Rising PSA

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I am 71 and have had BPH for about 15 years. I tried Avodart for a year in 2012. I have been doing self cathterization (5/day) since May 2018. When I started catheterization my PSA went from 2.8 Aug 2018 to 5.3 Mar 2019 Which as I understand is somewhat normal due to the irritation caused by catheterization. Then PSA went to:

6.3 July 2019

7.55 Jan 2020.

I had a mp 3T MRI Feb 2019, The report says

1 & 2. Things I already knew.

  1. There are no focal areas of restricted diffusion demonstrated. There is a generalized restricted diffusion within the left side of the prostate when compared to the right side . There is a generalized decrease within the ADC map on the left side of the prostate. Following infusion of contrast there is a generalized increase in contrast enhancement within the left side of the prostate.

  2. PIRAD-3

The place I had the 3T MRI is near a hospital 2 blocks from my home in Fremont California. I think it is a general MRI imaging center and does not specialize in prostate images, so don't know what weight to place on the report.

I sent the images to Dr Karamanian in Houston, Tx. He said the quality of the images was not good enough to tell much about prostate cancer. He said the size of the prostate is roughly 85g.

I will see my urologist on March 4, 2020 and he will probably want to do a biopsy.

I had originaly wanted the 3T MRI to avoid biopsy.

Should I watch and wait getting another PSA test in 3 months and maybe another 3T MRI in 3 or 6 months, at a reputable institution like Stanford Univ, or University of California San Francisco ? Should I take my present images to Stanford or UCFS to find an expert to read them, for second opinion ? Can I get Medicare and my insurance to pay for another 3T MRI in less than a year?

Any help would be appreciated,

Thanks,

Thomas

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  • Posted

    I have had Prostate Cancer, which was found as my PSA went from 4 to 6 in a year. I was given a biopsy, which you do need if you are to know whether you have cancer or not.

    If the urologist suggests one, do have it. It may show that you have a very slow growing lump which is not a problem, or that you need treatment.

    I was treated by Pencil Beam Proton Therapy, over a year ago, and there is no sign of cancer now. My PSA is only 0.15.

    Don't put off something that a Dr recommends! Goos luck.

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  • Posted

    Thomas,

    UCSF has a very high reputation for imaging specialists. It does seem, however, that you are going to need a biopsy. I had two of them, not fun, but bearable. You can take a few Tylenol capsules before the biopsy and that will dull the pain, or, you could request sedation. You will have to discuss this with your urologist of course. You have to find out if you do have any prostate cancer and what the Gleason grade is before you make any treatment decisions. I am about 6 years ahead of you and so far, my cancer is gone after treatment with HD Brachytherapy at Kaiser in Santa Clara.

    Tom

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