Certainly Not Under the Bell Curve
While chasing some mild anemia, my primary decided we needed to run a PSA. Quite a shock when it came back at 16. I had zero symptoms, even of BPH. Routine DREs had always and were normal. PSA had been almost at zero when last checked 15 years prior. We waited a couple of weeks, ran it again and this time it was 19.8, however I had a mild UTI so antibiotics. Referred to a urologist. 1st one I fired immediately after the visit, major personality clash. 2nd urologist is a keeper. He listens and we have been jointly plotting the course.
First diagnostic tests
First he wanted to ensure that the PSA was not due to lingering asymptomatic prostatitis so 4 weeks on Cipro, test again and some improvement with PSA dropping to 14.2, but way short of what had been hoped. Unlike most urologist, mine wanted to get a full PIRAD 3T mpMRI of the prostate to get a lay of the land as we both anticipated cancer would be indicated and it would give him targets for a biopsy. MRI performed and much to our surprise, PIRAD 2 and NO focal lesions found. In fact other than a couple of minor (about .5mm) BPH consistent nodules in transition zone (why the PIRAD 2 rather than a 1), the MRI images were totally clean. He talked to the radiologist and the prostate oncologist that wrote the report and they indicated that they simply could NOT find a single thing anywhere. BTW, my prostate was completely normal in size at 20cc.
Seeking other testing options
So we are at a decision point. We are trying to locate anywhere that does prostate shear wave elastography which might gives us a target area. Without the SWE I am faced with a standard 12 core stab in the dark biopsy that in my case has 80% odds of not finding anything and virtually a zero chance of finding clinically significant cancer. Yet, there is that nasty PSA #. Very conflicted as to how to proceed. Not really wanting an unnecessary and likely meaningless biopsy as we all know finding nothing means nothing but a repeat biopsy. The risks from TRUS-B really make me question preceding and the risk from transperineal...well that is a non starter as well. I am really of the mind to put a hold on any further exploration and continue to monitor my PSA along with another mpMRI down the road.
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