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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Re: Prebiopsy MRI
Aug 9, 2018
That written report has a significant clue about size: 81 mL, which is the same as 81 cc, indicates a very large prostate. The rule of thumb is that regular or benign enlarged prostate cells will produce about 1 unit of PSA for every 10 cc of volume; basically, just divide the 81 by 10 to get what you would expect from non-cancerous cells, in your case about 8. That means, after subtracting 8.1 from 9 and getting .9, that there is very little PSA remaining to be accounted for by cancer, infection, or other cause. This isn't exact science, but it does have a basis in research; indeed, a prostate of 81 cc (or mL) might well cover a PSA of 9 due to BPH alone.

On the other hand, my understanding is that BPH is not usually (ever?) a rapid process and therefore does not cause a rapid increase in PSA, and my impression is that your PSA climbed rapidly, which seems, to my layman's eyes, not exactly consistent with the BPH explanation. (You posted earlier: "back to early 2017 ( psa numbers were in the mid 3 range in early 2017, gradually increased, and most recently jumped from mid to high 4 to 9.")) This is where a urologist experienced in prostate cancer, BPH and prostatitis could help sort things out.

Getting a second opinion (or more, I had at least 9 before deciding on my strategy during the first year, but I had a challenging case) is par for the course with prostate cancer. I still think, from my layman's viewpoint, that the PI-RADS result of 3, in the context of a rapid increase in PSA (in fact a doubling to a significantly elevated level) warrants a biopsy, but this size clue, and your history of infection, calls for a little more head scratching and possibly some other tactics before doing the biopsy.

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