I found you guys by accident and the advice has been very rational and calming. I am 57, and went to the MD in July for an unrelated issue. They were "selling" various tests and I asked for a PSA. I told them my Dad had an advanced PC case found by accident @67 which he has been battling for 20 years. He had proton beam. My results came back at 3.0 I got a letter saying it was a bit high and come back in one year. Around December starting having BPH type symptions - slower stream mostly off and on. I drink 2 pots of weak black tea- read the Scottish study :( switched to weak coffee. A co worker, tea guy also, died of PC recently. Anyhow went back in early Feb for another PSA- 4.51. My MD called and they said get in quickly to the Urologist. DRE was negative, she said that was reassuring but was otherwise totally deadpan. She said you need a 12 core biopsy in a month which has given me ample time to read journal articles. I am at a loss for what to expect. I have had a bit of mild bilateral hip pain for two years which resolves with stretching before a walk.
7/15 PSA 3.0
12/15 BPH symptoms
2/15 PSA 4.51, negative DRE
3/15 12 core biopsy scheduled
Welcome to HW,
PSA isn't a test for cancer. Just tests prostate activity. Many things can rise PSA, infection, BPH (enlarged prostate), sex before the test, bike riding, shifts in the tide and bad days at the lab. Your PSA while not good, isn't alarmingly high. That much of a rise in a year is notable. Generally you don't do a biopsy until you rule out all other factors.
PC at this PSA normally doesn't have symptoms. Having BPH could explain both your symptoms and PSA level and in my thinking the more likely problem you have. Your hip pain is more likely due to being 57. Bone pain due to PC would be constant and would not resolved with stretching.
But, I am not a doctor, just some random guy on the internet.
As for the biopsy - well it's annoying, uncomfortable and undignified but not painful. You will feel a bit of a punch when they take the sample and of course will have a probe up your back side. Post biopsy you'll have some discomfort, bleeding and blood in your urine and seamen for awhile. It can take a week or two to get the pathology report back.
Hang in there and keep us updated on your progress.
I'll be in the shop.
Age 56, 52 at DX
PSA 4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13, .7 5/14, .5 10/14, .5 4/15, .3 10/15
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post
PSA isn't a test for cancer. Just tests prostate activity. Many things can rise PSA, infection, BPH (enlarged prostate), sex before the test, bike riding, shifts in the tide and bad days at the lab. Your PSA while not good, isn't alarmingly high. That much of a rise in a year is notable. Generally you don't do a biopsy until you rule out all other factors.
PC at this PSA normally doesn't have symptoms. Having BPH could explain both your symptoms and PSA level and in my thinking the more likely problem you have. Your hip pain is more likely due to being 57. Bone pain due to PC would be constant and would not resolved with stretching.
But, I am not a doctor, just some random guy on the internet.
As for the biopsy - well it's annoying, uncomfortable and undignified but not painful. You will feel a bit of a punch when they take the sample and of course will have a probe up your back side. Post biopsy you'll have some discomfort, bleeding and blood in your urine and seamen for awhile. It can take a week or two to get the pathology report back.
Hang in there and keep us updated on your progress.
I'll be in the shop.
Age 56, 52 at DX
PSA 4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13, .7 5/14, .5 10/14, .5 4/15, .3 10/15
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post
Norsk, the biopsy isn't that bad. They'll probably give you some Cipro to take the night before and the morning of, and will have you do an enema to clean things out. The day of, they'll give you another shot of antibiotic in the butt, then you'll have the biopsy. It's unpleasant...they stick an ultrasound probe up your butt to image things, then they take a needle gun and take the samples.
You'll bleed a little from your butt, you'll pass some clots and blood in your urine for a while, and your semen will be reddish/black for a month or so. That's about it. Do what they tell you to do to keep things clean, and you'll be fine. Usually the results take about a week.
When you get them, let us know and we'll help interpret them.
Age at Diagnosis: 56
Biopsy: 3 of 12, G3+3, all on LT side, 20%, 5%, 3%
Clinical Stage T2C
Bone Scan, CT scan negative for spread
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024
You'll bleed a little from your butt, you'll pass some clots and blood in your urine for a while, and your semen will be reddish/black for a month or so. That's about it. Do what they tell you to do to keep things clean, and you'll be fine. Usually the results take about a week.
