1. < Prostate Cancer

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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lyricw | @lyricw | Feb 20, 2024

Transferral using ultrasound fusion. They said they hit the area so not sure. I was thinking of second opinion from Mayo if PSA stays elevated.

REPLY
lyricw | @lyricw | Feb 20, 2024
In reply to @frank1956 "lyricw, That is a great news. What have you been doing to lower the PSA, if..." + (show)
@frank1956

lyricw,

That is a great news. What have you been doing to lower the PSA, if anything?

Jump to this post

I started taking daily vitamin C & D. My symptoms were minimal & prostate only about 39cc. I read vitamin D helped some with prostatitis so Idid & I took Augmentin for a week prior to 6 month PSA & decreased 5.0 to 4.1. Pirad 4 MRI area BX DX focal atrophy with inflammation so I wanted to try vitamin D & Augmentin ( for another procedure anyway). Urologist said focal atrophy inflammation could raise PSA. I still want to watch in case focal atrophy area pre-cancerous.

REPLY
bjroc | @bjroc | Feb 20, 2024

@lyricw Was your biopsy transperineal or transrectal? They can not reach apex transrectally.

REPLY
1 reply
frank1956 | @frank1956 | Feb 19, 2024
In reply to @lyricw "All BX sites came back benign except core pirad 4 area& it was focal atrophy with..." + (show)
@lyricw

All BX sites came back benign except core pirad 4 area& it was focal atrophy with inflammation. I just did 6 month PSA & it fell from 5.0 to 4.1. Urologist email message “PSA stable. I suppose I will get another PSA in 6 month via internist yearly checkup.

Jump to this post

lyricw,

That is a great news. What have you been doing to lower the PSA, if anything?

REPLY
1 reply
frank1956 | @frank1956 | Feb 19, 2024
In reply to @handera "Read your other post to get more background info. From what you’ve indicated NONE of your..." + (show)
@handera

Read your other post to get more background info.

From what you’ve indicated NONE of your 13 core samples came back with 3+3 Gleason, even those targeting your PIRAD 4 lesions, correct?

Were all 13 cores “benign”?

Sometimes a core will come back “suspicious” or HGPIN, but not cancer.

Jump to this post

On page one, all my 13 diagnosis show 'Benign prostatic tissue'.
Page two is a diagram showing where the needle went in.
Page 3, relists the 13 diagnosis, and each line with a column of 'cores'. Some diagnosis shows 2; some with 3; some with 1. I added them up, there are total 26.

There are no other words on the pathology report. It is as if the pathologist did not actually do any work, just rubber stamped using a 'SAMPLE' report.

I am meeting with my Urologist tomorrow to go over this. I will ask him about the report.

REPLY
handera | @handera | Feb 19, 2024
In reply to @lyricw "All BX sites came back benign except core pirad 4 area& it was focal atrophy with..." + (show)
@lyricw

All BX sites came back benign except core pirad 4 area& it was focal atrophy with inflammation. I just did 6 month PSA & it fell from 5.0 to 4.1. Urologist email message “PSA stable. I suppose I will get another PSA in 6 month via internist yearly checkup.

Jump to this post

That biopsy and latest PSA result sound encouraging!!! Congrats!!

REPLY
lyricw | @lyricw | Feb 19, 2024
In reply to @handera "I had PIRAD 4 and PIRAD 5 lesions that were both 3+3 Gleason upon TRUS targeted..." + (show)
@handera

I had PIRAD 4 and PIRAD 5 lesions that were both 3+3 Gleason upon TRUS targeted fusion biopsy.

As far as I know, the PIRAD scoring system doesn’t tell you anything about the aggressiveness of your PCa. It certainly didn’t in my case.

Instead of subjecting yourself to additional biopsies, with such a favorable initial biopsy result, you may want to ask your doc about the genomic ExoDx test. It only requires a urine sample to perform the test.

ExoDx test has Level 1 evidence, based on a 1000+ patient study, with a 91 % Negative Predictive Value (much higher than the PSA test). It designed to indicate the likelihood of GG2 (or greater) PCa. I’m going to ask to have this done before deciding on having my next biopsy, due in October.

ExoDx test is covered by Medicare.

You can read much more about it (including study trial paper) here:
https://www.exosomedx.com/physicians/exodx-prostate-test

Jump to this post

Thanks for info. My urologist didn’t mention urine ExoDX so I will ask internist to do

REPLY
lyricw | @lyricw | Feb 19, 2024
In reply to @handera "Read your other post to get more background info. From what you’ve indicated NONE of your..." + (show)
@handera

Read your other post to get more background info.

From what you’ve indicated NONE of your 13 core samples came back with 3+3 Gleason, even those targeting your PIRAD 4 lesions, correct?

Were all 13 cores “benign”?

Sometimes a core will come back “suspicious” or HGPIN, but not cancer.

Jump to this post

All BX sites came back benign except core pirad 4 area& it was focal atrophy with inflammation. I just did 6 month PSA & it fell from 5.0 to 4.1. Urologist email message “PSA stable. I suppose I will get another PSA in 6 month via internist yearly checkup.

REPLY
2 replies
handera | @handera | Feb 19, 2024
In reply to @frank1956 "I did do the ExoDx urine test before biopsy. My score is 18.77. Normal range is..." + (show)
@frank1956

I did do the ExoDx urine test before biopsy. My score is 18.77. Normal range is 0 - 15.6. Mine is a little higher the normal upper range. My Urologist mentioned this score to me, and I believe he accounted for this information before he recommends the biopsy.

Jump to this post

Read your other post to get more background info.

From what you’ve indicated NONE of your 13 core samples came back with 3+3 Gleason, even those targeting your PIRAD 4 lesions, correct?

Were all 13 cores “benign”?

Sometimes a core will come back “suspicious” or HGPIN, but not cancer.

REPLY
2 replies
frank1956 | @frank1956 | Feb 19, 2024
In reply to @handera "I had PIRAD 4 and PIRAD 5 lesions that were both 3+3 Gleason upon TRUS targeted..." + (show)
@handera

I had PIRAD 4 and PIRAD 5 lesions that were both 3+3 Gleason upon TRUS targeted fusion biopsy.

As far as I know, the PIRAD scoring system doesn’t tell you anything about the aggressiveness of your PCa. It certainly didn’t in my case.

Instead of subjecting yourself to additional biopsies, with such a favorable initial biopsy result, you may want to ask your doc about the genomic ExoDx test. It only requires a urine sample to perform the test.

ExoDx test has Level 1 evidence, based on a 1000+ patient study, with a 91 % Negative Predictive Value (much higher than the PSA test). It designed to indicate the likelihood of GG2 (or greater) PCa. I’m going to ask to have this done before deciding on having my next biopsy, due in October.

ExoDx test is covered by Medicare.

You can read much more about it (including study trial paper) here:
https://www.exosomedx.com/physicians/exodx-prostate-test

Jump to this post

I did do the ExoDx urine test before biopsy. My score is 18.77. Normal range is 0 - 15.6. Mine is a little higher the normal upper range. My Urologist mentioned this score to me, and I believe he accounted for this information before he recommends the biopsy.

REPLY
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