The high PSA with a low gleason can be caused be a couple of things.
1. The tumor is a transition zone tumor which is usually contained but generates a high psa.
2. The cancer has spread outside the gland to the lymphnodes.
3. The tumor is large enough to generate high psa.
4. The psa is coming from an infection and not from the PC.
You should really try to find out what is causing the high PSA as it will affect the treatment option you choose. Your PSA puts you in an itermediate or high risk catagory.
An MRIS with a telsa 3 machine (most facilities use a Telsa 1.5 and should be avoided) should be able to see the tumor and it's
location. Using the size of the tumor and its
location a good oncologist should be able to determine how much psa the tumor is generating along with your normal prostate. If your PSA is higher and you don't have a transition zone tumor, then it is probably coming from outside the prostate. In this case a Combidex MRI can accurately eliminate or identify any lymph node involvement.
If you have a transition zone tumor it is important to know exactly where it is located as the uretha passes through the transition zone. This is a difficult surgery and should only be performed by a top surgeon because getting a clear margin without injuring the uretha is very difficult. Radiation may be a better option in this case.
Right now your urologist is only guessing at the staging and it's way too early to determine a treatment option. Once you have staged your PC then you can better determine what treatment is the best for you.
Because of your stats you need a good prostate oncologist that can think out of the box like a dectective to find out exactly why your psa is so high. I would not trust a urologist to have this skill level.
The PCRI web site has a list of prostate oncologists and a lot of information for the newly diagnosed.
Please keep us posted on your progress, best of luck.
64 years old.
I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.
In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.
I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.
A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.
Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,
I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.
The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.