When you get them, let us know and we'll help interpret them.
Age at Diagnosis: 56
Biopsy: 3 of 12, G3+3, all on LT side, 20%, 5%, 3%
Clinical Stage T2C
Bone Scan, CT scan negative for spread
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024
Norsk,
There are several things you should do before a biopsy. A biopsy should be the last resort, not the first tool in the box. There are 1,000,000 biopsies done annually and 750,000 are negative,
A short course of antibiotics to eliminate psa caused by prostitis.
Ask your doctor about PHI or prostate health index test. Also ask the doctor to estimate the size of your prostate by DRE, if you multiply the estimated size by .1 it should give your normal expected psa. A 4.1 psa would equate to a 41cc prostate, which is normal for one who has BPH, a normal prostate is around 25 cc.
70 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 6 years of psa's all at <0.1.
There are several things you should do before a biopsy. A biopsy should be the last resort, not the first tool in the box. There are 1,000,000 biopsies done annually and 750,000 are negative,
A short course of antibiotics to eliminate psa caused by prostitis.
Ask your doctor about PHI or prostate health index test. Also ask the doctor to estimate the size of your prostate by DRE, if you multiply the estimated size by .1 it should give your normal expected psa. A 4.1 psa would equate to a 41cc prostate, which is normal for one who has BPH, a normal prostate is around 25 cc.
70 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 6 years of psa's all at <0.1.
Thanks everybody. This was helpful.
Went for the ultrasound guided biopsy today. Not bad. Friendly folks. She said mine was 43cc, so "matched the model perfectly" and was smiling. She saw nothing interesting on her new hi def screen. Nobody is saying anything yet but the body language was encouraging. Results in a week.
Went for the ultrasound guided biopsy today. Not bad. Friendly folks. She said mine was 43cc, so "matched the model perfectly" and was smiling. She saw nothing interesting on her new hi def screen. Nobody is saying anything yet but the body language was encouraging. Results in a week.
Post Edited (Norsk11) : 3/17/2016 5:36:50 AM (GMT-6)
Norske,
Best wishes foe a no PCa outcome. Keep us posted.
Beth n Gary
Best wishes foe a no PCa outcome. Keep us posted.
Beth n Gary
Got the biopsy results- all normal. She wants me back in 6 months for another PSA. She says they are getting a new MRI device of some kind. If my PSA stays steady I am likely OK if it goes up they have to keep hunting.
7/15 PSA 3.0
12/15 BPH symptoms
2/15 PSA 4.51, negative DRE
3/15 12 core biopsy - negative, 43 cc
7/15 PSA 3.0
12/15 BPH symptoms
2/15 PSA 4.51, negative DRE
3/15 12 core biopsy - negative, 43 cc
Harrah! 
After smiling at the slogan out here that a falling PSA (esp. ~4) is usually not cancer away I went. The annual biometric exercise at work led me back to the lab for cholesterol tests so added in a PSA. It was 4.1. Moments after reading the results online the Urologist's office called. They said I needed a MRI prostate scan- they have a shiny new piece of equipment. The last time they got excited about "PSA velocity" this time it was a "slow steady PSA rise" - sigh. Is PCa in my future- yep. Is this the day- I think not- my numbers match an enlarged prostate /BPH case nicely. I think I would not be happy with another needle biopsy but this new kind seems expensive but not dangerous.
7/15 PSA 3.0
12/15 BPH symptoms
2/16 PSA 4.51, negative DRE
3/16 12 core biopsy - negative, ultrasound clear, 43 cc
5/16 PSA 2.99
9/16 PSA 3.2, Negative DRE
9/17 PSA 4.1 BPH symptoms
7/15 PSA 3.0
12/15 BPH symptoms
2/16 PSA 4.51, negative DRE
3/16 12 core biopsy - negative, ultrasound clear, 43 cc
5/16 PSA 2.99
9/16 PSA 3.2, Negative DRE
9/17 PSA 4.1 BPH symptoms
Post Edited (Norsk11) : 9/19/2017 5:03:56 AM (GMT-6)
My PSA went up and down for 4 or 5 years. never over 6. then started to rise this year. My URO is at the city of hope, one of the best on the west coast. The MRI pinpoints the spots that look like cancer. After the results are in, I was scheduled for a 12 point biopsy. The device up my rectum was guided by a computer that was reading the MRI results. It pin pointed where to take the sample. Then the URO pulls the trigger. Really hi tech. nun of this showed the cancer growing outside my prostate. I opted for robotic RP. URO took a lot more than I planned on as he was skilled enough to see the cancer growing out. he took most everything. I was really bummed till I read the pathology report.
