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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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heavyphil | @heavyphil | 5 hours ago
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.

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No PSMA BEFORE SURGERY??

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heavyphil | @heavyphil | 4 hours ago
In reply to @greg52 "Based on MRI/Biopsy, all cancer is contained within the prostate." + (show)
@greg52

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

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Kudos to your RO for giving you a detailed explanation. With your low to intermediate grade either surgery or radiation will give you the SAME outcomes….But - you MUST get a Decipher test to see if your cancer is the kind that could spread based on its aggressiveness. Really can’t proceed without this.
If low, radiation IMO is the way to go - probably MRI guided SBRT - (the lowest tissue toxicities available), since your chance of recurrence is much less.
However, if your Decipher is above .5 you “may” have a more aggressive type that could recur; in that case, surgery is probably the better option since you can have radiation down the road if necessary. The opposite - radiation and then surgery not so good.
Also, remember that your doctors - all of them - want to keep you “in network” meaning THEIR network cause that’s where the $$ goes. DO NOT hesitate to travel for better therapies outside your network or your local area. The difference between IMRT and MRI guided SBRT can be significant.
BTW, 150 robotic surgeries is NOT a number I would want my surgeon to have - more like 1500. In any event, get as much knowledge and info possible before you pull the trigger - to say later “but I didn’t know” doesn’t cut it in today’s information based world. All the info is there but you gotta use it! Best
Phil

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