Prostate Health Index (PHI) results: Time for a second opinion?

Not being a physician, I would view this s follows: You're absolutely right to be questioning this. Based on your husband's PSA and PHI results, the likelihood of prostate cancer is likely higher than the 50% the NP mentioned — especially given the PHI of 89.2 and the % free PSA under 15%. Those numbers aren’t just mildly concerning and they usually prompt more urgent follow-up.

The fact that your husband has CLL and a history of multiple cancers, only raises the stakes here. He’s not the kind of patient where you wait around for months just because the cancer might typically be slow-growing. Population statistics don’t override individual risk, and he clearly has one.

Being unavailable between May 27 and June 17 is totally reasonable — what’s not reasonable is having to wait until the end of August just to speak with someone about the MRI. That kind of delay might be fine for someone with mild BPH and a PSA of 5, but not in this case.

No question: it would be smart to get a second opinion from a urologist — and preferably someone affiliated with a cancer center or large hospital system. Even if it’s just a consultation to review the labs and history, having a urologist weigh in could fast-track better diagnostics or at least give you a clearer sense of the urgency (or not). You might also want to ask if the MRI could be done sooner at a different imaging center — sometimes just calling around can open doors that the central scheduling systems don’t.

Bottom line: you’re not overreacting. You’re being proactive. And in this situation, that’s exactly what’s needed.

Is it probable that infection or inflammation caused the high PHI score? Is it a good marker that the PSA test went down from 16.01 to 10.56? A strong indication that inflammation is the culprit in his test results? His urine cultures were negative for infection. Just curious if a PHI of 89.2 is abnormally high when inflammation is present.

Thank you, Hans for this insightful reply. It is much appreciated. Very, very informative and helpful.
The reason we are not available May 27-17 June, is because we will be in Spain celebrating our 50th wedding anniversary. Walking the Camino de Santiago! I am sure Duke will be sick of me, as I plan on calling every day to see if an earlier MRI appointment has opened up. I received info from another gentleman on a forum and he recommended an urology center close to us, and the urologist are affiliated with Duke. They are solely dedicated to urology and their urologist have decades of experience. I’m going to call tomorrow and see if we can get an appointment, and since they do imaging, maybe an earlier MRI appointment may be available. A second opinion is worth pursuing. Thank you again, Hans, for weighing in on my post. Repeating myself, but your info up is just really helpful. Thank you.

Judging from my experience. Don’t take no for an answer and be as annoying as you need to be. And enjoy your trip.

Congratulations on your 50th! My wife and I leave for the UK to celebrate ours next week — 14 years after I was diagnosed with prostate cancer at age 59 resulting in an urgent radical prostatectomy. Prostate cancer does have a reputation for moving slowly, but it doesn’t always. Long story short, my PSA never went high enough to be of concern, alone, but after ticking up for the first time in a routine physical, my doctor monitored it more frequently. It continued to rise enough that he had me see a urologist even though it was still at an “acceptable” level. The urologist shared the PCP’s concern and suggested I consider a biopsy. I agreed to the procedure, and when told of the results was informed that the first 12 samples taken were all fine, but the 13th and final sample taken confirmed the presence of cancer. I quickly met with a team of specialists (radiologist, surgeon, oncologist) in the same room at the same time, expecting competing points of view regarding treatment, but they readily agreed without a doubt that a radical prostatectomy was the correct course of action in my particular case. The surgery was scheduled for as soon as possible, but when a cancellation occurred, I received a call saying that I was at the top of the waiting list and to come right in! After the surgery, the pathology report showed that my PSA number was still(!) in the acceptable range, but was quickly moving higher as the cancer was aggressively accelerating. Thankfully, it had been contained, and totally eliminated. Had it not been caught, and aggressively treated, so early, it would have gone undetected and quickly metastasized. Everyone is different, I was younger, had lost my mother to cancer at a young age, and I know older men who have taken a wait and see approach. But, even with my case being but a single point of reference, I would strongly encourage your husband to at least get a biopsy taken right away.

@lizzview
If it were me, I would focus on getting the MRI done anywhere that has at least a 3T (tesla level) machine to give the best possible image and then locate a great urologist at any center of excellence that can give you a second opinion through telehealth, in a timely manner, without worrying about traveling.

Absolutely. There are many accredited radiation centers you can go to and have them send the results to your dr.
Even Sloan Kettering couldn’t get me in for 6 weeks for my PSMA PET, so I went to Zwanger-Pisiri and had it done in a week.
Phil

Good morning,

Thank you for this information. I have called Duke and am requesting a referral to another practice. Hoping to get the ball rolling with the new doctor/s asap. Don’t want to wait until end of June for that MRI!

Thank you again,

Thank you, Ben. I have called Duke and am waiting for a callback. Requesting a referral to a new urology practice. I certainly hope we can get in to see the urologist in the next couple of weeks, if not sooner. Then, hoping they can schedule the MRI sooner than end of June.

One other step you can take while waiting for the MRI is to request one of the newer predictive tests such as the EpiSwitch PSE test (there are others as well) which look for biomarkers of prostate cancer in blood or urine samples. One of the other contributors to this group - @jeffmarc - has a very helpful chart that shows the various tests available and their relative accuracy. Perhaps he will see this posting and add the chart for your reference.