1. < Prostate Cancer
Profile picture for twhite33

PSA relative to prostate size - anyone been told this?

Posted by twhite33 @twhite33, Oct 14 11:23am

I am currently in AS protocol, monitoring my PSA at regular intervals. After flirting with 10 for about a year, my PSA is now consistently above that, with most recent reads at 11.8 and 13.8. My urologist expressed deep concern at these numbers despite unsuspicious MRI and PET scans earlier this year. His DRE also yielded nothing suspicious. Gleason scores 3+3=6 a year ago. In his words, as closely as I can recall: "Something is going on with your prostate. If you had a a bigger prostate I might be less concerned, but those numbers are simply too high to blame on BPH for a gland the size of mine."

My questions:
Has anyone else heard this from their doc?
Is there a correlation between the size of your prostate and what is considered a 'too high' PSA level?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for brianjarvis
brianjarvis | @brianjarvis | Oct 16 8:38am
In reply to @twhite33 "@brianjarvis Other information helpful to know: > What PIRADS score resulted from your MRI? I've had..." + (show)
Profile picture for twhite33 @twhite33

@brianjarvis
Other information helpful to know:
> What PIRADS score resulted from your MRI?
I've had 2, 1st in August '24 and another in August '25. In '24 PIRADS score of 3 with one suspicious lesion in peripheral zone. In '25 no PIRADS score given, but this notation, "No MRI evidence of clinically significant prostate cancer. Previously noted PI-RADS 3 lesion in the left mid gland is no longer discretely seen."

> What SUVmax scores resulted from your PSMA PET scan?
I can find no reference to SUVmax score in my PET result. The only information that I can decipher is this, "Prostatomegaly with no focal increased uptake on a PET/CT scan." and the note "No evidence of extraprostatic disease." I looked up the former and it seems like favorable news, and the latter seems self-explanatory.

> Have you gotten a second opinion on your MRI, biopsy, and PSMA PET scan images/tissues?
Yes, New York pathology found 5 of 12 cores at 3+3 and 2 of 12 at 3+4. NC Path found nothing but 3+3, and recommended AS with 6 month PSA test and repeat biopsy after 2 years.

>?Have you had a biomarker (genomic) test?
I requested the Decipher test (based on my reading here) of my NY doc, and he ordered the GPS instead as he is familiar with it. Scored 24, likelihood of disease progression=lower. His comment was, "under 20 is great, over 40 is very bad, but in between is not particularly helpful."

> Have you had a genetic (germline) test?
Not sure if this is what you are after, but I have a family history of cancer (breast, pancreatic and bladder), with BRCA2 present in 2 of my sibs, but I have tested negative for BRCA2.

Thank you for your input!

Jump to this post

@twhite33 That’s good information for you to use, Always remember that PIRADS/Gleason/SUVmax/etc. results are just one specialist’s educated and experienced opinion of what is seen in the scan/tissue/etc. Much of the interpretation of images, scans, and slides is often as much an art as it is a science and dependent on the skill and experience of whoever is doing the reading. There’s no way to know which one is “right.”

So, the statement - "No MRI evidence of clinically significant prostate cancer. Previously noted PI-RADS 3 lesion in the left mid gland is no longer discretely seen” - has to be accepted cautiously.

And in your case, with New York pathology finding 3+3 and 3+4, but NC Path finding nothing but 3+3, that leaves some doubt and need to watch closely.
> With that 3+4, what % were “3” and what % were “4”?

Regarding your PSMA PET scan, the comment - “Prostatomegaly with no focal increased uptake on a PET/CT scan." and the note "No evidence of extraprostatic disease." - is great, but again …..get a 2nd opinion.

With PSMA PET scans, radiotracer uptake is always compared to the uptake in your blood, liver, and parotid glands.
> Was there any mention of SUVmax scores for your blood, liver, and parotid glands?

As for the genetic (germline) test. They say that about 15% of prostate cancers have a genetic component. (I’ve attached a chart showing others.)
> It’s good that you tested negative for BRCA2. (Some say not so good to have a negative BRCA2, because if you did have a positive BRCA2, there are targeted PARP treatments for that.)

It’s complicated……
REPLY
Profile picture for survivor5280
survivor5280 | @survivor5280 | Oct 17 3:07pm

I had an exceptionally small prostate due to having been on finasteride for 20+ years prior to prostate cancer (stop hair loss). My PSA was normal high but I have read of guys with PSA's many times greater than mine was.

REPLY
Profile picture for widude63
widude63 | @widude63 | Oct 24 6:52pm

I’m in that camp, prostate at 134 ml, PSA 20.4. I went right to a biopsy, didn’t know size of prostate at the time. The biopsy came back negative.

Now I plan to slow down some, in the future another PSA test, maybe an MRI 6 months out. I just saw the urologist today, Dutasteride prescribed today.

REPLY
View MoreView Less
Please sign in or register to post a reply.