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11.16 PSA, two negative biopsies, queued up for a third
Switched urologist 11/25 and I’m now queued up for biopsy number 3 in Feb 26 with new urologist. I am starting to feel some uncertainty about current path. Curious to hear thoughts / recommendations. I’ve outlined my journey below.
Thanks
3/22 - PSA: 3:39
1/23 - MRI wo/Contrast
(PIRADS 2)
6/23 - PSA: 5.25
2/24 - PSA: 5.37
3/24 - PSA: 5.5
3/24 - MRI w/Contrast & wo/Contrast
(Suspicious 8 mm nodule)
4/18/24 - Prostate Biopsy # 1 (Rectal)
(Pathology Report: Atypical Glands at Left Apex)
1/25 - PSA: 7.2
2/14/2025 - Prostate Biopsy # 2 (Perineal)
(Pathology Report: 12-core biopsy. right base (no tumor), right mid (no tumor), right apex (no tumor), left base (no tumor), left mid (no tumor), left apex (no tumor). Increasing LUTS)
8/25 - PSA: 8.71
9/25 - MRI w/Contrast & wo/Contrast
(Normal sized prostate with estimated volume of 35.8 to be centimeters yielding a maximum predicted PSA of 4.3)
Switched Urologist
10/25 - Doxycycline recommended to treat bacteria/infection. 2x per day @ 14 days
12/25 - PSA: 11.16
02/26 - to do: Biopsy # 3
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@ma740988 - I had the ISO PSA test done after my PSA went to 4.2. That med to an MRI, which led to the biopsy. My doctor was very thorough and didn't skip a step. Biopsy led to a 3+4, grade 2, 2 small lesions which were 7mm and 8mm. PET scan was negative except the prostate. Culminated in 5 Radixact treatments over a 2-week period. That ended 3 weeks ago so dealing with some annoyances. Bottom line of all this...don't let them skip steps and guess. If a doctor is including the ISO, then you probably have a good one.
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2 Reactions@bellasdad The isoPSA came back at 30.8 with a total PSA of 12.2.
I purchased a PSA at Quest the same day (12/17/2025) I did the isoPSA at Quest and the Quest PSA test result was 8.84.
Quick follow-up on this. Third prostate biopsy conducted. 2/19. Results came back 2/23 as follows:
1. PROSTATE, LEFT LATERAL BASE, CORE BIOPSY:
- BENIGN PROSTATE TISSUE
2. PROSTATE, LEFT MEDIAL BASE, CORE BIOPSY:
- BENIGN PROSTATE TISSUE.
3. PROSTATE, LEFT LATERAL MID, CORE BIOPSY:
- BENIGN PROSTATE TISSUE.
4. PROSTATE, LEFT MEDIAL MID, CORE BIOPSY:-
- BENIGN PROSTATE TISSUE.
5. PROSTATE, LEFT LATERAL APEX, CORE BIOPSY
- BENIGN PROSTATE TISSUE.
6. PROSTATE, LEFT MEDIAL APEX, CORE BIOPSY:
- BENIGN PROSTATE TISSUE.
7. PROSTATE, RIGHT LATERAL BASE, CORE BIOPSY:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 +
4 = 7 (GRADE GROUP 2), INVOLVING APPROXIMATELY
50% OF THE FRAGMENTED TISSUE. APPROXIMATELY
10% GLEASON PATTERN 4. PERINEURAL INVASION IS IDENTIFIED.
8. PROSTATE, RIGHT MEDIAL BASE, CORE BIOPSY:
- BENIGN PROSTATE TISSUE AND SEMINAL VESICLE.
9. PROSTATE, RIGHT LATERAL MID, CORE BIOPSY:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 +
4 = 7 (GRADE GROUP 2), INVOLVING APPROXIMATELY
30% OF THE FRAGMENTED TISSUE. APPROXIMATELY
20% GLEASON PATTERN 4.
10. PROSTATE, RIGHT MEDIAL MID, CORE BIOPSY:
- BENIGN PROSTATE TISSUE AND SEMINAL VESICLE.
