PSA results: What next?

@leroyh53, did you get your results and discuss them with your doctor? How are you doing? What's next?

@colleenyoung, I have an appointment at Mayo Clinic Phoenix on Friday the 7th. I am assuming we will discuss PSA results to date, perhaps more bloodwork?I hope he will order MRI.

@leroyh53 Instead of “hope he will order an MRI,” make the recommendation —> “ Isn’t an MRI the next step?” Or “Ok, when can we do an MRI?”
Try to take an active, self-advocacy role in your diagnosis and treatment. You’ll get more out of it.

An MRI would help put the PSA numbers in context and enable you to calculate prostate density, volume, whether prostate is enlarged or not and give you a pirads score so you can make a decision about next steps. That’s where I am at.

@leroyh53, how did the appointment go? What are the next steps for you?

Ok, I met with Urologist at Mayo/Phoenix on Friday. We did more blood work, Urinalysis, and Uro Flow test. Uro Flow test was good, as well as Urnialysis. I just got blood results today.
PSA - 5.4 Which is close to what it was in April and October
Free PSA - 0.5 ng/ml
Free PSA/PSA Ratio - 0.09
I have no reference for these last two numbers?

Oh yeah, MRI Scheduled for November 21st.

Very Good News! MRI showed no cancer, but did show BPH nodules. Dr. asked if I would like to proceed with Biopsy or PSA testing every 6 months. I opted for monitoring PSA, holding off on Biopsy. He also recommended ExoDx, which I agreed to. Any advise with my decisions?

@leroyh53, thanks for the updates. Such a relief that no cancer was detected.

I'm tagging a few members who have experience with ExoDx like @tinamaria1 @astrodoc @handera and others.

You might also be interested in this discussion where @ezupcic asks a similar question about:

- Continued Monitoring or Biopsy? https://connect.mayoclinic.org/discussion/continued-monitoring-or-biopsy/

@leroyh53

The ExoDx test certainly is better than relying simply on a PSA test, if the concern is whether clinically significant PCa (csPCa) may be present (>= GG2) and a biopsy is recommended.

However, the ExoDx can understate or overstate the csPCa concern…significantly….as researchers at Duke University found a few years ago….see my post here https://connect.mayoclinic.org/comment/1445226/

The reason ExoDx is being recommended, and not My Prostate Score 2.0 or PSE, is that the former has already received special “FDA‑breakthrough device program” and “Clinical Laboratory Improvement Amendments” certified lab available status AND has been worked into standard insurance reimbursement systems.

You may want to review this 2024 study which has shown improved positive predictive value (PPV) and negative predictive value (NPV) when the ExoDx result is combined with mpMRI results.
https://ascopubs.org/doi/10.1200/JCO.2024.42.16_suppl.e17090
This study found that if one’s PI-RADS score is ≥4 AND the ExoDx result is ≥ 26.43, the PPV increased to 55.6% versus 48.5% with a PI-RADS score of ≥4 alone or a ExoDx result of ≥ 26.43 alone. Still not great….but better….

IMHO the initial data indicate PSE and MyProstateScore 2.0 are better tests, when attempting to determine PPV and NPV as to whether csPCa is present prior to biopsy….BUT not as much “critical research mass” has been assembled for the urological establishment to begin recommending their use, as they are now doing for ExoDx. I think it’s just a matter of time…