Consultation with urologist about mri results

You could get a PSE test, which would tell you whether or not there is cancer and you need to get a biopsy.

When I asked the geisinger urologist about getting a pse, or some similar test, he just said they didnt normally use them at Geisinger, they realied on frequent psa testing. I am going to see if the VA can pay for this, though. There are others, too. Was surprised they know about, but dont use these tests.

Whether they use them or not does not take away their value. Knowing it might tip the scale to move forward quicker if your PSA takes a slight increase and your Urologist says that’s okay it wasn’t very much lets test again in 90 days. Knowing more might make you decide no, let’s not wait for another 90 days, it’s biopsy time

These are things to consider. Thanks.

So everyone here has a different experience and point of view. I (and some others on this forum) come from the perspective that MRI’s and PSA are not always a good predictor of cancer having had to go through treatment for a large lesion following a clear MRI and a PSA of only 2.
While you have a fairly large prostate that could account for PSA rise, I would argue that a biopsy and depending on results could be followed by routine PSA tests might be a plan to consider.

For me an ISOPSA tipped the scale. I had a PSA fluctuating around 4 for one year. On my MRIs (I had two) I got readings ranging from 2 to 4 each, depending on who read it. In the end, I had what turned out to be a 3+4 with non-negligible 4. So, PSE or ISOPSA is probably the way to go.

Ill ask about that test, but dr indicated they dont do these blood tests at this facility. The reason Im not so worried is because 90% of the data so far points to bph as the culprit, so to speak. I wouldnt have been refered to a urologist to begin with if my regular dr had just done a repeat test as did the urologist almost first thing, which showed my psa at my usual baseline number.

@beachflyer well, my mri didnt come back clear, so it is not like your case. And more than that, so much points toward its being a very small nodule from bph. Density, lesion size, radiologist's suggesting it is extruded hyperplastic nodule, near the tz, and no where near the capsule, my prostate being 4 times the normal size, the original psa being some kind of outlier which kicked the whole thing off to begin with., the fact that this same nodule was most likely seen during a ultrasound years ago. Im just not going to have dozens of needles stuck in me without alot more proof. Psa every 3 months sounds more reasonable. Final question, though, how did a mpmri with contrast miss a giant tumor?

Hi benz57

Sounds like you have a lot of good data to go on including imagery that shows little change. That is good.
So my surgeon (Dr Ahlering , Chair of Urology, at UC Irvine) stated that 8 to 11% of men can develop MRI negative cancer. He said coupled with low PSA expression, it usually goes undiagnosed until it is well advanced.
I was 65 and got concerned when my PSA doubled from 1 to 2 in a year and saw some brown spots in semen. My mother had died of a rare form of breast cancer that had been misdiagnosed early on as benign cysts and my sister had developed a similar and unusual precancerous condition that was successfully treated.
Both my primary care doctor and 2 urologists ( one associated with a major cancer center) told me everything was fine. They said that based on my low PSA and a lot of guys get spotty semen and Mother dying of breast cancer is irrelevant since it was not PC. Not trusting the Doctors, I pushed for a contrast MRI…and it came back clear. …ultrasound also clear.
Offered to pay for biopsy… bingo…there it was … Gleason 3+4, (30% was 4) and the lesion occupied 20% of the prostate. I received apologies from all 3 doctors involved. Apparently some cancers are on a cellular level and dont produce a well defined target mass for an MRI.
One last comment, medical centers are different and while the San Diego center did not place any weight on my mothers cancer history, UC Irvine disagreed with how my case was handled saying there is a link between breast cancer in a woman and PC in her son. UC Irvine would have fast tracked me through all tests based on what I had presented.I learned that Medical science is an art coupled with the bellcurve of treatment afforded by insurance companies and second opinions may differ greatly from original diagnosis.

I agree with the comments of others in this message string that are encouraging you to pursue an IsoPSA or similar test. I had to switch Urology groups after retiring, and as the workup at my initial exam with the new Urologist I had a PSA test which was stable and a DRE which was normal. I asked for an ExoDx test just to make sure everything was ok, but the test score came back and indicated an elevated risk of prostate cancer. The Urologist recommended an MRI as a next step, and that came back completely clear. The Urologist said that it was up to me whether to have a biopsy or not but he recommended having a saturation biopsy. I had that and the results showed 2 of the 24 cores had very small amount of 4+5 cancer. I had an RALP and the pathology on the prostate after removal downgraded my final Gleason score to 4+3 with tertiary Gleason 5. I am very thankful that I had the ExoDx test as I am quite sure it would have been at least another year before my cancer would have been diagnosed (annual PSA tests and assuming the PSA test a year later would have been elevated and led to the diagnosis.)

All the best to you as you go through the next steps.