Hi all,
Im trying to understand a few things,
routine blood test with PSA added.
52 years old, PSA 4.9, DRE smooth slightly enlarged.
MRI requested.
Density 0.15 , 30ml no other real concerns, no lesions etc mentioned.
Biopsy undertaken, consultant said he wasn't worried as very unlikely to be anything given the MRI, PSA etc.
Came back today with a Gleeson 7 (3+4), he seemed surprised.
I forgot to ask about how many of the cores were positive for cancer and what type etc.
I was concerned that as I had a 7 score but psa of 4.9, if my 3 month tests stay around 4.9 could the cancer still be growing but we wouldnt know without an MRI. or would the psa still rise ? i guess we dont have a base line prior to my initial blood test.
if the MRI doesn't show any lesions, tumors etc where is the cancer ? is it possibly too small to show etc ?
im probably concerned as most people are that the PSA doesnt show any issues and by the time we get to an MRI again its progressed.
Do 3+4 always progress to treatment ?
Will they know the cancer type and charecteristics present and therefore know the likely chance of spread and timescales ? or are we relying on timely psa and mri ?
sorry lot of question, minds spinning
Hello Steve (Steve1973)
Let me say at the outset I am not a believer in Active Surveillance but this is a personal opinion as I have seen people go from AS to Stage 4 incurable.
The prostate is the normal size but it takes 9 million cancer cells to show up on a scan. The cancer is there as you are a low Gleason 7 (3+4) as opposed to (4+3) which means the majority of the cells are slow growing.
As humans we are all different and cancer grows usually slowly but as a Gleason 7 at some point I would anticipate you will need some form of intervention.
I think you are jumping the gun wanting answers that the MRI can't give as it looks like the cancer is there but just too small to show up on a scan (I am going through just the same issue myself!).
I personally think there are 2 ways you can go here:
* Relax and go for 3 monthly PSA's and an MRI every 2 years (NICE guidelines for AS) or
* Tell your team you don't want the anxiety of waiting and come up with a plan to deal with it - there should be plenty of options.
I hope that this helps.
Best wishes - Brian.
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Hi Steve1973
The PSA normally tells you there's something going on and if it rises it's indicating that there maybe a few more cells developing. But also theres other things that can make you PSA high like infections/ riding a bike apparently and recently having sex can also affect it. Probably more things as well. The MRI will scan the area to see if there is something visible and where it is. Firstly - Prostate cancer is VERY slow growing as a rule so don't worry about it spreading, it takes a while and 4.9 is very low. If it turns out that you do have something it is likely to be contained in the prostate and very easy to eliminate. The consultant was probably surprised at the 3+4 because of your age, because as a rule this is an older mans cancer (if you have it) If you do have it you have found it very early and its likely to be very small. The "4" is saying = in the sample we have found some cells that are abnormal and their structure has changed, but the PSA is saying = you only have a few and that is why it is low. So thats a good thing, caught very early and very treatable.
Try not to worry too much, remember = Very slow growing, incredibly treatable, it has a very high survival rate. You need a PSA a lot higher than 5 to be in any sort of trouble.
I hope that helps you.
Lorraine 