Norsk-
If you don't want to commit to an mpMRI/US fusion biopsy yet, you can get a Prostate Health Index (PHI) blood test and a PCA3 urine test. Both should be covered by insurance after a first negative biopsy. They are somewhat more prognostic than just a PSA test.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog
If you don't want to commit to an mpMRI/US fusion biopsy yet, you can get a Prostate Health Index (PHI) blood test and a PCA3 urine test. Both should be covered by insurance after a first negative biopsy. They are somewhat more prognostic than just a PSA test.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog
It was a Three Tesla brand new mpMRI machine. It took an hour, there was no prep (no food for four hours) and nothing inserted. This will cost quite a bit but seems safer and easier than a needle biopsy for routine screening. They are hedging a little below- how solid is this report?
FINDINGS:
PERIPHERAL ZONE: There is diffuse T2 hypointensity throughout the
peripheral zone, with only mild indistinct restricted diffusion and diffuse
enhancement. There are no focal lesions.
TRANSITIONAL ZONE: Typical BPH changes. No suspicious foci.
No extracapsular extension or neurovascular bundle involvement.
No seminal vesicle invasion.
No pelvic lymphadenopathy.
No lesions in the visualized bones.
PROSTATE GLAND VOLUME: 44 cc
CONCLUSION:
1. Diffuse abnormality throughout the peripheral zone may represent
prostatitis, and is assigned PI-RADS CATEGORY 2: Low. Clinically
significant cancer is unlikely to be present.
FINDINGS:
PERIPHERAL ZONE: There is diffuse T2 hypointensity throughout the
peripheral zone, with only mild indistinct restricted diffusion and diffuse
enhancement. There are no focal lesions.
TRANSITIONAL ZONE: Typical BPH changes. No suspicious foci.
No extracapsular extension or neurovascular bundle involvement.
No seminal vesicle invasion.
No pelvic lymphadenopathy.
No lesions in the visualized bones.
PROSTATE GLAND VOLUME: 44 cc
CONCLUSION:
1. Diffuse abnormality throughout the peripheral zone may represent
prostatitis, and is assigned PI-RADS CATEGORY 2: Low. Clinically
significant cancer is unlikely to be present.
Post Edited (Norsk11) : 9/27/2017 6:48:24 AM (GMT-6)
Veldig bra. Utmerket.
Keep in mind that mpMRI is not a substitute for biopsy. As previously mentioned, it can identify areas that look suspicious that can then be targeted for fusion biopsy. It is not infallible, however, especially with respect to low grade PCa. In my case, while there were PIRADS 2 and 3 areas identified, they were not the areas of my prostate that ultimately had G6 lesions on biopsy. Given that your PSA didn't rise and your prior biopsy was negative, I think that your MRI just reinforces the conclusion that there is nothing to get excited about currently.
Age 64 - PSA 2/05 - 3.31, 5/06 - 3.02, 9/07 - 3.42, 2/10 - 6.67, 9/11 - 7.07, 2/13 - 8.28, 9/15 7.87, 11/16 - 13.1;
2 BX both negative, third BX (fusion) 2/17 - 2 of 21 cores Gleason 3+3 (6) (40% Right Base and 5% Right Lateral Base), no PNI, High Grade PIN (Focal) in 3 locations;
MP MRI 12/14 2 lesions PI-RADS 3 - 67 grams, 12/16 3 lesions PI-RADS 2 & one lesion PI-RADS 3 - 72 grams.
