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Cancer: Prostate Message Board


Cancer: Prostate Board Index


Hello IADT3,

Thanks again for you reply and your resources. It does not seem like the multi-parameteric MRI is available anywhere close to where my father lives.

The Urologist performed a cystoscopy today around noon and informed my father that his urethra was fine.

For my father's high PSA value, the Urologist told him that it could be prostate cancer and ordered a MRI.This is a regular MRI and not the multi-paramater MRI or endorectal coil MRI that you described in your previous message.The Urologist told my father that if the MRI shows any cancer, a biopsy would be done. The MRI was completed and the results of the MRI have been sent to the Urologist, who will discuss it with my father tomorrow.

There was a rectal examination done by the nurse before and after the cystoscopy. Not sure why the Urologist did not do it himself!!

Following are some of his previous values of PSA and prostate volume for the period of 2012-2016:

October 13, 2016:
PSA (ng/ml) : 0.522 (0-6.5)
Prostate Volume(ml) : 15

Dec 12, 2013:
PSA (ng/ml) : 0.79 (0-6.5)


April 1, 2013:
Prostate Volume(ml) : 10

March 14, 2013:
PSA (ng/ml) : 0.612 (0-4)

October 1, 2012:
Prostate Volume(ml) : 5


If you don't mind, I have the following questions for you:

1) How good is a regular MRI in detecting prostate cancer? I recall reading your other messages where you described that biopsy can miss the cancer as it is 12 random spots and only examines less than 1% of the prostate? Can the same problem arise in a regular MRI?

2) My father's last ultrasound of abdomen and kidney was performed in Jan 6, 2018. The prostate volume was 23 ml. There was no sonographic abnormality found in the ultrasound. For the period of Oct 2012 through January 2018, his prostate volume has increased from 5 ml to 23 ml. With this background, can this be a case of an aggressive form of prostate cancer as his most recent PSA has shot up to 11.22 on 03/17/2018?

3) If MRI/biospy do not detect cancer, is the only option to wait for 3 months and test for PSA again? If PSA has increased again, repeat MRI/biopsy?

I will update more tomorrow.

Thank you,
Zent
Hello IADT3,

Following are some more updates:

1) The MRI was negative for prostate cancer. A trans-rectal ultrasound was done this morning and it was negative for cancer as well.

2) The Urologist will measure PSA again tomorrow and will also perform a biopsy. He told my father that he needs to investigate why PSA is so high.


Questions:

1) From the above results, can we conclude that my father does not have a Stage IV or Stage III prostate cancer, but could have a Stage I or Stage II prostate cancer that is restricted to the prostate given the high PSA?

2) Does my father need a biopsy if his PSA tomorrow is less than 11.22? I am certain it will be a trans-rectal ultrasound biospy and not the multi-parametric guided MRI biospy. Just worried about risks of infection, bleeding etc.

3) Does it not make sense to wait for 3 months and test for PSA again? If PSA has increased again, repeat MRI/biopsy?


Thank you,
Zent
Hi Zent,

I've read authoritative sources that state as early as 6 weeks but also up to 12 weeks. Of course, one approach is to get a test on the early side, and, if it's low - fine, but if it's not, retest a bit later. Sometimes there are reasons to do the next test early.

In my own case, with the doctors very worried about advanced cancer and with the very unlikely possibility that the lab work was faulty, my second test was done early after the biopsy. My first PSA was on December 4, 1999. My biopsy was done on December 13. My next PSA was just two weeks later on December 27, and the result was 125. :( MY PSA could have increased due to (1) cancer growth alone from what evidence has indicated was an aggressive cancer, (2) from the aftereffect of trauma from the biopsy, (3) from the effects of a Lupron shot one week before on December 20 (a brief phenomenon known as "flare" before Lupron causes the PSA to plunge), or (4) from some combination of the above. There were some reasons to do it so early, including to see if "infarction" might have explained a lot of the initial high PSA result (it didn't). Usually it is best to wait longer to eliminate the role of trauma from the biopsy.





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