Not my PSA, my blood draw is next week. This is about my son. I've mentioned him before.
Because of the fact that both me and my dad had Prostate Cancer, my son began testing at around age 37. He is now 41. I dont have exact dates, but i know i am pretty close, here is his PSA history....
January 2018 - .7
January 2019 - 1.0 (I think, not 100% sure, this was a different lab, but it made me nervous)
June 2019 - .88
January 2020 - .7
And now May 2021 - .86
He is being tested by a urologist, not his PCP, and he had a DRE that was perfectly normal last week.
I'm assuming the DRE was done after the blood draw, not before, but it just occured to me as i write this, that i should ask him. Also he said the 1.0 might have been the day after sex because back then he didnt know he shouldve abstained for a couple days. But not sure of that.
So i think i am ok with this, he seems a bit concerned, thinking that .7 to .86 is a big jump. He asked the nurse about it, she just responded "the doctor signed off on the results so it shoujld be ok.
My feeling is that its not a big jump considering the tests were 16 months apart. But i told him that if hes concerned he should call the Urologist and ask to be retested in 6 months, rather than 1 year. I also wonder, is this level a little high for his age, 41? I know the good news is it seems to be stable.
I'd like to ask opinions of the group. Am i giving him the right advice? Is this nothing to be concerned about, or is it something that needs to be watched more carefully?
I am not a doctor, just a guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru November 2018 – T = 4, PSA = <.05
Decipher test, low risk, .37 score
My story.... https:// tinyurl.com/qgyu3xq
I have two 37 year old sons and have explained the basics to them as a result of my journey and their grandfather’s. Have done the same for my brother. I will revisit the topic when my sons are 40. My brother is 60 and seems to get checked often enough for various maladies.
No reason to scare the bejesus out of them prematurely. I found trying to tell my son’s to eat healthy, reduce alcohol and cigars, and otherwise live like they are in pandemic all the time falls on deaf ears. I wait for the opportunities then preach for the few minutes I get until the eyes glaze over. Then have a beer with them.
I feel good that they wear seat belts and don’t do drugs. A PSA under 2 is probably meaningless at the younger ages, especially if it is variable.
7/2018-66yr, PSA 4.1->5.1
8/2018-MRI PI-RADS 5, MRI guided biopsy, 8/14 cores, G7(4+3)
9/2018-CT/Bone scans clear
11/6/18-RALP Surgery
11/2018-Post-Op Path G7(4+3)5% Tert Gr 5, pT3a pN0 Gr 3
Marg(SM+), EPE, <3mm, L=0.1mm?
11/2018-Decipher 0.47, Ave Risk
1/2019-Epstein-G9(4+5) Gr5, pT2x, margin vs. incision not clear
4-6/2019 ART 37 day
PSA<0.10: 2/19, 5/19, 8/19, 11/19, 2/20, 6/20, 9/20, 3/21
No reason to scare the bejesus out of them prematurely. I found trying to tell my son’s to eat healthy, reduce alcohol and cigars, and otherwise live like they are in pandemic all the time falls on deaf ears. I wait for the opportunities then preach for the few minutes I get until the eyes glaze over. Then have a beer with them.
I feel good that they wear seat belts and don’t do drugs. A PSA under 2 is probably meaningless at the younger ages, especially if it is variable.
7/2018-66yr, PSA 4.1->5.1
8/2018-MRI PI-RADS 5, MRI guided biopsy, 8/14 cores, G7(4+3)
9/2018-CT/Bone scans clear
11/6/18-RALP Surgery
11/2018-Post-Op Path G7(4+3)5% Tert Gr 5, pT3a pN0 Gr 3
Marg(SM+), EPE, <3mm, L=0.1mm?
11/2018-Decipher 0.47, Ave Risk
1/2019-Epstein-G9(4+5) Gr5, pT2x, margin vs. incision not clear
4-6/2019 ART 37 day
PSA<0.10: 2/19, 5/19, 8/19, 11/19, 2/20, 6/20, 9/20, 3/21
As you know, I'm not an expert on PSA trends. But the differences strike me as a pretty ordinary fluctuation over time. If you were to map this in Excel, I'd guess that that any trend line would be barely up. And keep in mind how many things affect PSA that have nothing to do with PCa.
That said, this is certainly worth keeping a close on eye on this.
Age 60, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and ADT (Casodex, Lupron and Zytiga)
Completed ADT (18 months) in April 2014
9/20: PSA = 0.03
That said, this is certainly worth keeping a close on eye on this.
Age 60, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and ADT (Casodex, Lupron and Zytiga)
Completed ADT (18 months) in April 2014
9/20: PSA = 0.03
Personally, I do not see anything alarming. But if his PSA rises to a level of concern (say 1.5 to 2?), I would consider adding free PSA to the annual testing. JMHO.
