PSA 8.6, MRI PIRADS 5, Biopsy scheduled, so a bit worried

I started out three years ago same numbers almost identically including Pirads 5, first biopsy only got a 3+3. This past year same lesion got one needle with 4+4 (but only a 0.2 mm slice) but one other needle 3+4. I had Tulsa Pro going on 2 months ago, so far that has been good choice. My lesion was accessible so Tulsa was an option. It is bad if it spread out (PSMA tells), or is in-accessible, or really high gleason, or is really wide spread even if not gone out of prostate as that limits options somewhat. Don't let it get to you too much, and once past biopsy don't go for the first RP recommendation necessarily as that is given to just about everyone even people that so go on surveillance. Take time to find all the options and only if needed. I spent my time doing a lot of reading as many do. You will find differing opinions, some conservative some more progressive but you will need time to digest it all for what it means for you, so one has to go a lot of places, some might mean travel time if you want good opinions.

The rate of PSA increase is more important than the absolute number. I recommend getting educated on prostate cancer and treatments via Dr Patrick Walsh book (Guide to Surviving Prostate Cancer ) and online material at Prostate Cancer Foundation (PCF.com) and Prostate Cancer Research Institute (PCRI.com). In addition to Mayo Connect and its members, these resources will provide you with the questions to ask your doctors, help you ensure you are being treated by a center of excellence by an experienced doctor, and help you understand all of the options. Including the biopsy - you have options that you will want to decide. All the best wishes on your journey.

After Biopsy and Gleason score (Look up Gleason Score and how it is scored) if any is found you will then be scheduled for a CT Pet Scan to see if cancer has possibly spread. I would ask your Uroligist if that could schedule you for a CT Pet scan after your Biopsy (say 2 weeks post biopsy). All these test can be difficult to timely schedule. So, if it was scheduled and then not needed, it could always be canceled. Let's say Biopsy comes back with a Gleason score that warrants a CT Pet scan. Ask your Urologist if they can prescribe a ADT treatment to put the growth of the cancer in check prior to you receiving treatment (R/P or radiation). I was able to get MRI, Biopsy and Pet Scan scheduled say 2 weeks apart for each which moved things along... I'm 65, 5 cores positive all 4+4=8 with CT Pet Scan showing no spread. R/P scheduled for January 29th. Be proactive to get your needed testing done quickly! Best of luck in your journey with us!

My journey with PC started a little over a year ago with elevated PSA. For me, the waiting between doctor consultations and procedures was the worst. I like jsh327’s recommendations of resources (I used them as well). They informed me but caused me lots of angst when my mind couldn’t help but go “dark” from time to time.

Then my “Mayo-friend,” Michael, sent me a DM encouraging me to have the faith of my research and approach. As you have (or will) heard here, there is no one answer to similar facts as we’re all in different places in our lives, etc. I’d encourage you to read all you can between your appointments to educate you as to questions for your advisors. You will come to an approach that is right for you. Once done, be positive and focus your energy on getting better. If you aren’t concerned, you’re not paying attention it seems to me. That’s natural and to be expected.

I am blessed to have lived long enough to have several “issues,” but I’m not done living yet. I choose to fight, make my best decisions, and enjoy life in the meantime. I wish the same for you.

Greg52: if you have Prostate Cancer, you probably will be given a choice of Radiation or Prostate removal.

I had Gleason 3+4 and a 10.2 psa. I had a narrow margin type radiation machine to protect my healthy tissue, along with Spaceoar, a gel that separates the rectum from the prostate. I had 5 treatments in January and February of this year.

If you have Radiation, there are different types of machines and different types of radiation. Try to collaboratively choose A radiation machine that will limit the exposure to your healthy tissue as that will have an impact on your quality of life.

Keep coming back to this website and use the search function to look for various experiences that people have had. The decisions are not always black-and-white and you will see many people that swear by their choices.

We are all here to help you through the process and most are willing to either private message or speak with you on the phone to share their experiences as well as respond publicly on this site.

It is scary so take one day at a time, research here, centers of excellence web sites and other sites mentioned in this string. You WILL get through this.

There are two types of prostate biopsies; the traditional transrectal biopsy and the newer MRI guided transperineal biopsy. My MRI identified two lesions, both of which were toward the front of the prostate and were PIRADS 4. The transrectal biopsy is somewhat challenged to get samples from the front of the prostate. By having the MRI guided transperineal biopsy, my doctor was able to more precisely target the two lesions as well as the twelve other samples taken from throughout the prostate. It seems that National Cancer Institute centers of excellence seem to be more likely to offer the MRI guided transperineal biopsy. My transperineal biopsy was done at one of these centers of excellence and the procedure went very well. Here is a website that lists the NCI centers of excellence: https://www.cancer.gov/research/infrastructure/cancer-centers/find

You might also ask your doctor to obtain a Decipher genomic test from the tissue samples obtained from your biopsy. It might more precisely define the risk associated with your prostate cancer, if indeed you have cancer.

Best wishes for a positive outcome!

PC is slow going so you have plenty of time to ruin your eyesight reading the hundreds and hundreds of articles on prostate cancer along with driving yourself crazy. Not much you can do until your biopsy that will tell you exactly what you are dealing with. I went through what you are starting in this wonderful year of 2023 and I am looking forward to 2024 and many more after that. What I will say is that you should make sure you get a trans perineal fusion guided biopsy at a center of excellence. It was painless even though I had a 30-core biopsy because of my 120 gram prostate. I did tell the urologist and his team that did it I would much rather visit the dentist than do another one. LOL! Biopsy showed a 4-3 and some 3-4 all from the area of the lesion. I did the 5 proton radiation treatment at Mayo Phoenix. My PSA was a 2.9 and my first check at 3 months was undetectable. I did the radiation instead of a proctectomy because I am 74 years old which is much older than you and if I get 15 years before it comes back, I will be 89. Age makes a big difference in what you chose. Good luck to you and be careful of those eyes.

