1. < Prostate Cancer

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

Posted by lizziew @lizziew, Apr 15 2:15pm

My husband recently had his first PSA test. It came back at 16.01. He was referred to an NP in urology. She did a DRE, which confirmed an enlarged prostate. She ordered additional PSA testing. The next day, his PHI showed 89.2, PSA total was down to 10.56, PSA free was 1.56, and %Free PSA was 14.8, p2PSA is 42.8

The NP sent a message in my chart stating that there is a 50 possibility of prostate cancer. He has an appointment for an MRI end of June. We are unavailable between May 27 and June 17, and no earlier MRI appointment is available. The NP made a video visit appointment for end of August to discuss MRI results and next steps.
After reading about the PHI tests, and my husband’s results, it seems like there is a greater likelihood of prostate cancer than 50%. My husband has CLL, and has had several secondary cancers. Numerous squamous cell carcinomas, and a malignant gist in his duodenum. Would it be prudent to get a second opinion with a urologist? We were not given the option of seeing a urologist at his first appointment. We know that prostate cancer is slow growing, but still want to speak with a urologist before end of June. Any recommendations?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

bens1 | @bens1 | Apr 16 11:36am

As @rider51 suggested, the PSE test is valuable and has a 94% plus accuracy rating and gives you results that either say you were likely to have prostate cancer or less likely to have prostate cancer. It works in conjunction with a PSA test but checks a number of bio markers.

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jeff Marchi | @jeffmarc | Apr 16 11:58am
In reply to @rider51 "One other step you can take while waiting for the MRI is to request one of..." + (show)
@rider51

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.

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Here is the list of available tests. Not sure if it stays this way, but I can’t see the image that I attached but it is there. Click in the blank spot on the left and the image pops up.
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1 reply
lizziew | @lizziew | Apr 16 4:58pm
In reply to @jeffmarc "Here is the list of available tests. Not sure if it stays this way, but I..." + (show)
@jeffmarc

Here is the list of available tests. Not sure if it stays this way, but I can’t see the image that I attached but it is there. Click in the blank spot on the left and the image pops up.

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Thank you so much!
I hope everyone knows how helpful these recommendations, insights, and guidances are.

A lot of good people on this forum. Helping others in many ways.

Thank you! Thank you!

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lizziew | @lizziew | Apr 16 5:02pm

Thank you guys so much!!!

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happydappy | @happydappy | Apr 16 10:01pm
In reply to @lizziew "Thank you, Hans for this insightful reply. It is much appreciated. Very, very informative and helpful...." + (show)
@lizziew

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.

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I started my prostate journey at Duke. There are some renowned experts there and they are a national center of excellence. But I also ran into waiting a long time for appointments and biopsies. I also found that questions weren't always answered and I was even told false information about a grading finding. I sought a second opinion at UNC down the road, also a center of excellence. Appointments were much faster, and they found a separate lesion that resulted in a higher Gleason grade. When I told them about what I was told about the grading system at Duke, two UNC doctors both joked out loud if Duke was making up their own grading system. Sure there's a heated basketball rivalry between these two, but you might seek a second opinion at UNC. Have everything sent over and you'll get called quickly - I was.

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lizziew | @lizziew | May 5 3:29pm

So hubby had the MRI. It did reveal three lesions, two were considered as PI-RADS 4 lesions and one was graded as a PI-RADS 5 lesion. The PI-RADS system is the grading system used by the radiologists to convey the level of suspicion that a clinically significant cancer may be present. A PI-RADS 4 lesion is associated with a 50-60% likelihood and a PI-RADS 5 lesion, 80-85%.
Biopsy will be done in the near future.

My question. Has anyone had these MRI results and the lesions turned out to be inflammation and not cancer?

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jeff Marchi | @jeffmarc | May 5 9:45pm

To @lizziew

I have seen people with PI-RADS 5 lesions and PI-RADS 4 lesions where they didn’t turn out to be cancer. Having three of them such high numbers, though, makes it likely that you do have it.

You could get a PSE test. It will tell whether or not there is cancer in your system, and if there is not then you do not need a biopsy.

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lizziew | @lizziew | May 6 6:23am
In reply to @jeffmarc "To @lizziew I have seen people with PI-RADS 5 lesions and PI-RADS 4 lesions where they..." + (show)
@jeffmarc

To @lizziew

I have seen people with PI-RADS 5 lesions and PI-RADS 4 lesions where they didn’t turn out to be cancer. Having three of them such high numbers, though, makes it likely that you do have it.

You could get a PSE test. It will tell whether or not there is cancer in your system, and if there is not then you do not need a biopsy.

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Thank you, Jeff. I really appreciate your reply to my post. hubby just had the PSE test yesterday, but doctor still has him scheduled for a biopsy. Should I contact the doctor and ask why he would still need the biopsy if the PSE comes back positive? Hubby does have a HUGE prostate, I believe the volume was 189. Could that be the reason why he would want to do the biopsy?

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jeff Marchi | @jeffmarc | May 6 10:23am

What was the result of the PSE test? If it was below .25 you might not need the biopsy. If closer to .5 then it makes sense to do the biopsy.

The size of the biopsy should not be the deciding factor. That is quite big, you are correct. I know two people who had huge Prostates but still didn’t have prostate cancer.

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lizziew | @lizziew | May 6 11:57am

Hubby just did the PSE test yesterday. Lab tech said that it would be a week to two weeks before we get results. I’m hoping she is wrong, and we hear earlier.
I believe that because his Pirads scores were 4 and 5, his PHI was 89.6, and his PSA is 10.6, that doctor will still do biopsy. I have been told that the blood test, while it has a high accuracy rate, is only one diagnostic tool. The biopsy is the only way to conclusively confirm PCa.

The office called this morning, and hubby is scheduled for biopsy on June 24th. Can’t do it earlier as we are out of the country May 27-17 June.

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