PSA Velocity over 4 months since UTI

PIRADS 2 is a good result indicating  that carcinoma is unlikely. I however don't understand what 2/5 means. I suggest you look into that and and establish whether the reporting refers to PIRADS v1 or v2

Is there a family history with PCa?

I think David was maybe saying, he got a PIRAD 2 score out of a possible 5. The PIRAD score range is 1-5.

Yes, 2/5 means my score is 2 of possible 5. Below is definition. My family has no history of PCa,

* PI-RADS 1: very low (clinically significant cancer is highly unlikely to be present)

* PI-RADS 2: low (clinically significant cancer is unlikely to be present)

* PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal)

* PI-RADS 4: high (clinically significant cancer is likely to be present)

* PI-RADS 5: very high (clinically significant cancer is highly likely to be present.

Saw a discussion last week where a US Radiologist giving a talk/slide show to other doctors about MRI. He said he had never seen a MRI with no BPH present in a prostate in a male 30 years and older. He also said PIRAD2 was about the best to hope for. He went through 10 cases and had the benefit of biopsies in each case to support or dismiss his findings. One case he displayed the MRI said no meaningful PCa, but the biopsy taken(due to rising PSA) showed Gleason 3+3 dispersed through the tissue, and not localised into a lesion. He said this proves the MRI is not yet ready to replace biopsy where the PSA is rising .

Geoff,

Even though MRI is about 90% accurate, there is 10% PCa can still be found and this is the disclaimer my Radiologist had written in my MRI results. The discussion you saw last week pointed out that of the 10 cases, in 1 case MRI did not show PCa but biopsy did show PCa is within the expected 10% MRI will miss.

-David

If that is what he meant, then I agree. 2 is a good score.

Agreed. My PIRADS was 4 and 5, hence I accelerated the time to a biopsy. With a 2 I would not rush to a biopsy.

This is reasonable. I undersatnd that both MRI and PET scans are useful in detecting high grade (nasty) lesions. Low grade (eg 3+3) are not well documented by such scans.

So if the imaging does not show a high grade cance, I would not bother with a biopsy UNTIL the PSA started to climb quickly.

Yes, well in my case, fast rising PSA issue started my quest. 2.4 for many years then to 13 in 6 months, following a UTI, which may just be coincidence, or...... Anyhow, I need to resolve PSA. If the transperineal prostate biopsy is the only way, so be it. Not sure what tyhis will cost? Interesting the urologist along with the PSA has asked for a PHI (at $95, hope this is worth it, but apparently it is better than the PSA Free) at the end of 6 weeks??

I don't know much about the phi test. What I know is that if you must have a biopsy then transperineal is better than trans rectal.

That said, I would have always have a MRI before a biopsy. A MRI reported on by a specialist in prostate imaging and not just any old MRI scan.

Ask your urologist how long to wait for the UTI to clear up before you have a MRI or a biopsy. The urologist may have a time period in mind.

Note if the biopsy dictates surgery, then you should know that it is typical to wait at least six weeks after the biopsy for the area to settle down before surgery takes place.

Because I could not get into the urologist for 2 months, this is why I opted for the MRI to give us the best picture of what, if anything is happening. Because my urologist teaches other doctors and radiologists how to interpret MRI images, and specifically said only two of the specialist radiologist's could report on the findings, then I presume the MRI images and findings are the best possible.

 

I asked him about the UTI and PSA relationship and he said from UTI outset to cessation of symptoms, then from 3 to 9 months is typical for the PSA to be returning of its own accord. A 6 week dose of cipro should accelerate the return. He did warn however, that if the prostate had developed a non bacterial infection, which is very hard to diagnose, the PSA return can be over a very long time, and no amount of antibiotics will help.

 

At the appointment, he asked me how lucky I felt!! While the MRI shows BPH, the PIRAD 2 score images indicate a good prognosis overall, the rising PSA is a concern. He recommended the cipro as an initial treatment. If the PSA reduced, then we watch and wait for a further three months and repeat the PSA. If however, the PSA does not reduce or increase further, then "we"(meaning me) should be more aggressive and have the transperineal biopsy. If it came back all clear, then just accept the prostate BPH tissue is the cause and have a PSA test done every 3 months and a MRI every other year. If biopsy comes back with PCa, and he thought, considering I am 67, it was a 30% chance of low grade somewhere, then as the MRI already said no lesions, or extra capsular escapes, active surveillance maybe a good course of action. If I chose a positive action, then after the prostate settled down from the biopsy, we could discuss options.

If I were you and heard this from my urologist I would be pleased. He is alert to the fact that you have a PIRADS 2 and that you most probably have a non cancerous issue going on. But he will consider cancer as an option if the benign possibilities don't bear fruit. You should sleep comfortably.

I must say, I never really think about it. I tend to be the pragmatic type. Do your research, and get on with it. What will be will be....I took several weeks of research finding the doctor, and have to accept his advice...along with the great advice you get on forums like this.

We have never been so well informed since the internet, which I am sure the doctors kind of appreciate we take the time to learn.

At my last meeting with my general doctor of 30+ years, he thought my knowledge exceeded his in prostate cancer diagnosis and treatments...He is also going through the same issues, though his sound more serious, but I can't convince him to see a specialist!!!

Well, I am in a quandary right now...to biopsy or not??

After 6 weeks on cipro, my PSA reduced from 13 to 12..at least some sort of drop. So:

MRI said no meaningful PCA, no leasons to report.

PSA=12, down from 13 after 6 week cipro. Sort of good news!

PSA Free= 8.5% Not good! (but not reliable with PSA>10)

PHI= 75.4 index Not good! (but not reliable with PSA>10)

Urologist is eager to do a transperineal biopsy asap. He said as no PCa or leason indication on the MRI, it will be 'blind' with typically 25-30 samples taken.

Talking to the Radiologist, they said while the MRI is good at reporting high Gleason PCa, it is not so good at low grade AND in maybe 20% of cases can miss high grade PCa do to the way my tissue is compared to the PCa.

 

Biopsy = information. Information = power. I've had 2 biopsies through the rectum with no bad side effects and a result of useful information.

Hi Pepasan, yes, information is power, and it is this reason I will get the biopsy done. Means 4-6 hours at hospital, but the outcome is at least more helpful then wondering. When I had the MRI that said no meaningful PCa lesions , it sort of means if I do have PCa, then it is some dodgy cells spread out some where. The urologist said finding my PCa might be difficult as it could be anywhere. I think he means by this, lots of cores will be required.

Best of luck. Wishing you well.