Ken, this sure looks like normal fluctuations. He's 41, and his PSA is floating around in the <1 range, and he has a prostate that is completely functional. Sure, keep checking it....I started annual PSAs at 40 for similar reasons, and I don't even know what the values were until they went above 1--at 54.
Doubling time, with an intact and functional prostate, is meaningless at PSA below 1.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA Non-Detect since April, 2015
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024
Doubling time, with an intact and functional prostate, is meaningless at PSA below 1.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA Non-Detect since April, 2015
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024
Fluctuating levels all below one...he is fine. He should just keep doing annual testing and not worry in between.
Jim
Forum Moderator-Prostate Cancer. Age 62 (74 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-12 yr: <1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1
Jim
Forum Moderator-Prostate Cancer. Age 62 (74 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-12 yr: <1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1
Our son started testing when he was 28 he's 32 now. Testing has fluctuated from as low as .63 to .83 and back down again. Started testing super early so we'd have a really good baseline.
Wife posting for spouse - 50, age at dx 48
06/2016: PSA 6.48
07/2016: PSA 7.22 FPSA 10% 12 Core Biopsy Negative
10/2016: PSA 6.30 FPSA 13%
12/2016: MRI W/COIL PI-RADS 5 with Probable EPE, Bones/LN Clear
12/2016: Biopsy Two cores 3+4 and Seven cores 3+3
02/2017: RP Pathology 3+4 Grade 4 component is 5%
Prostate: 32.7 gm Tumor Volume Estimate: 35%
No EPE or lymphovascular invasion 13 lymph nodes, Seminal vesicles, vasa deferentia, no tumor present
High grade prostatic intraepithelial neoplasia, Perineural Invasion: Present
Tumor involves proximal basilar margin of 2.0 mm Gleason at margin is 3 pT2c,N0,MX,R1
04/2017: 6 Week PSA <0.01
05/2017: 3 Month uPSA <0.006
8/2017: 6 Month uPSA <0.006
11/2017: 9 Month uPSA 0.014 12/2017: Re-test 0.012
2/2018: 12 Month uPSA 0.006
5/2018: 15 Month uPSA 0.014
8/2018: 18 Month uPSA 0.013
11/2018: 21 Month uPSA 0.018 12/2018 Re-test 0.021
SRT: Started 1/2019
Decipher 0.75
100% Dry
Wife posting for spouse - 50, age at dx 48
06/2016: PSA 6.48
07/2016: PSA 7.22 FPSA 10% 12 Core Biopsy Negative
10/2016: PSA 6.30 FPSA 13%
12/2016: MRI W/COIL PI-RADS 5 with Probable EPE, Bones/LN Clear
12/2016: Biopsy Two cores 3+4 and Seven cores 3+3
02/2017: RP Pathology 3+4 Grade 4 component is 5%
Prostate: 32.7 gm Tumor Volume Estimate: 35%
No EPE or lymphovascular invasion 13 lymph nodes, Seminal vesicles, vasa deferentia, no tumor present
High grade prostatic intraepithelial neoplasia, Perineural Invasion: Present
Tumor involves proximal basilar margin of 2.0 mm Gleason at margin is 3 pT2c,N0,MX,R1
04/2017: 6 Week PSA <0.01
05/2017: 3 Month uPSA <0.006
8/2017: 6 Month uPSA <0.006
11/2017: 9 Month uPSA 0.014 12/2017: Re-test 0.012
2/2018: 12 Month uPSA 0.006
5/2018: 15 Month uPSA 0.014
8/2018: 18 Month uPSA 0.013
11/2018: 21 Month uPSA 0.018 12/2018 Re-test 0.021
SRT: Started 1/2019
Decipher 0.75
100% Dry
Thanks all, very helpful responses, confirmed y thoughts. It’s hard to be objective when it’s your son (and even harder when you are a worrier), so I needed this feedback
I am not a doctor, just a guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru November 2018 – T = 4, PSA = <.05
Decipher test, low risk, .37 score
My story.... https:// tinyurl.com/qgyu3xq
I am not a doctor, just a guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru November 2018 – T = 4, PSA = <.05
Decipher test, low risk, .37 score
My story.... https:// tinyurl.com/qgyu3xq
You're a great advocate for your son, Pratoman --- certainly wise for fellows to get a rapport built with a trusted doctor, and maintain that bond, as far as yearly physicals, and so forth.
Great that he has a baseline already built, in terms of P.S.A. --- it's something to be tracked, as years go by, for every fellow.