You are very early on your journey. Your urinary issues could be related to an enlarged prostate (BPH). BPH is not cancer. Prostate cancer does not really have any physical symptoms so it is unlikely that your aches and pains are related to PC. An elevated PSA does not mean that you have PC; it is the biopsy that will potentially determine that you have PC. None of us are medical professionals; all we can do is provide our perspective of our own PC journey. At this stage my advice to you for the next four weeks would be:
- gain confidence in the experience of your urologist
- read the initial chapters of Dr. Patrick Walsh's book "Guide to Surviving Prostate Cancer"
- go to reliable websites like PCF.org and download their "Prostate Cancer Patient Guide"
- go to the websites of Centers of Excellence like Mayo Clinic, John Hopkins University and many others
- begin to focus on exercise and diet as these will become your friends if you are diagnosed with PC.
I was diagnosed in 2016 at age 74, had surgery in 2018, suffered recurrence and had salvage radiation in the summer of 2022 and since then my last five PSA's have been undetectable < .008. I am currently in Whistler waiting for some more snow to fall so I can start to enjoy my season pass.

Thanks so much to all for your input, guidance, and advice. I understand I am very early in my journey and all of your input is very helpful.

Again, thank you so much and God Bless you all in your individual bouts.
Hopefully others will chime in as well.

Good morning and Happy New Year!
I am a 70 yo recently retired Radiologist (Interventional specialty mainly-biopsies, treating cancer by ablation, compression fractures of spine by kyphoplasty etc) but also have read many CT/PET/MRI exams in my 40 year career. I thought I knew a lot about prostate cancer; turns out I didn't.
I routinely had a yearly physical exam which included PSA. My PSA bounced around from 3-5 for a number of years and I finally got a contrasted Prostate MRI on a high field magnet/3T in 2019. It was normal so it gave me a false sense of security. Also sent a blood sample to Mayo for fractionation and they said normal for age. In early 2021 my PSA jumped to 7.5 (yearly rate of rise of 20% or more is the red flag, not the absolute number) so I went to the urologist and had repeat MRI. Now there was a 1 cm enhancing nodule (not good) in my prostate. Biopsy revealed Gleason 7, 8 & 9 cores from the nodule with the rest of the gland negative. Bonescan & MRI (urologist didn't order PET because he didn't believe cancer was outside the prostate) negative for spread. I went into full court press mode and had informal discussions with multiple colleagues (RO, MO, urologists) as well as formal consultations at several medical centers. Elected to have robotic prostetectomy with a very experienced surgeon. Surgery went well. Gleason 9 with extra capsular extension. PSA went down to 0.016 post 6 weeks but then went up to 0.37 two months later. PSMA PET revealed solitary met at T8. Consultation time again. Read extensively. Elected to have SBRT (radiation) at Emory to kill the cancer at T8. Four months later PSA now 4.5. Very rapid doubling time indicating agressive cancer. Again, extensively read literature. Got a zoom consultation with prostate cancer expert at Johns Hopkins with 30 years experienced treating prostate cancer (medical oncologist and head of the prostate cancer research facility there) and liked what I heard from him and his NP. I wanted an Oncologist that just specialized in prostate, not a general medical oncologist. Immediately started on Lupron. Within 2 weeks started chemo with Taxotere at Hopkins and added an anti androgen receptor drug (Darolutamide). Eight weeks after the chemo cycles ended I had full pelvic radiation. My PSA went undetectable after my second chemo session and has remained so for a year. I am now off all medications and awaiting return of my testosterone and hope PSA stays undetectable. That's my journey. Everyone is different.
I will offer my opinion about a few issues as a patient and not a physician. Even as a physician I would never advise anyone on a certain course of treatment because 1) I am not their doctor, 2) that is not my field of specialty, 3) I don't know anyone's full history etc. I am leery of those that make definitive pronouncements about treatments on this and other forums. Having said that:

Become informed as others have suggested. It is your body. Seek second opinions. See at least one Urologist and one Radiation oncologist before making a decision on Radiation vs surgery. There is no right or wrong. Both are good choices depending on the person"s age, health, Gleason score, Imaging results etc.

If you don't feel comfortable with your specialists fire him/her and seek another opinion. If they don't spend adequate time with you and answer your questions find another doctor that will.

In general, seeking treatment at a major medical center/ Center of Excellence is a good idea. If you elect to have surgery, ask your urologist how many Robotic Prostatectomies he/she has done. It should be quite a few but I won't give my opinion to the exact number. I practiced at a major medical center and I can tell you from experience that when a new procedure came out I was much more proficient after the first hundred than I was the first 10. Just something to think about.

Treatments are changing rapidly regarding prostate cancer. Limited metastatic disease (1-3 lesions) is considered potentially curable by many oncologists whereas several years ago it was not.

Don't let this consume you. Live life no matter the result of the biopsy and future treatment. Easier said than done. At your age you need to seriously consider quality of life in your decisions. Ask your doctors how their treatments will impact that.

I wish you well. Numerous people who have gone through this freely gave of their time to me so I feel I should do the same. The above is just my experience and opinion. Not definitive. Good luck.