Fluctuating PSA levels

Hello Necam 

A warm welcome to the group although I am so sorry to find you joining us.

With the 10 result, an enlarged prostate and PIN I would have thought you are on course for a further MRI and Prostate biopsy. (PIN isn't a confirmation of cancer but High Grade PIN almost always leads to a cancer diagnosis).

As to questions and other tests - you could ask for a CT or PSMA-PET scan but think these would be refused on cost grounds and not required at this stage - the same with a bone scan.

Questions are also very personal so here's a link to a list to help you decide what to ask:

Questions-to-ask-your-healthcare-team.

I hope this helps - feel free to come back with any questions - nothing is too trivial.

Best wishes - Brian.

Hi Necam

I agree with Brian, u need another MRI, to see what's happened.

Also ask for previous MRI details to see exactly what was spotted then , abnormality, what does that mean exactly, ask about size of abnormality 

Best wishes 

Steve 

Thanks Brian

Thanks Steve

Will ask for further details once the next appointment is scheduled.

MRI scored PIRADS 5 but thought i was in the clear after negative biopsy.

Pirads doesn't mean that much really,  just a likelihood of cancer but biopsy said no.

Yes always keep on top of MRI results as always reckon really the most important part.

Just my thinking obviously.

Good luck

Steve 

Hello - Necam 

A PIRADS 5 (Prostate Imaging Reporting & Data System) score means the MRI has shown a clear view of the prostate and the risk probability of a cancer diagnosis is between 72 and 90%. it looks like on your 1st MRI you fell into the 10%!

You can always ask the questions once you receive a date for your "urgent appointment".

Best wishes - Brian.

I am wondering whether you had the TRUSS biopsy ( through the back passage) or a template biopsy ( through the perineum and guided by scan)? The former can only reach part of the prostate and is not as reliable as the latter.  The template biopsy also poses less infection risk.

my husband refused the TRUSS biopsy when his PSA was first noted as elevated. This was also, in those days, not preceded by MRI scan. He was told to go back to urology when his PSA reached 10. He was totally without any symptoms and the digital rectal examination caused absolutely no concerns. At PSA 10 he was diagnosed with Gleason 4+3 T3a N0M0 in autumn 2022. He had 20 fractions of radiotherapy and 18 months of hormone therapy. Latest PSA 0.026. 

hth

The shift in PSA in June and August does indicate that large rapid fluctuations are possible in your PSA. You are right to be cautious the rise to 10 is significant 

A urine test could help determine if an infection or acute prostatitis could be responsible. 

Another MRI seems the minimum requirement and likely another biopsy. If no other obvious and treatable reason is found. 

edit. I think asking what size your prostate is in volume rather than relative to a fruit is a good idea. Then you can work our PSA density.

Thanks for the advice John.

I could just say "I agree with them up there ^^^" but maybe there should be a little more than that.

I had a not too dissimilar set of fluctuations in my PSA over the years before final diagnosis.

For me, the end process was MRI, Biopsy, CT Scan and Bone Scan. The last two were because my identified cancer had gone bonkers over the last year and blessed me with a Gleason 9. I am really glad that the second batch of doctors were more cautious and went for the full set, because only a year before my diagnosis I had been advised that I was good to go unless the PSA level went to 15 or above.

All the tests were ok - the least pleasant being the biopsy of course - and they meshed together quite well.

Once you have the results, you will know what options are available. Then comes the second worst thing - making up your mind about the course of treatment.

As an aside, if the biopsy comes up clean again, I would be asking the consultant exactly what sized orange he had been talking about. With a large prostate and distinctly flaky cells involved, I would want to be talking about what kind of treatment might be indicated for that problem alone.

I wish you very well.