11. PROSTATE, RIGHT LATERAL APEX, CORE BIOPSY:
- BENIGN PROSTATE TISSUE.
12. PROSTATE, RIGHT MEDIAL APEX, CORE BIOPSY:
- BENIGN PROSTATE TISSUE.
Three biopsies - one per year and new doctor was able to provide some relief.
Next steps.
Recommend Orgovyx for 30 days while I get a PET-Scan (March 13) then discuss a treatment plan. Doctor says all options are on the table but highly recommends HIFU given age and health.
I do plan to get a second and perhaps third opinion post pet scan, nevertheless has anyone done HIFU? Thoughts ?
Yes, it looks like you do need to get treatment. The high percentage of cancer in the cores Is what’s important at this point.
Have you considered getting a decipher test? That can tell whether or not there is a chance of reoccurrence and can give you a better idea of what’s actually in your body.
Orgovyx Is it a great choice but make sure you don’t start taking it before that PSMA PET scan. You want your PSA to be as high as possible for that scan, If the Orgovyx Reduces your PSA quickly, as it usually does, you will not get the benefit of the scans Ability to see metastasis.
HIFU isn’t the only choice. Depending on how aggressive your cancer is and what other things are found, you can have either surgery or radiation or a few other types of treatments with Focal Therapy like NanoKnife, cryotherapy, HIFU,, TULSA-PRO, etc. Focal therapy does have a higher risk of reoccurrence.
If you go to the top of the prostate cancer forum, you can search for each of these treatments and find Messages where people talk about their results.
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5 Reactions@ma740988
Your case is great illustration of why yearly biopsy is important with suspected cancer. Now you caught it in time *high five, and you have MANY options for treatment and very successful one at that ! : )))
I agree with Jeff, ADT before scan might effect PSMA scan , so double check with your doctor what his thoughts are about that.
I would also suggest from personal experience (which was not good at the beginning), that you always seek a second opinion and now that you need a treatment go to the best possible cancer center in your area that offers all those different options and works with cancer patients exclusively.
Wishing you all the best : ))) and complete eradication of PC in very near future ! I know that hearing those words that C is there are frightening - try to keep in mind that you discovered it very early and that you have a great chance of getting rid of it for good .
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2 Reactions@ma740988 As others have suggested, don't take Orgovyx before you do a PSMA PET scan. You need that scan to work as best as possible and Orgovyx will suppress your testosterone and resulting PSA that the tracer fluid in the scan relies on. The fact that your doctor recommends Orgovyx before having that scan is a red flag. Start seeking more opinions right now. See my bio for more info.
If you are looking at HIFU, I urge you to look at Tulsa Pro. Uses same High Intensity Ultrasound but in an MRI environment. MRI ensures precise margins and required temperatures to kill the cancer.
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3 Reactions@ma740988 It seems odd to me that he would put you on Orgovyx right off the bat…
Yes, you need treatment, but without the PSMA you don’t know at this point if there’s any spread.
He could be overly cautious at this point, but as others have pointed out, you DON’T want to lower your PSA before the PET scan…weird
Phil
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1 Reaction@ma740988
So out of 12 biopsy samples on your third biopsy, you had 2 that were 3+4, and of the two, one had 10% Gleason 4 and the other 20% Gleason 4. Favorable intermediate (7). You've had 3 biopsies total, probably 36 biopsy samples, and only 2 are 3+4. You are a candidate for active surveillance and/or remediation. One step above 3+3 which many doctors don't consider cancer at all. If you were a 7 unfavorable, or worse, the decision would be easier. The fact that there is some cancer present warrants a Pet Scan, which is more information in making a decision based on data.
Get a second opinion about hormone therapy based on your biopsy results before starting. It seems excessive for a intermediate favorable and has some very undesirable side effects. Get the Pet Scan to see if there is any cancer outside your prostrate. Before making any decision on radiation or surgery, get a second opinion on the two biopsy samples from a reputable pathologist. You have a higher PSA, but PSA doesn't confirm cancer, only biopsy can do that. Your results are favorable intermediate, you have time to make smart decisions. Good luck.
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