1. < Prostate Cancer

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

Posted by greg52 @greg52, Dec 30, 2023

Just came across this group.
I am a 52 year old man. Routine PSA test showed an 8.6. Immediately referred to Urologist then MRI/PIRADS 5 for targeted biopsy. Biopsy still 4 weeks away so 4 weeks to worry, speculate, and research is probably not good. Every ache, pain, and moment of fatigue/weakness I've had the last several months/years has me convinced it's related to this. I understand I should not jump to any conclusions until after biopsy but just curious.
Other than the normal symptoms associated with prostate cancer, wondering if any experienced other symptoms?
I've always had back pain (golfer) so assumed it was related to that.
The last several months I've felt weak. Occasional pain during urination and more frequent trips to bathroom at night.
Occasional pains in abdomen and bruised feeling at times in different areas of my body where there in no bruise.

Just curious what input/advice others might have as I wait for my biopsy and diagnosis/prognosis.
No evidence of spreading at least from what I can understand from the MRI.

Thanks all.

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greg52 | @greg52 | Feb 5 10:40am

Thanks again to all for your input/stories. I thought I had posted an update last week but apparently I didn't hit "post comment".
Had my transrectal ultrasound fusion biopsy on 1/26. Results did show cancer.
Urologist said it was not the aggressive type, that it's very treatable, and I am meeting with him on 2/8 to discuss biopsy results in detail and my treatment options.
My uncle had prostate cancer in his late 50s and had his prostate removed.
My dad had it at 75. Opted for radiation treatment. He's now 81 and no signs of cancer since his treatment.
I will post an update after my appointment this week.

God Bless.

REPLY
2 replies
bens1 | @bens1 | Feb 6 7:55pm
In reply to @greg52 "Thanks again to all for your input/stories. I thought I had posted an update last week..." + (show)
@greg52

Thanks again to all for your input/stories. I thought I had posted an update last week but apparently I didn't hit "post comment".
Had my transrectal ultrasound fusion biopsy on 1/26. Results did show cancer.
Urologist said it was not the aggressive type, that it's very treatable, and I am meeting with him on 2/8 to discuss biopsy results in detail and my treatment options.
My uncle had prostate cancer in his late 50s and had his prostate removed.
My dad had it at 75. Opted for radiation treatment. He's now 81 and no signs of cancer since his treatment.
I will post an update after my appointment this week.

God Bless.

Jump to this post

greg52: did you get a Decipher test done? It can impact the doctor’s treatment decision.

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hammer101 | @hammer101 | Feb 7 9:03am
In reply to @greg52 "Thanks again to all for your input/stories. I thought I had posted an update last week..." + (show)
@greg52

Thanks again to all for your input/stories. I thought I had posted an update last week but apparently I didn't hit "post comment".
Had my transrectal ultrasound fusion biopsy on 1/26. Results did show cancer.
Urologist said it was not the aggressive type, that it's very treatable, and I am meeting with him on 2/8 to discuss biopsy results in detail and my treatment options.
My uncle had prostate cancer in his late 50s and had his prostate removed.
My dad had it at 75. Opted for radiation treatment. He's now 81 and no signs of cancer since his treatment.
I will post an update after my appointment this week.

God Bless.

Jump to this post

Greg52 - Sorry to hear the diagnosis of PC, but glad it is not the aggressive form. At your young age, take the time to do your research on treatment plans and definitely don't make the mistake of utilizing a local doctor for the treatment. Find the best possible center of excellence and then find the best possible doctor at that center of excellence.

