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Continue PSA surveillance or have a Prostate MRI?
I'm 72 and taking tamsulosin for BPH, it's working. My recent annual Total PSA was 7.41, lower than last year's 8.35 (it was 4.5 in 2018 and has increased a bit annually). However, my Free PSA/PSA Ratio was 29% (it's been 25-32% range since 2018). Both my Urologist and PCP claim my PSA test results point to my BPH and not cancer.
That said, my Urologist recommended I consider having a Prostate MRI, to see if I have any cancer, and if not, possibly save me from an unnecessary biopsy. What to do?
Given my test results and BPH, I'm thinking of continuing my surveillance for now, possibly increasing my PSA test frequency, if my doctor recommends. Wishful thinking or have the MRI?
Thoughts?
Thank you!
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Sorry, I should have been clearer. But I used that word because that's what the Mayo Clinic used in their book "Mayo Clinic on Prostate Health" (2022) - "PSA testing remains controversial" -- when describing the accuracy of PSA tests. I believe the example that kjacko gives in his post is a good example. My Primary Care Physician calls PSA testing a "quagmire."
My primary care doctor is Mayo Jacksonville. In his opinion the PSA is an indicator that if rising or high needs to be investigate. The rising number is really important.
My Mayo urologist and radiologist/oncologist say the same. UFPTI radiologist/oncologist says PSA is the marker to indicate further testing. UFPTI as well as others use the PSA numbers to actively monitor your treatment outcome. The goal of UFPTI after radiation treatment is PSA to be below 1 but may take 1-2 years to get that low. The most concern they have in monitoring stage is a increase in PSA numbers.
The prostrate makes PSA regardless of cancer. Having PSA number is not a sign of cancer it is when it rises or gets high. That is where testing comes in to determine what is causing PSA to rise or be so high.
Having prostrate surgery should results in non detectable test results. If prostrate cancer has spread elsewhere after surgery you will have PSA numbers and rising. According to my doctors and research institutes the prostrate is the only organ that makes PSA. If you have Prostrate Cancer it will make PSA levels rise and this can happen after removal of prostrate and have rising PSA number indication of cancer was NOT just located within prostrate.
What I found on PSA testing was controversy in late in life testing because of the USUAL (not all) slow growing prostrate cancer where death would be from something else not prostrate cancer. This is where I read a lot of disagreements and controversy. My Mayo urologist stated to me I would die from something else not prostrate cancer based on my test and biopsy results.
But if you don't have the tests and biopsies you do NOT know the stage and seriousness of your prostrate cancer and if still within prostrate or spread nor if you have a very aggressive one. I chose proton radiation to cure the prostrate cancer and my prognosis is very good that it will. I am 4 months post end of radiation treatments.
I am not a urologist or oncologist just a ton of research and asking tons of questions from all the medical professionals that have seen me and treated me. Lot of information and not always what you want to hear especially if you have different opinions.