Seeking Wisdom and Guidance

(Thanks for the later clarification regarding the scheduling of the MRI & biopsy.)

With the average age at diagnosis being 66y, your “middle-age” status is right at the cusp of that curve. (I was 56y when I was initially diagnosed.)

What’s important first is the MRI results, not the biopsy results. Once you get your MRI results you’ll have a good indication of the “probability” of the direction you’ll be heading post-biopsy.

Much of prostate cancer diagnosis and treatment involves waiting. Use that down-time to study, research, and become a “student of prostate cancer” (as I refer to it). If you do, you’ll be better prepared to make an informed decision no matter what the biopsy results are.
(Plus, it’ll keep you busy and not “just sitting around thinking about worst case scenarios.”

As you’re researching this, don’t just “read on the internet.” Instead, read from legitimate medical/hospital sources (like Johns Hopkins, Mayo, and others) as well as reputable organizations (like PCF, PCRI, and others).

As for testosterone, are you tracking that along with your PSA tests? Knowing your testosterone level will be beneficial later.

Lifting weights only creates a very slight increase in testosterone - and that slight increase is only temporary. (Otherwise, top bodybuilders wouldn’t need to take performance enhancers.) Also, weightlifting will be beneficial down the road (but, not for needing “strength for a potential battle with cancer”).

Regarding your family history of cancer. What they’ve found is that there are a few genetic markers that are common to prostate, cancer, ovarian, and some other solid-tumor cancers - and those genes can be passed from either parent to their children. They say that ~15% of prostate cancers have a genetic component, and that if a first-degree relative (parent/sibling) has prostate cancer and they have one of those genes, that it increases the odds of getting prostate cancer by 50%. (See attached chart of those genes.)

Yes, you should get the genetic test while you’re waiting. You may (or may not) have inherited any of those genes. If you can’t get the genetic test from your doctor or your insurance company won’t pay for it, you can get a free prostate cancer genetic test here: https://www.prostatecancerpromise.org/
==========

Curious as to what your annual PSAs were in the years prior to that November PSA of 5.8?

Are you sure that your “Free PSA” is 10.3? Or is that your “% Free PSA”? (Free PSA is typically lower than Total PSA.)

When the Total PSA is between 4.0-10.0 (the “grey zone,” they call it), % Free PSA is a helpful predictor of prostate cancer and helps decide if a biopsy is needed, with a lower percentage (< 15%) often suggesting a higher risk of prostate cancer.

@brianjarvis thank you so much. My PSA last June '24 was 2.8. It ranged between that and 3.8 for the previous six or seven years. I guess that's why I was surprised when it jumped to 5.8 in November and 6.5 in December. My biggest fear is that's an indicator of an "aggressive" cancer, which is what makes sitting around doing nothing all the more agonizing.

The 10.3 number is the % Free PSA. I read that lower than 10 suggests a higher risk of prostate cancer, which is why being only .3 above that marker makes me think I am essentially in the higher risk category. Perhaps that's why my doctor decided on a biopsy regardless of what the MRI might - or might not - show?

As for the free PC genetic test, I clicked the link and tried to sign up, but it said I did not qualify because in the questionnaire, I could not say that I have been diagnosed with PC.

I'm grateful for all the feedback. I realized my comments weren't entirely clear on MRI vs. biopsy. Some caught it. The MRI is actually scheduled for Jan 7th. The biopsy for Jan 27th. I thought it was strange that the doctor wanted to get a biopsy on the schedule before even seeing the results of an MRI (which I thought would or would not warrant a biopsy). But as some have said, maybe it's just to be sure the biopsy gets on the calendar and can always be deferred or cancelled if the MRI comes back clear.

This subject of lower back pain is also concerning. I've been a golfer/athlete most of my life and have suffered from some sort of lower back pain off and on over the years. I was not aware of the association with prostate cancer and back pain. I just figured I'm getting old, have some strained muscles or maybe a pinched nerve. The worrisome part, I guess, is that the pain just sort of lingers. It helps to stretch and take Advil. Many of my friends also complain of lower back pain as we have aged. Now, it's just added to my anxiety.

If anyone has more clarification on the kind of back pain you have experienced, it would help. Mine seems to be in the muscles or tendons in the left lower back/pelvis region. But that's just a self-diagnosis.

@jbuscher123
A couple of things
Even if your MRI shows nothing, you could very well have even Gleason nine prostate cancer. If you were to look through the last year or two of messages in this board, you would find people that had exactly that happened to them. The MRI can be very useful. It is not the final answer.
A biopsy may still be necessary If your PSA continues to rise.

As far as lower back pain goes. I’ve had it for probably 40 years. Hits maybe once a year. I put on this belt. I found about 40 years ago that just stops it. I’ve had it no more or less while I’ve had prostate cancer for the last 16 years. I’ve been on ADT for eight years and it makes no difference to my back pain.

There are muscular issues that can occur from ADT and low testosterone. That could be what’s happening or could just be a normal condition you have. Usually, you hear about joint pain when people have problems with ADT not lower back pain.

Your timing for the MRI and biopsy is so soon that it really isn’t an issue. Prostate cancer is relatively slow growing and your being sick could’ve affected your PSA. Your doctor was getting a little anxious Considering how quickly you can get an MRI.

You should definitely get genetic testing. I got PC at 62 because I have BRCA2. My brother got it at 77 because he didn’t, but he had a father with PC. My father died of it at 88 but he did not have BRCA. I got it from my mothers side of the family. Both of her sisters had breast cancer. One died of it and So did her daughter at 60. My mother never got it, but passed on the BRCA2 to me.

Has hereditary genetic testing been offered to you by a doctor? You can get it done free with the below link, if you live in the United States. Do not check the box that you want your doctor involved or they won’t send you the kit until they get in contact with your doctor. It takes about three weeks to get the results and then a genetic counselor will call you.
`
http://prostatecancerpromise.org/

Jeff, do you attend the reluctant brotherhood?

Hi, welcome to the group and so sorry you found it necessary to join. I was just diagnosed in May so I'm far from old hat at this but... You are at the "I don't know what I don't know" part of this journey. It's not time to worry yet. Don't let worry rent space in your head. It has no useful purpose other than to ruin your ability to sleep. As others have said, there is a "standard of care" process. The first phase is of that process is diagnostic. The reality of this phase is that no matter what initial scans say, the only way to know, for sure, if you have PCa, or not, is biopsy. I was hospitalized last spring for renal failure caused by urine retention due to (unknown at the time) PCa. 2 CT scans, an MRI, and 2 ultrasounds came back negative with zero mention of possible malignancy. A few weeks later, biopsy came back with 12 of 12 cores involved.

Once that diagnostic phase is over, you'll have a choice how to handle it. If no cancer, congratulations and get on with your life. If cancer is present, you can worry (which still does absolutely nothing to help) or you can do what I did and just get plain pissed off at the cancer and fight it. Learn everything you can about it and then get on with your life. You're at Johns Hopkins. That's a pretty darn good place to be if you end up having to fight.

As far as back pain, I can empathize. I ruptured a disc @ L4/L5 probably playing golf. In June, a PSMA PET scan identified a metastasis on L5. Back pain is part of life for me at this point, but the tumor will get zapped if my next scan does not show improvement and inversion traction keeps the disc in check. Maybe if you let your doc know about the pain, he can order a full lumbar scan while you're in the MRI anyway. At least then you'll know if you blew a disc or not and if so, get some PT to help. Best wishes and just keep in mind that a positive PCa diagnosis doesn't end life. It just changes it up a bit.