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  • Is it OK to wait to have a biopsy?

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    Old 09-04-2019, 10:23 AM   #1
    Scors65
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    Is it OK to wait to have a biopsy?

    Hi, everyone. I am new to the group and have a question.

    First, let me give you some background. I am 65 years old. A little over a year back, my PSA was 2.5 and had been there for a while. Then a subsequent test showed it had jumped to 5.3. My Uro wanted to test more often so I began having tests every 8 weeks and each one was a 4K test. The test AFTER the 5.3 result showed a drop to 3.1 with a 5% chance of cancer on biopsy. Then, the next showed an increase to 5.4 with a 15% chance. The next, another drop to 3.2 and 8%, then the most recent 7.3 with a 35% chance. These tests, even the 4Ks have been all over the map. So, my Uro ordered up an MRI for me, which I had done last week. Now HE has not contacted me on those results, but being the anxious person I am, I went to the radiology practice's patient portal and read the report that was sent to him. It wasn't great. There were 2 small areas of concern, a 4x5x6mm area with a PIRADS of 4 and a 6x9x9mm area with a PRADS of 3. My prostate volume is 38cc. I have zero family history of cancer and, although the MRI confirmed mild BPH I have absolutely none of the usual symptoms. All of my DREs have been normal.

    So, here is my question. I am obviously concerned and realize that when my Uro does call me he will, in all likelihood, want to perform a biopsy. I don't mind having that done, but my personal situation at this point makes doing that before October 14th or so impossible (it is now September 4th). Can I wait that long? Do my numbers indicate an emergency situation requiring immediate attention, or would it be OK to wait a few weeks until my work/personal situations resolve? Thanks for any insight or advice. Obviously, I will discuss this with my Uro once he calls me, but I just want to have some background, even if it is anecdotal. first.

     
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    Old 09-09-2019, 08:12 AM   #2
    IADT3since2000
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    Re: Is it OK to wait to have a biopsy?

    Hi Scors65 and welcome to the Board!

    The bottom line, from my savvy but laymanís viewpoint, is that you can wait until October 14th with a very high likelihood of not adding to your risk. Two main considerations support that: (1) prostate cancer is commonly, indeed in the vast majority of cases, a slow-growing disease, especially for men with good risk characteristics, and (2) you have some good risk characteristics. A very few of us constitute the exceptions, but it is highly unlikely that you are in that group.

    The key evidence that would warrant a biopsy is that PI-RADS score of 4 for one small area, combined with an arguably elevated PSA. A score of 4 means there is a fairly high chance that you have prostate cancer, while the 3 indicates about an even chance. The good DRE and fairly low PSAs, though elevated, combined with the fairly good 4K results, suggest that cancer, if it exists, is mild and not high-risk, though there is some uncertainty.

    Infection could explain all that has been observed, especially that roller-coaster PSA pattern. While the 4K score is a pretty good indicator, two of the four constituent elements are PSA and free-PSA, and both are subject to elevation by infection. Cancer does not cause PSA to go up and down; rather, there is a steady exponential increase, though that is often clouded by influence from BPH and especially infection, especially at lower PSA levels. You could have a small amount of cancer and an infection, as well as the mild BPH that you already know about.

    Unfortunately, the absence of symptoms is typical unless the disease is quite advanced. Prostate cancer is stealthy.

    Good luck! Jim

     
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    Old 09-09-2019, 09:54 AM   #3
    Scors65
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    Re: Is it OK to wait to have a biopsy?

    Thanks very much for the detailed reply, Jim. I very much appreciate it.

     
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