BPH and prostate cancer screening

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A few months ago I had a liquid prostate screening cancer test which consisted of a vigorous massage of my prostate followed by me providing a urine sample. The idea of the test is to look for mRNA pieces in the urine that are indicators of certain forms of prostate cancer. There are several tests like this one but I cannot name it here.

The test came back positive and said I had > 94% chance of Gleason 7 or greater!!

I have severe BPH with a high PSA (27) though my PSA density is very good ( .08).

These liquid biopsies are designed to screen men for needle biopsies with normal prostates who have PSA value between 4 and 10. If their "score" from this test is high then they would be referred for biopsy, otherwise they would be spared that ordeal.

The scores are based on proprietary correlations from large databases that include not only the mRNA measured in their pee but also their PSA values. I believe there is no provision in these tests for men with BPH and hence elevated PSAs for reasons other than cancer.

A few weeks ago I underwent a grueling MRI to look for this cancer. Today I got the very good news that my very large prostate (300cc) is perfectly fine!! I can tell you that the past few months have been nerve-wracking.

Clearly my PSA of 26 threw their algorithm for a loop regardless of what the pee contained. So the warning here is to avoid these "liquid biopsies" if you have BPH unless there is published research that shows the algorithms they use are adjusted for men with BPH and cover your PSA range.

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  • Posted

    Very interesting. Along the same lines, 20 years ago I foolishly signed up for one of the very first calcium score heart scans. Long story short, the result suggest I was in the highest 1% percentile for a "widowmaker" heart attack within ten years. My own doc at the time was not happy that I took this test. My wife and I were frightened to the max, as you might suspect. It is now 20 years later and I do have cardiac stress testing done every other year -- doc's orders. But supposedly, I am nowhere closer to a heart attack now than I was at age 40. I am, btw, 72 years of age. (And I know. You can drop dead right after a perfect stress test. But you have to incorporate some kind of yardstick in all this...and that is mine. I have a job in retirement by choice: delivering auto parts. It requires me to lift 50 pound brake rotors an similar gear every day. My doc says it's a good thing at my age. So far, I enjoy it and can't imagine a sedentary daily routine.)

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  • Posted

    May I ask, why not just simply go and get the 3 TMRI in the first place? Hopefully using a Siemens Skyra machine and in that using a lap blanket body coil that just lays over your pelvic area. No rectal insertion. Very comfortable process.

    The key would however be to have a very good Interventional Radiologist who is only specializing in Prostate Cancer and BPH read the MRI. This particular IR does not have to do the MRI for you, he only needs to read it after you get it done and upload it to him. Do it in your city and then upload the CD and report you get to him.

    This is what I decided to do when my urologist wanted to do the random 12 needle biopsy on my prostate because of high PSA. I said NO and found a real specialist who is an IR and knows what he is doing with the prostate. He has a clinic dedicated to only mens prostates issues.

    If the PCa lesion had been in my MRI I would have then had a focal single needle biopsy by the same IR Doctor of the particular lesion. Very precise and focused. Not a random 12 needle horrible, unreliable, biopsy that the Urologists sell all the time.

    Luckily like you I did not need that. So I then had FLA (focal laser ablation) done for my BPH and life after nine years of suffering with BPH has been really good for the last two years. My requirement for the FLA procedure was to have NO sexual side effects with relieve from those horrible BPH symptoms. That is what I have gotten. FLA is very precise to 1mm and very focused and specific in tissue removal with "eye on" during the procedure. You have it done while in the MRI so the doctors sees what he is doing. Not just a random shot in the area and a hope that the right tissue was removed.

    My two year anniversary was this month!

    Good luck.

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    • Posted

      Thank you for your post here. Congratulations on your own FLA results. I actually followed the scenario you outlined and uploaded my MRI cd to a wonderful interventional radiologist named Dr. Karamanian in Houston. We had a great discussion on all matters prostate!

      I did the liquid biopsy test at the recommendation of my urologist during a routine annual exam. Since it was just a simple urine test and covered by insurance I went ahead with it not realizing it would send our lives into a tailspin for 3 months. An MRI is not the easiest thing in the world and was only considered appropriate following the cancer scare from the liquid biopsy results which turned out to be bogus. Take care.

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  • Posted

    Howard, are you sure an MRI would see the cancer? I read somewhere the cancer needs to be ~ 2mm before the MRI will see it.

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    • Posted

      You are correct but if there is a lesion less than 2mm is it clinically significant? That is, would it develop over our lifetime into any thing we need to worry about? That is the problem with blind TRUS needle biopsies. They almost always will show some isolated cancer cells in men over 70 but so what - does it need to be treated as it would likely 40 years to develop into a cancer.

      This is something Dr. Karamanian stresses often - that if the cancer is not clinically significant then it likely is not worth worrying about - just watch it over time to see if it develops. Most urologists on the other hand want to do radical cancer treatments at the first sign of a cancer cell which often causes more problems than it solves.

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  • Posted

    For anybody out there with high PSA readings , here is my story,

    2013 PSA 4.1 biopsy negative

    2015 PSA 8 + biopsy negative

    gradually increasing PSA (every 6 months)

    2016 PSA 21 MRI negative, prostate 80 grm, central lobe

    changed from Tamsulin to Alfuzosin

    2018 Dec PSA 12.7 MRI negative, prostate 81 grm central lobe

    now considering REZUM

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