Positive ExoDx urine test with negative MRI

Was the mri a MP-MRI?
I can understand not doing a biopsy if you can't find a lesion. However if you has a basic mri but a high Exodex, I think I would get a 2nd opinion at a center of excellence. I'm not sure the test would be ordered and results ignored.

Thanks yes the MRI was an MP-MRI

I am 68 yrs old and 9 months out from RALP last October 2024. I had negative DRE, negative Contrasting MRI, and negative ultrasound Gleason 7 cancer with a PSA of 2.
I also had a family history. Earlier in 2024 my PSA had doubled from 1 to 2 in a year. I was given an MRI based on PSA velocity. It was negative… completely normal. I knew something was wrong and asked for a biopsy and was told I did not qualify based on insurance. I offered to pay for my biopsy and the doctor reluctantly agreed. The biopsy was a blind jab as the MRI was not imaging anything. The biopsy came back positive with gleason 3+4 a large lesion occupying 10 percent of the prostate. Decipher was favorable however with family history I opted for surgery.
The UCI surgeon (Dr Ahlering) told me that about 10% of men get MRI invisible significant cancer that often goes untreated until it is advanced. He congratulated me on being proactive in spite of my family doctor and Urologist telling me there was nothing wrong. Not that it matters, but I had heartfelt apologies from both and I did not have to pay for the biopsy!

Thank you!

@astrodoc I have been following this discussion because my husband has been through a diagnostic process when his PSA continued to rise. I will add here that my husband is a pathologist (retired) with specialty in clinical chemistry. He continues to receive a monthly publication from the US and Canadian Academy of Pathology (USCAP) that I read on occasion.

Here is what I've learned through my husband's medical appointments in urology at Mayo Clinic and from the USCAP publication. Some of these "liquid" biopsy lab tests are unreliable. PSAs are easy to obtain but even these are not always reliable however the results do prompt medical providers to order additional testing such as imaging with an MRI. A urologist who saw my husband saw at Mayo Clinic told us that the MRI is the standard. So, I take this to mean that the ExoDx numbers you received are not reliable. Should you repeat the ExoDx? Probably not according to the urologist we saw. Should you continue to see your urologist and obtain periodic MRIs or ask for biopsy if you are experiencing symptoms? My husband would say "yes".

It sounds like you came up with a follow-up plan with your urologist. This is what my husband does and so far his diagnosis is BPH.

Thank you for allowing me to pop into this discussion.

What do you think you will do?

Hi thank you for chiming in! Yes I too am a retired doc, an orthopedist actually. So I was a carpenter, not a plumber 🙂 And I don't pretend to know anything about plumbing, But I do know some things about how this business works in general and let me tell you it is NOT fun being on the other side of things. You have to fight for yourself as 'beachflyer' described very well in his earlier post. You cannot take anything for granted and you cannot assume anything. It's rarely the same from case to case as this is such a grey area with this stuff.
So thankfully I do have a urologist friend or 2 and yes they do say the same thing namely that MRI is what they give the greatest weight to. So my diagnosis is also BPH but because of the positive Exo and strong family history close monitoring is advised. They were actually going to wait a year before redrawing the PSA. I said no I'm not waiting a year I want it redrawn at 6 months which will be Nov, so not far from now. The MRI was end of July. And the urine test was done 2 months before the MRI . So I feel ok about it for now. Then if there is any question with the updated PSA I will request a biopsy with or without a repeat MRI.
Hope that helps!

Hey Doc, there is also the new PSE test which is about 94% accurate for diagnosing the presence of cancer.
Ask your friend about it - we have info on the forum or you can Google it - and get it done.
Phil