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High PSA, uptake of PSMA marker and two negative biopsys
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Hi There
My prostate has been playing up since 2017. It started of with issues going to the bathroom – stinging and weak flow. My GP did a blood test and I think the PSA count back then was around 5 or 6. I was referred to a specialist and an MRI was carried out, along with a physical examination. The prostate was large but smooth and pliable. Since then I’ve several specialists, as a few just couldn’t answer my questions. One was asking me what I thought we should do! The count is currently 10. I personally make sure I get 6 monthly blood tests. The count has kind of gone something like this pattern since it was discovered: 5, 6, 8, 6, 7, 5, 8, 8, 9, 7, 8, 9, 10. I did change pathology lab half way through to the one where the test gives a higher count. That said, the trend is up. Not a massive hockey stick uptick, but a gradual increase over time. I had a PSMA test in 2022. This showed an uptake of marker locally in two spots within the prostate. Following this I had my first biopsy, which came back negative. I had my second biopsy three months ago and another MRI. This latest biopsy also came back negative. The MRI showed the prostate is almost double in size, which can in and of itself also lead to a higher PSA count. The most recent physical examination confirmed that one half of the prostate feels firmer, but both sides are still smooth – no lumps. What should I do? Is there anything I should be asking my specialist? Despite two negative biopsies, I’m well aware that the needle only needs to pass 1 or 2mm to the side of something nasty and it will show up as a negative tissue sample i.e. in the clear. If there was something in there, is there usually a noticeable uptick in PSA if it is on the way to metastasising? I did ask if we could just remove the gland but was told this isn’t possible without a positive tissue sample i.e. imagine if something happened and there was nothing dodgy found other than e**********. I don’t lose sleep over this, but just want to know if you feel there is anything else I should be doing or looking at. Any thoughts gratefully accepted.
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Comments (8)
Have you had a PET scan? No expert, but this type of scan makes anything that is potentially cancerous “glow”. Then the biopsy can be targered. I had a PET scan and it did “glow” in another area away from a known tumour site, however subsequent biopsy showed no cancer.
G’day mate
Have you seen your reports from the MRI’s and the Biopsies? If so:
Do they mention anything about Benign Prostatic Hyperplasia (BPH),
and/or Prostatitis/Acute Prostatitis/Bacterial Prostatitis?
In the reports I have received back from imaging/histological/pathological some have intimated that the abovementioned could be the case.
Were any PI-RADS scores attributed? Your description(s) sound like
PI-RADS 1 and 2 possibly 3.
My PSA has followed a similar trend, not exceeding 10.
What was your Gleason score? If you don’t mind me asking, and even
if you were given a PI-RADS score after your first biopsy?
I would be asking my urologist about my Prostate Volume/Density
values, and if they can determine the aforementioned non-cancerous
maladies.
But here’s the kicker…They can mimic Prostate cancer.
Secondly, I would ask for a targeted fusion biopsy.
In my case, as mentioned I had radiologists/pathologists suggesting
BPH, Prostatitis, and Prostatomegaly.
But this was not the case after my first biopsy (Gleason 3+3=6), which
isn’t supposed to be aggressive, they said it was low grade so I went
on Active Surveillance.
This year however things changed so I’m having a fusion biopsy
(systematic/targeted MRI guided biopsy) soon so I can finally begin
some therapies.
Incidentally, I have several, no numerous, PI-RADS 4 and 5 lesions
and my last PSA was 8.6 after a previous high of 9.1 four weeks
earlier…This disease does my head in LOL.
As others have suggested, I too would NOT ask to have a
radical prosatectomy at this stage.
Good Luck mate! I hope you find pleasant answers to your questions!
You wouldn’t want the prostate removed if you didn’t have to. It’s not a pretty life after removal, and there’s a lot to get over.
What age are you?
It would be good to have a signature panel so others can see where we are coming from in our PC journey. Thanks for posting
Not sure what happened with the formatting there ^. It should have said “imagine if something happened and there was nothing dodgy found other than e**********”. If it has any bearing, I am 60 years old.