Not sure what to do?

Hi , hopefully we'll hear from others too. We've been hearing a lot lately about PSA results without any detectable cancer. I'm curious what your doc has planned for keeping an eye on the rising PSA. Has there been talk of any imaging tests? These may not be used until your doc is more certain that there could be cancer present: https://prostatecancer.net/diagnosis/. This article talks about how PSA can be affected by conditions other than prostate cancer, and some of the unreliability of the test: https://prostatecancer.net/diagnosis/psa-test/. It's tricky to know what is alarming, and what should be taken slowly. In addition to any word from community members, I hope your doc is helpful in answering questions. - Nina, SkinCancer.net Team

Hi , I did not have your experience, but I know men in my support group who did. One of them eventually had his biopsy results sent to John's Hopkins and found out that cancer was detectable. I will find out more about this at my group meeting next week and reply again with more specific information. Will Jones ProstateCancer.net Moderator

You might ask your doctor about advanced prostate imaging with MRI and genomic biomarkers. For the former maybe a normal MRI or a Multi-parametric magnetic resonance imaging (MP-MRI).

My my PSA was incredibly elevated abs my cancer was high volume, so all 14 cores came back cancerous - either Gleason 9 or 10, so I didn’t have the dilemma you’re facing. In my case, I started with a CT scan and then a transrectal ultrasound–guided (TRUS) biopsy.

I am at the same place, but different side of the equation. High PSA, NO biopsy yet, PIRADS 2 mpMRI and absolutely NO evidence of cancer in the images (only 2, tiny BPH consisted transition zone nodules, 1 PIRADS 1, one PIRADS 2). My prostate is totally normal in size at 20cc and multiple DREs come up negative. My PSA is running in the lower to mid teens. We eliminated prostatitis early in the process. With my PSA alone indicating a 58% chance of PCa yet the mpMRI turning up absolutely NOTHING, I do know all too well the angst of not knowing and no proven way to proceed.

I can tell you from extensive research that the 12 core systematic biopsy is a poor test for ONE SIMPLE REASON, it has a lousy negative predictive value (NPV), in other words, if the biopsies turn up negative, it means ONLY ONE THING, another biopsy. Its NPV runs about 11-12%. The mpMRI on the other hand has a NPV of around 88-90%. The imaging resolution of a 3T mpMRI is .5mm and even .25mm can be detected. But the mpMRI is not yet considered diagnostic as cases such as mine continue to confound the odds. The 12 core systematic biopsy does NOT sample the transition zone, the anterior and typically misses the apex due to difficulties in reaching these areas transrectally (it can be done with an end firing, parallel needle setup). These are ALL places where cancer can begin despite 88% of PCa starting and occurring in the peripheral zone where the systematic biopsy targets. That stated, we are moving forward with a modified 12 core systematic biopsy where additional cores in the apex, transition and anterior zones will be taken along with longer cores. This modification came out of a MSK study on how to improve the systematic biopsy. This decision to do the modified biopsy is completely mine and my urologist and I would certainly not advocate anyone to blindly follow suite. I was prepared to forego the biopsy entirely and my urologist was in concurrence but we decided to give the modified 12 core systematic biopsy an opportunity.

The one thing that is NOT a good plan is to bury your head in the sand and hope the PSA scores go away. Knowledge, data and research into options are the best defense but getting into the fringes can be disheartening as most of the urology world revolves around the center of the bell curve where the "process" works. As my Dr stated we are likely to not turn up anything in the modified biopsy but it is worth a "stab" (yea ugly pun).