Good luck with deciding on your treatment plan,

Jim

REPLY
greg52 | @greg52 | Feb 17 3:45pm

Met with the Urologist that does the robot guided prostatectomy. Apparently he has done about 150 of them. That is the current recommendation for treatment based on my overall health, biopsy results, and age.
I will also meet with the radiation specialist to discuss those treatment options, do more research, and make a decision on treatment.
As of right now it seems surgery is the best option but, at 53 years old and no kids, the potential for permanent incontinence, ED, and the inability to have kids (at least not without freezing sperm or harvesting) is the current reality I am faced with. I guess I didn't really give that part much thought.
Initially you're concerned about the cancer and the possibility of it spreading. Now, with "low to intermediate risk" prostate cancer that comes with a (God willing) favorable outcome with treatment, I now need to assess the potential quality of life impacts from the treatment options I have.
I will continue my research based on the current info/recommendations from my care team.
Will be interested to hear from those "younger" men, the treatment they opted for, and how they're dealing with their side effects.

Thanks again to all for your input and support.

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greg52 | @greg52 | Apr 26 11:42am
In reply to @retireddoc "Good morning and Happy New Year! I am a 70 yo recently retired Radiologist (Interventional specialty..." + (show)
@retireddoc

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.

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Thank you so much for taking the time to provide your input/experience. Going back through all the replies again. I had met with the surgeon in my health network a few weeks back and just met with the Radiology Oncologist yesterday (4/25/2024). Apparently it took so long because they sent the referral to the wrong provider?
The Radiology Oncologist was a lot more helpful than the surgeon that would be performing the RP. Just a lot more info about the different treatments. Spent a lot more time with me. His main message was that (as many here have said) both forms of treatment are effective and that it's really about what makes the most sense for me.
He said PSA 8.6, Gleason 7, Stage 2 are the numbers I need to focus on. And the fact that more than 50% of my biopsy samples showed cancer (3+3, 3+4).
Those are the things that dictate his course of action/treatment recommendations. He said that because I am kind of "in the middle" as far as age, radiation OR surgery are both good options.
I was leaning toward RP before I met with him but now I'm not so sure. His area of expertise EBRT and that is the treatment I would get if I opt for radiation treatment with my current provider.
He said incontinence/impotence likelihood for surgery is also higher than radiation (50% to 33% respectively)?
He said he, in my position, would not have a problem having the surgeon in my network perform the surgery if I chose that.
He said there can be benefits to going to a Center of Excellence for treatment but in many/most cases, the added travel, cost, and trouble just don't justify it unless you live somewhere where treatment quality/cost, or the experience level of your docs/surgeons (or lack thereof) warrants it.
He said the peace of mind of getting the best care available to you regardless of cost may be the biggest benefit and not trivial if it brings you peace and gives you confidence to move forward.
So more info to digest from yesterday to help with my decision.
Hoping others will chime in based on this latest info.

Thanks all.

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dwb1 | @dwb1 | Apr 26 1:17pm

I have not read all the comments so my question may have been addressed earlier. Did you mri and biopsy show that the cancer is contained within the prostate or is there extraprostatic extention? This could be a factor in your treatment choice. If there is extraprostatic extension I would definitely have a psma pet scan before making a choice. I was 4+3=7 with very minor extraprostatic extension and chose RP. My six week post psa test was higher than before surgery. PSMA pet showed my entire pelvic bowl was clear but it had jumped to my abdominal and chest lymph nodes. I probably would have made a difference choice if I had this info prior. Knowledge is power.

REPLY
1 reply
greg52 | @greg52 | May 14 12:41pm
In reply to @dwb1 "I have not read all the comments so my question may have been addressed earlier. Did..." + (show)
@dwb1

I have not read all the comments so my question may have been addressed earlier. Did you mri and biopsy show that the cancer is contained within the prostate or is there extraprostatic extention? This could be a factor in your treatment choice. If there is extraprostatic extension I would definitely have a psma pet scan before making a choice. I was 4+3=7 with very minor extraprostatic extension and chose RP. My six week post psa test was higher than before surgery. PSMA pet showed my entire pelvic bowl was clear but it had jumped to my abdominal and chest lymph nodes. I probably would have made a difference choice if I had this info prior. Knowledge is power.

Jump to this post

Based on MRI/Biopsy, all cancer is contained within the prostate.

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