There are fellows walking down the street --- right now --- who currently have prostate cancer --- and that simple lab test could lead them to valuable treatment.
There have been times I have been at a staff meeting --- or a large social event --- or a restaurant --- or a grocery store -- or a sports event --- and I have had this thought running silently through my mind:
"SOMEONE in this group --- some unsuspecting fellow --- has prostate cancer --- right this very moment --- and they don't even know it today!"
We must all find ways to quietly the beat the drum --- with our neighbors, colleagues, friends, comrades, and brothers --- and advocate the importance of men's health.
Thanks for being a health advocate --- a steadfast messenger --- and trusted compadre --- for all fellows !
A good day ahead,
CYCLONE ~~~ # Iowa State University
Post Edited (Cyclone-ISU) : 5/6/2021 2:29:45 PM (GMT-6)
Thank you Cyclone. And well said. In this case, its my son, but i think we all need to talk to friends and others any chance we get about being vigilant.
I hope my sons baseline stays where it is for many years, but i know he needs to be vigilant.
I am not a doctor, just a guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru November 2018 – T = 4, PSA = <.05
Decipher test, low risk, .37 score
My story.... https:// tinyurl.com/qgyu3xq
I hope my sons baseline stays where it is for many years, but i know he needs to be vigilant.
I am not a doctor, just a guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru November 2018 – T = 4, PSA = <.05
Decipher test, low risk, .37 score
My story.... https:// tinyurl.com/qgyu3xq
Pratoman said...
I hope my sons baseline stays where it is for many years, but i know he needs to be vigilant.
That's right, Ken -- he needs to be vigilant, not you. You've done your part. And it sure sounds like he's being vigilant, so you did a good job. Now move on.
--Richard.
My PCP started testing my blood on a semi-annual basis in my early 40's due to cholesterol meds. Unknown to me, he was also testing my PSA, (obviously before any pressure not to do so). I specifically remember asking him what PSA was and what a 2.2 meant. He said all is good, nothing to worry about. Over the next ten years I saw my PSA slowly rise into the 3's until he advised action. I was about 54 maybe.
I'm fortunate for having a PCP that was monitoring something without my request or knowledge. I'd advise any man in his 40's to start requesting PSA tests, on an annual basis. But any young man in his 40's shouldn't unnecessarily worry until his PSA is into the high 2's or the 3's.
I'm fortunate for having a PCP that was monitoring something without my request or knowledge. I'd advise any man in his 40's to start requesting PSA tests, on an annual basis. But any young man in his 40's shouldn't unnecessarily worry until his PSA is into the high 2's or the 3's.
JFL, I was also fortunate with my PCP--at my Dad's suggestion, I asked for it starting (I think) at 40 or 45, along with a DRE annually. He was kind of like, "That's not really recommended at your age, but given your history I understand, and it's no biggie."
And, when it hit 3.2, at age 56, he said, "You need to make an appointment with Dr. N____, we will send your records over to him." This was a small town, with one urology practice. I did so, and here we are today.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA Non-Detect since April, 2015
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024
And, when it hit 3.2, at age 56, he said, "You need to make an appointment with Dr. N____, we will send your records over to him." This was a small town, with one urology practice. I did so, and here we are today.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA Non-Detect since April, 2015
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024
Saipan Paradise said...
Pratoman said...
I hope my sons baseline stays where it is for many years, but i know he needs to be vigilant.
That's right, Ken -- he needs to be vigilant, not you. You've done your part. And it sure sounds like he's being vigilant, so you did a good job. Now move on.
--Richard.
Rich, what I need to instill in him still, is not to just take “the dr signed off on it so it must be ok” IF he’s not sure or not comfortable with it. We’ve seen that approach end badly here countless times.
I am not a doctor, just a guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru November 2018 – T = 4, PSA = <.05
Decipher test, low risk, .37 score
My story.... https:// tinyurl.com/qgyu3xq
nice try...Saipan...Sigh.....oh well we all have our neuroses....they keep us...well...vigilant??
gleason 9 contained stopped psa testing jan 2015 with two consecutive psa's a year apart at 0.15
surgery 10/09 only treatment...eyes wide open...no sand...gonna live til I die...not the reverse forgive my virtues as well as my sins...age 77
gleason 9 contained stopped psa testing jan 2015 with two consecutive psa's a year apart at 0.15
surgery 10/09 only treatment...eyes wide open...no sand...gonna live til I die...not the reverse forgive my virtues as well as my sins...age 77
Pratoman said...
Rich, what I need to instill in him still, is not to just take “the dr signed off on it so it must be ok” IF he’s not sure or not comfortable with it. We’ve seen that approach end badly here countless times.
