PSA & MRI suspicious but biopsy benign

Posted by lyricw @lyricw, Oct 5, 2023

I am 66 & asymptomatic but PSA has been rising 2014-2,2, 2017-2.6, 2019-3.8, 2022–3.6, 2023-5.0 with 16% free. DRE negative & MRI revealed pirad 4 0.6 X 0.9 lesion of left posterior apex intracapsular & LN negative. 12 core grid biopsy & 1 core of lesion benign inflammation.

I definitely feel relieved, but wonder if there is any chance PC present. I will see doc & discuss future monitor.

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Colleen Young, Connect Director | @colleenyoung | Mar 1 7:18pm

In reply to @seb2023 "Yes. PSA is 6.5. Receiving treatment at UCSF." + (show)

What treatment has been recommended for you?

seb2023 | @seb2023 | Feb 24 10:21am

In reply to @colleenyoung "Hi @seb2023, have you been diagnosed with prostate cancer? How is your PSA?" + (show)

Yes. PSA is 6.5. Receiving treatment at UCSF.

Colleen Young, Connect Director | @colleenyoung | Feb 23 4:45pm

In reply to @seb2023 "How big is your prostate? What is your PSA density?" + (show)

Hi @seb2023, have you been diagnosed with prostate cancer? How is your PSA?

lyricw | @lyricw | Feb 22 12:40pm

In reply to @bjroc "@lyricw Was your biopsy transperineal or transrectal? They can not reach apex transrectally." + (show)

Trans rectal

lyricw | @lyricw | Feb 22 12:36pm

Actually PSA was 5,0 with free PSA .82ng/ml & %freePSA 16 norm >25. New PSA drawn 6 months later 1/24/24 was 4.1 ng/ml & they did not order free PSA & % free.

lyricw | @lyricw | Feb 22 12:31pm

In reply to @seb2023 "How big is your prostate? What is your PSA density?" + (show)

39ml & density was not listed

gently | @gently | Feb 22 9:23am

In reply to @frank1956 "I was tested with PSA 5.3 on November 2023, and 3T MRI shows 2 lesions (6..." + (show)

@frank1956

I was tested with PSA 5.3 on November 2023, and 3T MRI shows 2 lesions (6 x 9 mm and 5 x 3 mm). Both PI-RADS 4. The locations are:

T2 signal 4 o'clock left lateral lower mid peripheral zone.
T2 signal right 7 o'clock upper mid peripheral zone.

I had a MRI fusion transperineal Prostate Biopsy few days ago. The pathology report shows all 13 diagnosis benign. The detail of diagnosis shows each diagnosis with the corresponding number of cores. (See attached). Total number of cores added up to 26.

I am ready to meet my urologist in few days to discuss the pathology report results. The report only shows that my urologist did not fine cancer, but it does not mean caner is not there giving my PSA number and PI-RADS numbers. I feel that I am back to square one.

I am ready to ask for more tests, but not sure if my Medicare/Medigap would pay without a positive diagnosis. Tests such as PSMA PET scan.

I read that a second biopsy can be requested though it requires a 3 month wait. There is a more focused biopsy technology:
Direct MRI-guided In-Bore Targeted Biopsy of the Prostate: A Step-by-Step How To and Lessons Learned | RadioGraphics (rsna.org)

"This potential optimized sampling makes in-bore biopsy an excellent second-tier strategy offered to patients in a scenario such as prior fusion biopsy with negative results and highly suspicious lesions (PI-RADS category 4 or 5). This technique can also provide improved accuracy in challenging clinical scenarios such as small lesions in a large gland or suspected local recurrence after surgery. A disadvantage of in-bore biopsy is the higher cost. Also, because systematic sampling is not routinely performed during in-bore biopsy, MRI-invisible lesions could be missed with this approach."

This seems to fit in my condition. I just do not know where I can request such a second biopsy. I am here seeking any suggestions, and guidance so I can have a constructive conversion in few days when I meet with my urologist. Thank you for listening.

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Frank 1956 (you lucky, lucky man)
Your plan for a PSMA pylarify is the best. If your urologist is reluctant or unable to order the PET/CT, see an oncologist. They'll tangle with the insurance.
Praying for your false alarm.

bjroc | @bjroc | Feb 20 11:12am

In reply to @lyricw "Transrectal. I may seek second opinion from Mayo if PSA stays elevated." + (show)

That is what I did, had transrectal locally was not definitive, then went to Mayo while being on AS basically. Mayo has really good transperineal biopsy, my lesion was small but they got it. Those apex lesions are difficult to reach. Mayo is impressive.