PSMA Scan

I think you still need a biopsy so that they can look at the actual cancer cells under a microscope and classify them (Gleason score, etc), but the PSMA PET scan will help increase confidence that it hasn't spread.

Best of luck!

Did they tell you what the size of the lesions are? Pi-rad’s 4 and 5 size lesions Frequently mean cancer.

The biopsy will tell you if you have cancer usually (They can miss the cancerous spot) And also tell you how aggressive it is.

If you Get a PSE test it can tell you whether or not you have cancer without doing a biopsy. If It shows you have it then you go ahead with the biopsy.

It's PI-RADs 5 for the large one and PI-RADS 4 for the other one. Pretty sure it's cancer. My biggest concern is whether it's local or more widespread. It might be March or April before I may get a PSMA scan. PC may be slow growing, but it's definitely growing. So, the bottom line is wondering if I should advocate and pay for a scan earlier and at least know the status if it has spread. I don't think I need approval as long as I'm paying.
The process with the Prostate Center here is, and has been - PSA test (high), wait 3 months, another PSA test (a bit higher, but not doubled), one more PSA test after 3 months (trending higher), wait a few months for an MRI, then wait 2 or 3 more months for a biopsy, wait 2 - 3 weeks before attending a required information session on PC treatment options, wait 2-3 weeks to finally see a urologist (that hopefully includes an oncologist) to discuss results and next steps, wait a few more weeks to begin any treatment options which may include a PET scan. This is 18 months from the initial high PSA (12.3) before any treatment action might begin. Who knows how long it was growing before the first PSA test. Probably years. Anyway, I guess I'm just frustrated with the waiting. The irony is because of age they wouldn't screen me and I had to lie about my age to get the first PSA test. It was a bit of a lark. In hindsight with no test I'd be oblivious to anything prostate and my first symptom could have been stage 4.

stew80, 9 weeks of anxiety: cruel. Maybe you could get in on a cancellation. Ask to be put on a cancellation list. Or MRI in hand you could find another specialist for the biopsy. The new contrast agent is making the PSMA /PET very expensive for a cash payer. Close to $5000.

Where are you?

Calgary alberta

There's a new Cancer Centre that just opened up in Calgary:
https://globalnews.ca/news/10816070/calgary-arthur-child-cancer-centre-opening/
I hope that cuts wait times by sharing the load with the Tom Baker Cancer Centre (assuming that keeps operating, too; I don't know a lot about healthcare in Alberta.)

Here in Ontario, I had my biopsy the day after my MRI in 2021 (and the results 3 business days later), but I was also a high-priority patient because I was rapidly becoming paralyzed as the metastasised tumour compressed my spine: I walked into hospital with a cane on Monday and was completely paraplegic by Friday. In one sense, it's good *not* to be one of those high-priority patients, though I know the wait is frustrating and stressful, especially over the holidays.

Personally, I wouldn't pay for a PSMA PET scan now; better to get the biopsy first, and then Alberta Health Care should cover the scan (if needed). Your mileage may vary.

I hear where you are coming from. I paid for a PET 5 yrs ago after my biopsy because I thought it would help in my treatment decision.
If the scan showed it was already out of the gland, why do surgery as I would need radiation anyway? If not, I would do surgery, which I did.
But even with all that I still needed salvage radiation so scans don’t see everything - especially micro metastases. But I still think it was valuable in my decision and I would do it the same way again if weighing surgery vs radiation - especially today with high and low brachytherapy treatment being combined with SBRT. A lot of options out there!

@stew80
Scans do not give a pathology results or Gleason score. A biopsy shows if cancer, a Gleason score.

Per your message you have not yet be diagnosed with cancer. Hopefully your lesions are benign. When I got my MRI results I was told 70% chance the suspicious areas would be cancer and they were.

For me and cannot speak what is best for you I would wait to see a biopsy results and then go from there. If cancer then if me would do the follow up tests, Decipher, PSMA. But talk to your urolgoist and R/O about your questions and concerns you area in the early stages of diagnostic.

You said you had to wait 9 weeks for a biopsy? Again if me I would go to a experienced major provider and have my biopsy done there. For me waiting 9 weeks would not be accceptable. After my MRI at Mayo my biopsies were done 1 week later.

In Canada paying for a biopsy earlier would typically mean travelling to the U.S., with all the extra expense and hassle that involves (especially with the CAD low against the USD right now).

As I mentioned in my earlier comment, while every province is a bit different, healthcare scheduling is usually on a triage basis here. If you're in crisis, you get taken *very* fast (that's been my personal experience); if they don't think it's urgent, then you have to get in line. Sadly, I probably bumped a lot of people down the queue back in 2021–22.

Unfortunately, they don't consider mental health in the equation. Waiting for a biopsy is a very different kind of trauma than just waiting for a knee replacement.