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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Hi Ohioguy inFL and welcome to the Board!

Your key question is whether to have a biopsy, which is a good question as some men with elevated PSAs combined with MRIs showing only enlargement can forego a biopsy with fairly high confidence (but start frequent PSA monitoring and perhaps other testing).

In your case, my now savvy layman’s view is that you should get that biopsy. It is far from a sure thing that it will reveal cancer, but there are several clues that in combination argue for going ahead now. First, your PSA of 7.7 ng/mL would be enough to go ahead unless other clues suggested other causes, mainly infection, for the elevated level. Second, you have the increase from 4.3 ng/mL from four years ago to the current level – an increase which is consistent with cancer, though that too – two snapshots four years apart – could represent a waxing and waning infection rather than a continuous upward trend that is typical of prostate cancer. Third, you have a low free PSA level of 9.7% that is in the range that suggests cancer and is below the equivocal zone. HOWEVER, free PSA too is influenced by infection, and an active infection could be reducing the free PSA result to that worrisome low range. Fourth, prostate enlargement does generate more PSA than normal, but the rule-of-thumb often used is 10 cc of prostate for each unit of PSA in ng/mL units; therefore, a prostate of 40cc would “explain” a PSA of about 4, based on size alone, but that leaves 3.7 units of PSA that are due to something(s) other than size, which opens the possibility of cancer, but also of, once again, infection, or both.

Do you know whether the MRI was a “multiparametric MRI” (mpMRI)? That’s the kind that measures at least three aspects that reflect the likelihood of cancer: specifically, it images the anatomy, water movement, and blood supply to any suspicious areas (with spectroscopic evidence a less frequent fourth component). If you had an mpMRI, then the result you report was basically negative for cancer, and you might want to consider working with the urologist to determine whether infection might be the cause of the PSA and free PSA findings. If it were me, assuming a negative mpMRI, I would want to talk about all this – infection, size, PSA and free PSA as possibly influenced by both, the negative MRI finding, and cancer – with the urologist before the biopsy.

However, a well-done biopsy, as likely is typical in your area, involves minimal risk, with effective measures for the very unlikely risk events that sometimes occur, and the biopsy can give good evidence about cancer. That’s an argument for just going ahead and getting more evidence. It would be wise to call the doctor’s office and confirm that at least twelve biopsy cores will be taken.

I am not a big fan of spending time in legal pursuit, but your primary doctor’s failure to follow up on that earlier PSA looks negligent to me. You might want to raise that with the medical board, or go further if you turn out to have an aggressive, dangerous case of prostate cancer. However, based on the evidence so far, it appears your case will likely not be “high risk” if indeed it does turn out to be cancer.

If you are diagnosed with “low-risk prostate cancer” (a very well understood term), be sure you learn about “active surveillance” as the likely best way to deal with such cancer.

I am a regular Sunday School and church attendee. Like many of us, I am still puzzled about the role of prayer in the world, but I am absolutely convinced that some of my critical prayers have been answered; I had a sense of divine presence, and my life changed. I believe prayer helped me deal with prostate cancer, and perhaps there was miraculous intervention for me. You have my prayer. :angel:

Good luck in not joining our “club”! :wave:

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