High PSA - planning ahead

Men's health
1

Hi all,

its probably been 2 years since i was last here. Back then I was dealing with BPH that has been largely manageable via meds. Now, potentially darker problems lie ahead.

Routine blood work returned PSA of 8..1 where it should be below 4. Urologist did another test 3 weeks later which just returned 8.4.

Of course urologist is ready to have me come in for an in-office biopsy. These guys all love surgery and cutting.

I’m staying a step ahead.

I already contacted insurance and radiology center last week.If I am getting needles in my prostate I do not want some medieval blind or ultrasound guided (TRUS) biopsy. Minimally want fusion guided using 3T MRI imaging. 3T is not available everywhere as it requires latest, expensive equipment. Thus, will go to NJ for that. Urologist said he is ok with that but insurance may not cover it before biopsy. I called insurance, they will approve. Again, i think these guys are all driven primarily by what they can do in office and bill for. To me the ideal prostate doctor would be certified as both a urologist and a radiologist.

i think, am not certain, that a follow up guided biopsy (fewer, more targeted needles as they map against the MRI) I’m Good with that, knock me out and wake me when done.

Anyway, should results be bad, what is the latest, greatest in treatment options? My main concern is that since I am still in my 50’s, i do not want a procedure that leaves me permanently with ED and wearing Depends.

2

Was the PSA checked both times by the same lab?
Why rush to a biopsy? I would wait to get a trend of results over a minimum of 6 months.

3

thanks for the reply. yes, both tests from Quest.

yes, this is partly why I want to get MRI first.

biggest concern i have is that PSA values over 8 seem extremely high for anyone in their late 50s

4

Sorry for my late reply.

  1. Good that you’re using the same lab over time for blood work;
  2. Is the MRI going to be reported by an expert in prostate imaging?
  3. The PSA number per se is not the determinant of likely cancer. The focus is the change in the number over time.
5

All,

had the MRI last week.

results came back as PI-RAD category 4 which says clinically significant cancer is likely to be present.

suspicious finding mid gland transition zone just to the right of center. something about a rounded area measuring up to 1.1 cm across.

next step is fusion biopsy. i guess its good i pushed for MRI first as i am told the transition zone is not normally targeted in standard biopsy.

i guess i will then need to consider treatment options. as discussed earlier, do not want to spend next 20-30 years in Depends.

6

Mike,

My PSA went to 7.55 which prompted my Urologist to call for a biopsy. He said insurance would probably pay for biopsy but not MRI. I stopped at a 3T MRI center and the people there gave me a form with some code boxes checked and said I should have no problem getting Medicare and insurance to pay for it. I did it and it was covered. I had 4 different doctors look at the MRIs, and they concluded there was nothing significant, and the high PSA was probably because of the enlarged 100g prostate, due to BPH. In the meantime I started taking 3 grams of Turmeric capsules every day for 3 months and the PSA went down to 5.5. Don’t know for sure if the Turmeric caused the decrease, but I’m still taking it and will go in for another PSA in two weeks. A good number to look at is PSA density rather than PSA, You get PSA density by dividing the PSA by prostate size in grams. For me it was 7.55/100g = 0.0755. As long as it is below 0.1 you are OK. You can get the size of the prostate from the MRI, using the equation for an ellipsoid.

Thomas

7

Hi Thomas, did you have to show people at the 3T MRI center anything from your doctor? How did you justify to get the insurance to pay for it? Hank

8

Hank,
The people at the MRI center gave me the form with the codes checked and my doctor signed it. I don’t remember if my doctor or the MRI center submitted it. I think (not 100% sure) they had the codes checked for pelvis exam.
Thomas

9

PIRADS 4? Join the club! Me too.
Don’t focus on the small possibility of having to wear DEPENDS for 20-30 years.
I ended up wearing them for 4 mths after robotic surgery.
I too had MRI guided biopsy.

10

Note the key is not a 3T MRI per se, but having the reporting radiologist being an expert in prostate imaging.
Better an expert reporting on a 1.5T scan than generalist reporting on a 3T.