Continue PSA surveillance or have a Prostate MRI?

Have you considered a PSMA PET/CT Pylarity https://www.onclive.com/view/fda-approves-piflufolastat-f-18-psma-pet-imaging-agent-for-prostate-cancer

Just spit balling, not an expert...

I like your dr's plan. If the MRI is negative, great. It's not end all be all of diagnosing this, but, if there are no lesions and the PSA doesn't rise too quickly...AND you're okay with surveillance... I'd say that's due diligence.
If there's anything suspicious you'd probably want the biopsy at that point.

If you're concerned but don't want to do invasive tests like the biopsy without more info, maybe a second opinion would be a good idea.

regarding the PSMA PET / CT given the cost of same, the insurance folks would probably not approve the PSMA unless there was a finding on the MRI followed by a biopsy. (that was my case anyway)

Also, in the article quoted it states the FDA approved that scan "....to identify suspected metastasis or recurrence of prostate cancer"

Of course things may have changed since that was written.
Best of Luck to you!

A MRI is not going to identify the area as cancer. It will show areas of concern. A biopsy is the only test that will confirm if cancer or not.

I had a MRI with contrast first and found suspicious areas. I was told 70% chance the areas were cancer and a biopsy was ordered. It came back as prostrate cancer in several areas. A lot of tests later and finally went from intermediate to low risk, confined to prostrate, no bone, no surrounding tissues or organs invaded.

The biopsies can be done under anesthesia and through the transperineal area. Have it done this way and not rectal. You will have no pain (hopefully same as I) and you don't have the increased infection rate if done rectally and without anesthesia. I had no pain during procedure as was out and nothing after. If I had not been told I had a biopsy would not known I had one as no pain in the scrotum area at all.

My urologist (Mayo) used what they call MRI/Fusion to do biopsies and is highly accurate for urologist to find areas to biopsy.

Then my radiologist/oncologist did proton radiation therapy on the entire prostrate. He did that because he stated that did not want to take chance any area of prostrate that had cancer was NOT biopsied could have cancer in it and missed by biopsies and minute so treated including margins.

Thanks, I appreciate your info, and I'll ask my Urologist about it when I visit with him. That said, and I'm not expert, but I read that a Prostate MRI is more accurate than a PSMA PET/CT scan for prostate cancer diagnosis. Perhaps it's something my doctor will want me to consider if and after I have an MRI, depending on the results. Thanks again!

Thank you, I agree and am on the same page, will discuss with my Urologist and take it one step at a time. I see the value of his MRI-driven approach vs. having an invasive biopsy unnecessarily (of course, I may need to have one after an MRI, tbd). While I'm not happy with my high MRI out-of-pocket cost, I'm glad I have Medicare. I'm to discuss w/my doctor soon.

> A MRI is not going to identify the area as cancer. It will show areas of concern. A biopsy is the only test that will confirm if cancer or not.

Thanks for that info, I'll discuss with my Urologist soon.

JMHO A PSA of 7 is pretty low, esp at 72yrs. IDK about your insurance costs but I would definately recommend MRI over a biopsy.

True a biopsy is the only way to 'know', but a (3D) MRI (w/contrast) much less traumatic (too me) and will give you an idea of the extent of 'weirdness'

In fact the MRI results can be used to guide the biopsy if you go that route. If you do opt for a biopsy I found the bang-for-buck being in-office with nitrous. It cost me $80 but much less 'uncomfortable' than 'numbing' and waaay less expensive / time consuming than anesthesia.

I met w/a very renown urologist who said he never saw anyone "die from prostate cancer". IDK if I understood this correctly but I think his point was, in some cases, the treatment can be worse than not doing anything.

If I understand correctly, obviously some cancers metastasize and kill - maybe it's not prostate cancer at that point?

IDK

I am going to clear this up soon and if you care will share the clarification

I have been in a similar situation. I turned 71 in May. My PSA has been on a roller coaster for about 5 years. I had a biopsy a number of years ago which was negative. In 2021 I changed urologists and she recommended an MRI, also negative. This winter my PSA went up to 7 and she recommended a biopsy. I got a second opinion and it was recommended I get an MRI first. It came back negative. My urologist noted that the MRI only examines about 80% of the Prostate. After some discussion I had a biopsy in August. I had 14 cores taken and 1 showed cancer, 3+4=7. I’ve met with two different surgeons and both agreed removal was the best option. I have surgery in 3 weeks. Hope this helps. Best wishes!

This is my understanding. All cancer cells have DNA. You can have prostate cancer in bones, lungs, etc. Despite where it is its still prostate cancer cells. Bone, lung cancer cells, etc have their own dna

Thanks very much! My doctor's advice with having the MRI and all the research I've read and comments received certainly make a strong case for having it. I'll keep your tip re: nitrous in mind, good one, may want to use it if allowable. I used it many years ago for a dental procedure, was effective.