Age 64 - PSA 2/05 - 3.31, 5/06 - 3.02, 9/07 - 3.42, 2/10 - 6.67, 9/11 - 7.07, 2/13 - 8.28, 9/15 7.87, 11/16 - 13.1;
2 BX both negative, third BX (fusion) 2/17 - 2 of 21 cores Gleason 3+3 (6) (40% Right Base and 5% Right Lateral Base), no PNI, High Grade PIN (Focal) in 3 locations;
MP MRI 12/14 2 lesions PI-RADS 3 - 67 grams, 12/16 3 lesions PI-RADS 2 & one lesion PI-RADS 3 - 72 grams.
Pohaku53 highlights an important point...I probably assumed you understood your mpMRI results already, but whether you do or not, it probably is worth repeating/highlighting because there will undoubtedly be others who stumble across this thread in the future who might misinterpret. He's a more complete answer...
Hey, at age 58 (?right), you probably do* have some prostate cancer...despite the negative biopsy you had last year (2016). Your mpMRI is specifically intended to look only for possible areas of high-grade prostate cancer—the type that might actually warrant an aggressive treatment. Having low-grade PC is not really very newsworthy. The wonderful news from your report was in the last sentence: "Clinically significant cancer is unlikely to be present." You've taken a valuable step forward in helping to separate the (likely) clinically insignificant PC (which you probably have, even though your random biopsy was negative) from the likelihood of any clinically significant PC (which would otherwise prompt likely treatment).
Hope that helps!
There's an "old saying" from the PC world that comes to mind: the harder one looks for PC, the more likely one is to find it. Of course, that is a direct outcome of the autopsy study combined with today's more advanced imaging techniques which can find smaller-and-smaller, and less-and-less-significant minuscule amounts of PC...the type which used to be ignored to no determent. Your next steps? If I were you, I'd ask about treatments for your BPH. And if you prefer tea over coffee, go back to the tea. Lastly, stretch before you go for long walks; you aren't as young as you used to be.
Hey, at age 58 (?right), you probably do* have some prostate cancer...despite the negative biopsy you had last year (2016). Your mpMRI is specifically intended to look only for possible areas of high-grade prostate cancer—the type that might actually warrant an aggressive treatment. Having low-grade PC is not really very newsworthy. The wonderful news from your report was in the last sentence: "Clinically significant cancer is unlikely to be present." You've taken a valuable step forward in helping to separate the (likely) clinically insignificant PC (which you probably have, even though your random biopsy was negative) from the likelihood of any clinically significant PC (which would otherwise prompt likely treatment).
Hope that helps!
- This is based on multiple autopsy studies of men of all ages who died accidental deaths. Starting at about age 40, the percent likelihood of men having at least some "detectable" amount of PC was roughly equal to their age. So by the time a man hits 50, he's about 50% likely to have detectable PC. At age 70, the likelihood is 70%. The important take-away from this study is the clear understanding that just having PC doesn't mean that treatment is needed. The counterparts who didn't die of accidents, who probably are walking around with PC at the same percentages, mostly will never know they have it and it will never affect them in their lives...because PC is most frequently indolent.
There's an "old saying" from the PC world that comes to mind: the harder one looks for PC, the more likely one is to find it. Of course, that is a direct outcome of the autopsy study combined with today's more advanced imaging techniques which can find smaller-and-smaller, and less-and-less-significant minuscule amounts of PC...the type which used to be ignored to no determent. Your next steps? If I were you, I'd ask about treatments for your BPH. And if you prefer tea over coffee, go back to the tea. Lastly, stretch before you go for long walks; you aren't as young as you used to be.
Post Edited (NKinney) : 9/27/2017 11:18:02 AM (GMT-6)
Norsk-
mpMRI reports are highly dependent on the experience of the radiologist who read it. PIRADS 2 is an excellent finding, if it is true.
You are now understanding, I think, why an mpMRI is not recommended before a first biopsy. You (or your insurance) wasted a lot of money to put you in the same situation you were in if you had never had an mpMRI. It is not accurate enough that you can rule out high grade prostate. And, because you don't know if you have low grade prostate cancer, you can't go on an active surveillance program. Because you do not have an adequate explanation for your elevated PSA, you may still need a TRUS biopsy - back to square one!
It's true that if PIRADS 4 or 5 were identified, you could have included additional cores from that area, but now you have no clue as to were to look.
I still recommend you use those biochemical tests first before having a biopsy.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog
mpMRI reports are highly dependent on the experience of the radiologist who read it. PIRADS 2 is an excellent finding, if it is true.
