that for starters. Other advice above is on the mark as well. I agree that RP shouldn't be high on your list of options. Your prostate size makes you a good candidate for other treatments if you need treatment.
@oxfordrob
I am new to this site. My husband died of prostate cancer in August 2024. I don’t know if I belong here, but I came to see if doctors are doing PSA tests regularly or if people had to insist that their doctor do it. My husband was first diagnosed in 2013 and his PSA at that time was 64. He went to see his primary care doctor because he was having symptoms that he did not relate to prostate cancer, but to getting older. He was 62 at that time. His cancer metastasized in 2020. Unfortunately neither my husband nor myself had thought to ever request a PSA test. But we did find out from someone else who had been seeing the same doctor and had requested a PSA test, that he was told that he doesn’t believe in doing them unless there’s a reason to. That person accepted that answer at the time, even though he wasn’t happy with it. Shortly, after that, he had a blood test done because he was applying for life insurance. That included a PSA test which led to this person being diagnosed with prostate cancer. His cancer was not as advanced as my husband‘s. They were both diagnosed within months of each other. That person did have his prostate removed and went through radiation treatment and has been going through some other treatments, such as the hormone shots, and continues to be monitored by an oncologist, but has had a much different life since diagnosis than my husband did, which I believe is because the cancer wasn’t as advanced when it was caught. I would like to say that I’m sorry to all of you who are going through this and I wish you well. It’s been hard enough losing my husband, but knowing that he probably would still be here if his doctor had only been doing PSA checks when he came in for his routine check ups is so hard to live with. I 100% blame that doctor for the fact that my husband is not here now. I don’t believe I will ever get over that. All I can do is try to spread the word that it is very important to be checked regularly to know what your PSA is, and if your doctor won’t do it, find one who will. Again, good luck to all of you.
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3 Reactions@marymellen
14 years ago the U.S. Preventive Services Task Force (USPSTF),was the major federal panel that opposed routine Prostate-Specific Antigen (PSA) screening for all men.
This was because men were being over treated when they had a Gleason score of 3+3.
As you and your husband found out, this was a major mistake. We are seeing many men today, coming in with advanced prostate cancer cases that never used to be seen.
Today some doctors are making it difficult for men over 70 to get PSA testing, And that is the Group that is most likely to have prostate cancer. People are living longer, so stopping at 70 doesn’t make sense.
In the last few years, this idea that PSA testing wasn’t necessary, has changed and more men are getting it if they are under 70. If you’re over 70, you have to twist your doctors arms to get tested In many cases.
I was diagnosed 16 years ago at 62. My father died of prostate cancer at 88 so in my case, they were checking sooner. About five years ago, I found out I have the genetic problem BRCA2, Got it from my mother, That makes my cancer, much more aggressive. My brother got prostate cancer at 77 because of my father, He did not have BRCA2.
I’ve been fortunate that my cancer has been treated regularly and with the latest drugs available so I’m still alive after 16 years and doing well. That’s after four reoccurrences.
Sorry to hear about your husband. It’s more than too bad, makes one think doctors should be liable for mistreatment. Your husband was one of the victims of this decision by a major medical group that guides doctors on what their treatment should be.
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Hug
3 ReactionsI never had problems getting doctor to give me PSA test. But where I messed up and the doctor did too is when it jumped up a point and a half in 7 months. Doctor said it's still wonderful you're okay. I think that the point in time where I initially got prostate cancer and should have been treated then, but ended up being 2 years later before they got looking further. And then PSA was only around 5.2 and I had to still get pretty tough with a doctor to get the first MRI. Should have went to a urologist when it jumped up and not depended upon my primary care physician.
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2 Reactions@jeffmarc
Thank you for your reply. I appreciate it. I never heard that before. You’re right, a very bad decision! I forgot to mention in my original post that my son had a hard time getting a PSA test done even though he told his doctor about his father‘s situation. He did end up getting it done, and the test result was 2. The doctor told him that was good, but didn’t talk about repeating it again. I told my son that two might be a good number, but it depends on whether it goes up and how quickly.
@diverjer
That is very good information to have.
@marymellen
What is most important is that he now has a baseline, but must insist on annual PSA’s for the first hint something might be amiss
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1 Reaction@marymellen I’m a pretty persistent bugger. Doctors have their marching orders and I have my goal of maintaining my health and being my own advocate. For 2 years I paid for my own PSA test, it is only $75. My doctor is a younger guy and may not appreciate the concerns of us senior citizens. I insisted on a PSA during my past visit, so this is how my whole situation started. My PSA went from 3.5 to 6.7 over 3 years. So I was concerned. My meeting with the urologist to educate me on possible treatments is on Monday. I will be requesting many different tests, thanks to the knowledge I have gained from this site.