Do doctors assume the worst based upon PSA results?
So, I received elevated PSA results (11.7) as a 57 year old, and I'm currently researching this whole PC thing. I'm scheduled for an MRI guided biopsy at the advice of my urologist (he's not doing pre biopsy DRE or MRI and no symptoms beside occasional slow to start urine stream if I wait to urinate for a few hours). When I questioned could I have BPH I was told that I'd have to have a pretty enlarged prostate to produce a PSA of 11.7. This all having been said for context; after speaking with both my Urologist and primary doctor, I'm getting the sense that they just assume I have PC based upon my elevated PSA. Anyone have any similar "assumptive" experiences with their doctors early in the process?
Hi
. It is possible for BPH to cause the PSA levels you are experiencing or even higher, but that said, it still completely makes sense at that level to check for prostate cancer. It is good that you verified that they plan on the biopsy being MRI guided. Concerning a pre-biopsy MRI, there are some potential benefits, such as possibly avoiding unnecessary biopsy and locating cancer spread ahead of time (see here for more comprehensive list: https://prostatecanceruk.org/prostate-information-and-support/prostate-tests/mri-scan). There is also research finding that the pre-biopsy MRI is not a benefit to many men (see: https://prostatecanceruk.org/prostate-information-and-support/prostate-tests/mri-scan). So, the main thing is that you are comfortable with the direction of your treatment - if you feel you might like the pre-biopsy MRI don't hesitate to ask for another opinion. Best, Richard (Team Member) Hi thig350. My docs ordered pre-biopsy MRIs with the goal of doing guided biopsies on 2 occasions. These biopsies presented “no targets” and did not point to cancer. Also, several dre exams did not detect abnormalities. So, you could say these procedures were not helpful. However, once a biopsy found cancer, these negative test results helped my docs determine the cancer was confined and stage 2. This in turn helped determine that drug therapy was unnecessary. I went through a lot of negative tests until the cancer was found, and those tests were sometimes uncomfortable, but I’d do it the same way in retrospect.
I believe a PSA >4 is the line where standard practice is to look further for cancer. With multiple PSA results the magnitude and rate of change are very important.Whenever the image your prostate(sonic scan, mri, etc.), they have a tool where they can estimate prostate size by drawing a circular line around it.
If you’ve had any scan, size should be on there.
I also think psa 11 is a bit far for BPH.
I would be moving the docs on toward biopsy right now.
I would suggest to start educating yourself on the major treatment pathways and cure rate for these so you will be ahead of the docs if you get barraged with choices. Make sure one of the books is mark scholz. Read peer reviewed papers as well. Usually the intro and conclusions are easy to read.
Also know in this place you find yourself, the cancer is not the only danger. Bad information, badly informed doctors, profit motive, proffessional advancement (ive done 1000 prostatectomies! Yay), are all in play and can be more dangerous than the cancer. Imho urologists are among the worst.
I would suggest going down the middle lane, of the most traveled path, of the most curative treatment for your cancer stage/type.Look up Dr Grim i think his name was. He compiled graphs of cure rates comparing the major treatment paths (surgery/radiation, etc) versus your risk staging. He passed on but theres a foundation that maintains and continues his work. There are real advantages of going one way or the other despite the industry mantra being… the outcome of surgery or radiation is about the same… Can’t count how many times i heard this false and ridiculous statement. Think its prostatecancerfree dot org.
