What PSA Score sent you to a Urologist?

If money's not an issue, you could see if you can get treatment somewhere in Western Europe. You wouldn't be covered by their universal healthcare, but the cost might also be lower.

(You could also try Canada, but I'm doubtful most provinces would let someone pay to jump a queue, even though as an American you wouldn't fall under the regulations of the Canada Health Act. It wouldn't hurt to try a few calls, though.)

I missed your age if you mentioned it in an earlier post. I don't think a PSA of 11 would be concerning in your 80s — it's normal for it to climb higher as you age — but (as a layperson) I'd think it be worth investigating in your 50s or 60s.

You are spot on! An mpMRI PRIOR to an initial biopsy should be mandatory!

First it provides information as to where to focus an ultrasound fusion guide biopsy AND it establishes an initial set point to compare to future mpMRI’s and biopsies that you may need to get if treatment is postponed for any reason (especially if one opts for AS).

I suppose some docs would say it’s not necessary if your PSA is sky high…as they are probably assuming a sky high PSA definitely means one has high grade PCa.

But if that’s the case you’re probably going to end up having a PSMA-PET scan after your biopsy to determine spread.

I don’t know if insurance companies will cover the cost of a PSMA-PET scan, w/o a PCa confirmatory biopsy…but I doubt it.

In any event, it seems to me a good doc is going to get an mpMRI PRIOR to biopsy…I’d go elsewhere if mine were to decide to “fly blind”.

I was treated at Mayo Phoenix with radiation SBRT (5 treatments) with 18 months of ADT in Aug '21. I was a Gleason 7(3+4) and my PSA was 9.2. A PSA of 11 would be concerning!

Well spoken!

Hi....I am 62. 11/05/2020 PSA was 3.0 02/22/2024 PSA was 5.7. Went to urologist and he performed DRE and did not find anything too alarming but ordered a 4score test which was high (16) and he then scheduled a prostate biopsy. The biopsy came back clean/no cancer...but I do have chronic inflammation in 4 of the 16 cores he tested.

Going to see doctor next week to review biopsy in detail, but I am curious - what is everyone doing to hopefully walk back or prevent cancer developing? (Diet/Exercise/other)? Any questions you think I should ask when I go next week? Thanks

When I got a PSA of 10.8, my primary care physician said he could either refer me to a urologist or order an mpMRI. I thought it made more sense to do the mpMRI, but my medicare advantage plan refused to cover it. I wrote a nice appeal letter explaining that it was appropriate treatment and citing research. I got no response at all.
Fortunately for me, I could drop the medicare advantage plan and switch to traditional medicare since I was within 6 months of turning 65, which I did. Also fortunately, I could afford the $600 payment out of pocket, which as never reimbursed. It did confirm the cancer and gave me a scope of what level of concern might be appropriate.
Fortunately for me, this led me to a clinical trial and a research doctor in another state. Unfortunately for me, the mpMRI at the in-network provider for my (prior) medicare advantage plan was not of high quality and on older equipment, so I had to redo the mpMRI for the research doctor. Fortunately for me, he planned a transperineal biopsy which was only just emerging as preferable to transurethral biopsies. Unfortunately for me, the higher quality mpMRI on state of the art equipment with top level pathologists reading it identified a nodule of concern the earlier MRI missed. Fortunately for me, the biopsy the next day included 20 cores, both systematic and targeted. Unfortunately, there were two cores from the newly identified nodule that returned 4+3, disqualifying me for the stage 2 clinical trial (new method of ablation). Fortunately for me, the research doctor in another state was able to refer me to a local urologist with an excellent surgical record for the now treatment of choice--RALP.
And so the journey continues :-).

My PSA level was around 9.0
and I had a biopsy which tested positive for cancer.

My PSA level was 26.7 sent me to the Urologist who did a biopsy to confirm prostate cancer with a 4+3 Gleason.

Jayhall - So many doctors rely on PSA level alone. This is so misguided and incompetent. In addition to PSA level, they must look at the velocity (rate of increase) and doubling time. Even if your PSA level is relatively low (say 6, 7, 8), you could very well have intermediate or advanced prostate cancer. For myself, the doctor started doing PSA checks when I was 50 years old. I trusted the doctor to be competent, but she only looked at PSA level. In hindsight, I reviewed my records and my PSA doubled twice and was doubling a third time. Even with this rapid increase, she never indicated there was a problem/concern. Fortunately, I retired at 55 and went to a cardiovascular clinic to improve my diet in hopes to get off of cholesterol medication (Statin). Fortunately, the nurse practitioner was a friend from our church and she reviewed my entire medical record. After talking through my cholesterol issue, she asked me if I was addressing my prostate problem. Ignorantly, I replied, what is the prostate? Goes to show how much I relied on doctors at that point of my life - Never again, you must own you healthcare and take personal responsibility for it. I immediately did research, contacted the best possible center of excellence, and made an appointment with Mayo-Rochester. In the end, I was diagnosed with PC, Gleason 7 (4/3). I went with a radical prostatectomy and for the past 1.5 years had PSA level of undetectable - Praying this remains the case for the rest of my life!!

Bottom line, my PSA level was just below 8, but it had doubled almost three times. Ignorant doctors and "I don't want to worry you" doctors are very dangerous and should be avoided. We must own our healthcare and ensure the doctors are interpreting test results accurately - Please don't solely look at PSA level, you must also take into account the rate of increase (velocity and doubling time)!

Best of luck and I pray all goes well with your upcoming appointments.

Have a great day,

Jim

I was 57., My PSA had increased from 1.5 to 2.0 in the past year. My nurse practitioner referred me to a urologist. DRE was ‘concerning’ in his words. Biopsy returned PC in all 15 cores, 3+4 Gleason, and a nasty cribiform component in nearly one half of the cores. I had surgery to remove the prostate one year ago. Negative margins (good) with seminal vesical invasion (bad) with pathology. PSA only dropped to 0.17 post-surgery and is now over 1.0 again. PSMA has confirmed 5 affected lymph nodes. 38 treatments of photon and proton radiation scheduled soon with 2 Lupron injections. Moral of the story is your PSA is only a relative predictor of PC and severity. Consult with urologist as soon as possible.