You are now understanding, I think, why an mpMRI is not recommended before a first biopsy. You (or your insurance) wasted a lot of money to put you in the same situation you were in if you had never had an mpMRI. It is not accurate enough that you can rule out high grade prostate. And, because you don't know if you have low grade prostate cancer, you can't go on an active surveillance program. Because you do not have an adequate explanation for your elevated PSA, you may still need a TRUS biopsy - back to square one!
It's true that if PIRADS 4 or 5 were identified, you could have included additional cores from that area, but now you have no clue as to were to look.
I still recommend you use those biochemical tests first before having a biopsy.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog
Tall Allen said...
Norsk-
mpMRI reports are highly dependent on the experience of the radiologist who read it. PIRADS 2 is an excellent finding, if it is true.
Norsk-
mpMRI reports are highly dependent on the experience of the radiologist who read it. PIRADS 2 is an excellent finding, if it is true.
This is an underappreciated point. Reading prostate MRIs is difficult and takes additional training and experience. As with other skill dependent services (like surgery and radiation oncology), it is worth inquiring about the qualifications of the radiologist reading the scan. Ideally you would want a radiologist that subspecializes in body reads (as opposed to a generalist or a musculoskeletal or neuro subspecialist), who has had additional training, and who reads a substantial number of scans on a regular basis. Most mpMRIs are performed on 3T machines, although a 1.5T machine can be used with the right coil. Endorectal coils which were once commonly used are now infrequently used, especially with 3T machines.
Age 64 - PSA 2/05 - 3.31, 5/06 - 3.02, 9/07 - 3.42, 2/10 - 6.67, 9/11 - 7.07, 2/13 - 8.28, 9/15 7.87, 11/16 - 13.1;
2 BX both negative, third BX (fusion) 2/17 - 2 of 21 cores Gleason 3+3 (6) (40% Right Base and 5% Right Lateral Base), no PNI, High Grade PIN (Focal) in 3 locations;
MP MRI 12/14 2 lesions PI-RADS 3 - 67 grams, 12/16 3 lesions PI-RADS 2 & one lesion PI-RADS 3 - 72 grams.
So I met with the Urologist today. He says based on the previous negative biopsy and bouncing PSA he was happy with the mpMRI result. He said he has never seen a PIRADS 1 score, and usually a 3 or greater was significant. The odds of a biopsy missing anything important he thought was 6-8%. He said PCa was "like a turtle" and if we find something in six months vs today it was no great loss as the treatments are good. He wants me back in six months. If the PSA is in the same range and not still rising we can go back on a yearly schedule "for 16 more years." I mentioned this forum and the PHI and PCA3 tests. He said he could not get those tests at his (huge) health system here but if I found a private lab he would order them. He said if you want to start a good debate - start talking about treatment options 
He did offer treatment if the BPH became annoying.
He did offer treatment if the BPH became annoying.
I just got another PSA result- 3.9. I am not feeling any panic and think yearly tests are better for the moment. This lowish PSA merry go round + BHP is annoying. If it pops up to 5 or 6- then I'm ready for a biopsy. We do need a better blood test. I will see the Urologist Monday. I did find a study that recent sexual activity can send the PSA result up .5 to a full point- a word to the wise.
7/15 PSA 3.0
12/15 BPH symptoms
2/16 PSA 4.51, negative DRE
3/16 12 core biopsy - negative, ultrasound clear, 43 cc
5/16 PSA 2.99
9/16 PSA 3.2
9/17 4.1 BPH symptoms, negative MpMRI
4/18 PSA 3.9
Wife: Stage 3 N2 BC
7/15 PSA 3.0
12/15 BPH symptoms
2/16 PSA 4.51, negative DRE
3/16 12 core biopsy - negative, ultrasound clear, 43 cc
5/16 PSA 2.99
9/16 PSA 3.2
9/17 4.1 BPH symptoms, negative MpMRI
4/18 PSA 3.9
Wife: Stage 3 N2 BC
Did you ever get the PHI or PCA3 tests? I should add another one - Confirm MDx - they do an analysis of your last biopsy cores. It confirms that a negative biopsy is truly negative with 90% accuracy.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog