Psa, mri, prostate biopsy what next to be sure

A number of papers in the literature have found wide variation in the interpretation of MRI. Getting a second reading at a center of excellence makes sense.

I looked at a paper once that showed that whether clinically significant cancer was found on MRI depended on which person at Stanford read it that day. Dr. Cooperberg explains, in this video:

At least I would ask, is the urologist certain that tissue was removed from this lesion the MRI showed.

@thmssllvn
Here is a link to a meeting with the company that does the MRI evaluation.

You can get an MRI second opinion in the United States

Here is a video about the company and procedure
https://ancan.org/

@jeffmarc
Thank you Jeff for that info. I will look into that. I just want to be sure that the biopsy is negative . I had a hard time with the biopsy. The biopsy itself wasn't bad but i couldn’t void after 3 hours of being home so i had to drive myself back up to the clinic and they put a Foley catheter in me for 7 days. Im in Massachusetts and have Blue Cross Blue Shield and it looks like biomarkers are not covered under insurance but RhodeIsland looks they cover some.
Thank you for this info, just a lot to process.

@wever59 Was this a fusion or MRI guided biopsy where they took at least 2 cores from the PIRAD3 lesion? If a random biopsy the lesion could have been missed, but if they sampled the lesion and it was benign than you are unlikely to have significant prostate cancer. Over 70% of initial biopsies when PSA is 3-10 are negative (probably less with MRI PIRAD3). PIRAD3 lesions are also benign about half the time. To be sure follow up with PSA tests to see if it is still increasing. Steady increase of PSA is a stronger sign of PCa than a low steady level below 10. Have your GP order so you have a historic reference as there can be significant differences based on lab procedures used. Free PSA of 16 is in the middle of the gray area (11-24) where it is inconclusive.

PSEs are great if covered but cost about $1000. Even if covered the PSE it is likely considered unnecessary after a MRI and/or Biopsy. The selling point of the test is to avoid the cost/patient impacts by reducing MRIs and Biopsies. Its binary result (Likely or Unlikely Cancer) has no info about its gray area (false+ 6%, false- 8%). If your PSA keeps rising this test might be worth it before another MRI and biopsy.

You say you have had many PSA tests over the years?
PSA is very accurate IMO.
I had MRIs and DNA urine tests but none of them saw my cancer. Only the PSA did.

But here is what i would suggest to determine if your PSA is from a large prostate or from PCa.

Get all of your historical PSA data and plot it.. A prostate that grows over the years puts out a little more PSA over the years. So if you see the PSA line going up over the years you can feel .. maybe.. a bit better.
But if you plot it and it stays lower and then all of a sudden starts shooting up… PCa probably

Also how do you pee? Good bad?
If you pee bad, they might reject you from radiation therapy.
Look into greenlight, get your pee performance up and all future treatment paths will be available to you

@groundhogy
Thank you yes my psa has risen slowly this is the first year it has gone over 4.0. I have a meeting with the urologist next month and i will have to get a list of questions together for him .
Thank you

@wever59 Questions should be about BPH and treatments for it if it is causing urinary issues. Also ED if that is an issue. With a negative biopsy and PSA/free PSA both in gray zones there is not much to do with cancer until there is further evidence. May want to increase PSA testing to every 6 months vs every year ... that is about all they can do unless your PSA continues to increase. One measure used for cancer is PSA doubling time. Divide your current PSA by 2 and look for the previous test that was about that number. Probably many years. It is usually months with significant prostate cancer.

The kicker is that even if one of your biopsy cores had been positive for cancer with 3+3 Gleason your urologist would likely recommend active surveillance until it got worse. Would ask if you were ready for ED and incontinence because a significant number of patients have those side effects from treatment. Almost everyone has dry orgasms. So have to balance treatment of a slow growing cancer against quality of life going forward. AS is required to make sure it is caught early if/when growth speeds up.

@wever59 With the size of your prostate (pretty large) your PSA of 5 isn't remarkable unless there are other indications of PC. More likely BPH issues.

@jim18
For intermediate risk Gleason 7 Tulsa Pro/Hifu is ideal provided you get it done by an experienced reputable specialist. If done right you will have no side-effects (urinary and ED).