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Posted 11/13/2024 6:24 AM (GMT -5)
Hi all.
I am looking for a bit of advice.
My story so far, 64 years old ( caucasian without any known family history )
PSA readings
2020 2.64
2021 4.6
2021 after a month 4.1/free ratio 30%
MPMRI shows Pi rads 4 / 46.8cc / PSA density 0.088
DRE- inconclusive/slightly indurated
Biopsy was clear ( 24 samples )
My next test was last year
2023 PSA 5.6/free ratio 33%
My urologist adviced for a new MPMRI which I haven't done yet ( both parents got sick and passed away )

For the last couple of years I ve been dealing with my parents health and I have neglected my own, I know that.
I hope it's not too late.
Posted 11/13/2024 7:17 AM (GMT -5)
Hi DJac and welcome to the Forum! I'm very sorry to hear about your parents.

I wouldn't worry about it being too late--prostate cancer is usually quite slow-growing--if you have it, which you may not. Also, one's prostate cancer can be of the indolent type that can be monitored (active surveillance) until/unless it ever progresses to the point it requires treatment. I'd go ahead with the MRI and see if it identifies any suspicious targets. If it does not, but your uro still advises another biopsy (e.g., your PSA continues to rise or is higher than you uro likes), I'd also go ahead with that.

Although any one MRI and any one biopsy can miss existing cancer, it won't continue to evade repeat imaging and biopsies. There are some other non-invasive tests that can be done, but they aren't conclusive and their results could just add to the advisability of repeat imaging/biopsy. As you probably know, you'll need another PSA test to determine your current value.

My feeling is that you shouldn't try to second guess your uro about cancer detection. You should trust your uro and, if you don't, you should find another uro.

My uro felt an induration on one side at one DRE. He said it required monitoring, but not a biopsy--it later resolved by itself. He felt a new nodule on the other side at a later DRE that did require a biopsy. The nodule itself turned out to be benign, but that same biopsy found high-grade cancer elsewhere in my prostate. A biopsy is still the only way to diagnose prostate cancer. It might show that even a very suspicious MRI-identified target is actually not cancer, and it might find malignant lesions that were too small for the MRI to detect.

Please keep us posted.
Posted 11/13/2024 10:30 AM (GMT -5)
Hello, your biopsy in 2021--3 years ago--was completely clean. That's really, really good. Let's further assume that they used the MRI results to guide the biopsy, and they actually hit the targets.

Your PSA is rising, so that is a concern. However it would be very unusual for you to go from a completely benign biopsy to a stage 4 in 3 years.

Getting the new MRI is important, and (Probably) another MRI guided biopsy is in your future.

We say in here that PSA is the 'check engine' light. It means something is happening, but we're not sure what. An MRI hot spot is indicating, again, that 'something' might be happening, but, again, we're not sure what.

Hang in there, get the MRI as soon as you can, and let us know what it shows. We've had several men come through here who had really high PIRAD scores on MRI--and benign biopsies. The biopsy--especially repeated biopsies--are the only definitive way to diagnose PC. It sure would be nice to not need the biopsy, but this is the state of medicine in today.
Posted 11/14/2024 2:09 PM (GMT -5)
Two months is not too much for this disease. But we diligent now that you can.
Posted 11/15/2024 1:22 AM (GMT -5)
It’s not too late. See what your body’s doing or not doing. There’s still chapters to be written no matter your circumstances.
Posted 11/22/2024 7:43 AM (GMT -5)
Thank you for your replies.
I will get a new mpMRI and come back with the resaults.
Meanwhile, I experience back pain and my xray showed possible fructure on L1. I have scheduled also MRI.
Needless to say that I fear for the worst!
I will also get an exam called Dual-energy X-ray absorptiometry ( I suffer from rheumatoid arthritis )
Also, one question, is free psa consider to be a reliable indicator?
Posted 11/22/2024 8:32 AM (GMT -5)
Djac,

It's common for us to attribute every ache or pain or issue to the worst case scenario. Bone pain is one of the symptoms of seriously advanced PC. I'm not sure if it actually causes fractures to occur. But, and this is huge, you last PSA is 5.6, which is slightly elevated from the average for your age, but nowhere near the kinds of PSA readings someone with advanced PC would indicate. To have PC related bone pain, your PSA would be 10-100 times higher than it is.

Here's the thing: PC is generally a slow grower. It's extremely rare for a man to go from a totally clean biopsy to untreatable stage 4 in 2-3 years. It usually takes a LOT longer for that.
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