Rich is correct....your son is a grown man, and as such he, like the rest of us, follows his own path. IMHO, you shouldn't be driven to instill your very detailed, and biased, approach into him. Many millions of men do just fine with the "what-me-worry" outlook.
Let it go, my friend.
Prato my main man,
I do not agree with garyi. But much respect to my brother gary to the i.....Disney's "Frozen" songs are not creed. Ignorance is not really bliss.
I would have loved to have my relatives worry about me and urge me to get tested, because I took it upon myself and ignored and not worry, and it cost me dearly.
Nothing wrong with being "overprotective" or "worrisome" or even anal in this case IMHO.
Even as I say that,.... with those results...I will flippantly say "Don't worry, be happy",!!! Okuna Matata... Now THAT song IS creed! Seems like normal values for a young man.
Winging it in So Cal
I do not agree with garyi. But much respect to my brother gary to the i.....Disney's "Frozen" songs are not creed. Ignorance is not really bliss.
I would have loved to have my relatives worry about me and urge me to get tested, because I took it upon myself and ignored and not worry, and it cost me dearly.
Nothing wrong with being "overprotective" or "worrisome" or even anal in this case IMHO.
Even as I say that,.... with those results...I will flippantly say "Don't worry, be happy",!!! Okuna Matata... Now THAT song IS creed! Seems like normal values for a young man.
Winging it in So Cal
Thanks Wings, I appreciate the comment.
To a parent, a child will always be a child. My son is a tough dude, and he doesn’t let me baby him. But on this subject, he knows how much I know, and he actually looks to me for guidance.
At this point I’m very comfortable with his numbers, and he knows to be vigilant and make sure he retests in a year. So I think I’ve done my job.
I am not a doctor, just a guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru May 2021 –PSA = <.05
Decipher test, low risk, .37 score
My story.... https:// www.healingwell.com/community/default.aspx?f=35&m=3297053
To a parent, a child will always be a child. My son is a tough dude, and he doesn’t let me baby him. But on this subject, he knows how much I know, and he actually looks to me for guidance.
At this point I’m very comfortable with his numbers, and he knows to be vigilant and make sure he retests in a year. So I think I’ve done my job.
I am not a doctor, just a guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru May 2021 –PSA = <.05
Decipher test, low risk, .37 score
My story.... https:// www.healingwell.com/community/default.aspx?f=35&m=3297053
As a non expert i would agree with others that the change is not a big deal just got to look at longbterm trendline. Also might look at prostate size and get psa density but that may be overkill
Also another note when i got my g6 dx with AS tx whrer they wanted to monitor psa change i decided to get checked every month for 8month had to psy out of pocket used this info to understand variability and decided for me a change of 0.5 is noise level. Many say i am crazy(maybe i am for other reasons) but as an analytical chemist it makes sense and more important gives me a number based on data to be concerned about not just something the doc says so
Get tested now every mo per AS protocol and track on spreadsheet
So much for my 2cents for whatever its worth
Age 67, 67 at DX, born 1951
PSA-2/18-4.3,8/18-3.5,9/18-3.7,12/18-3.3,6/19-3.1,9/19-3.5,1/20-3.2,3/20-3.3,5/20-4.2,6/20
biopsy 1/12, G(3+3)6,5%/0.5mm, Apex
MRI(6/18) pirads2,no dom lesion
MRI((1/20) pirads 2 no donin lesion,heterogeneous perif zone
oncotype GPS-31/very low risk/advers path 16%/Higrade disease-10%/non organ confine desease 8%/ Met(10yr)-1%
TX-AS,3 month PSA, annual biopsy/MRI
Also another note when i got my g6 dx with AS tx whrer they wanted to monitor psa change i decided to get checked every month for 8month had to psy out of pocket used this info to understand variability and decided for me a change of 0.5 is noise level. Many say i am crazy(maybe i am for other reasons) but as an analytical chemist it makes sense and more important gives me a number based on data to be concerned about not just something the doc says so
Get tested now every mo per AS protocol and track on spreadsheet
So much for my 2cents for whatever its worth
Age 67, 67 at DX, born 1951
PSA-2/18-4.3,8/18-3.5,9/18-3.7,12/18-3.3,6/19-3.1,9/19-3.5,1/20-3.2,3/20-3.3,5/20-4.2,6/20
biopsy 1/12, G(3+3)6,5%/0.5mm, Apex
MRI(6/18) pirads2,no dom lesion
MRI((1/20) pirads 2 no donin lesion,heterogeneous perif zone
oncotype GPS-31/very low risk/advers path 16%/Higrade disease-10%/non organ confine desease 8%/ Met(10yr)-1%
TX-AS,3 month PSA, annual biopsy/MRI