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Thread: Low grade, high PSA

  1. #11
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    Quote Originally Posted by doubleH View Post
    Thanks all for your informative and hopeful responses. I am happy to report that my PSA score went down to 7.8, which is just 0.4 higher than before my biopsy. My next PSA test is scheduled for mid-April. I also have an appointment early March for a second opinion regarding next treatment (or not) steps in the current situation.

    MF, I was not advised to have a biopsy back in 2017. Given my "low" (under 10) PSA score, my urologist didn't suggest an MRI at this point when I saw him last month.
    A low PSA score is under 3, not under 10. A persistent PSA score close to 10 indicates a 50% probability of cancer as your biopsy confirmed.

  2. #12
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    Here is an update on my situation. I had a prostate MRI earlier this month, which showed no evidence of clinically significant prostate cancer. It did show mild prostatomegaly with benign prostatic hyperplasia. I also had a follow-up TRUS biopsy, which showed stable disease -- no major changes from the biopsy I had 1 year ago. My doctor recommended another PSA test in 6 months.
    Last edited by doubleH; 10-27-2019 at 11:49 PM.
    * Age: 50
    * PSA:
    - 1/14/17: 3.3
    - 8/12/17: 4.3
    - 12/13/17: 5.2
    - 3/13/18: 6.0
    - 9/14/18: 7.4
    * Biopsy:
    - 10/8/18: 12 cores, left medial mid: 3+3, 10% involvement, left lateral apex: 3+3, 10% involvement, both positive cores NPI
    * Oncotype DX:
    - 12/13/18: Unable to report due to insufficient RNA quality or quantity
    * PSA:
    - 12/15/18: 12.9
    - 1/14/19: 7.8
    - 6/1/19: 8.5
    - 6/1/19: 7.1 (switching from Beckman Coulter to Siemens method)
    * Prostate multiparametric MRI:
    - 10/1/19: No evidence of clinically significant prostate cancer; mild prostatomegaly with benign prostatic hyperplasia
    * Biopsy:
    - 10/15/19: 12 cores, left medial apex: 3+3, 10% involvement, left lateral apex: 3+3, 5% involvement
    * Under active surveillance

  3. #13
    doubleH,

    So far, you seem like a typical low risk case. The question I would have is whether you have had other blood tests, like PHI, 4K Score, ConfirmMDX? Or, even better, a genomics test like OncotypeDX, Prolaris, or Decipher?

    The relatively high PSA needs an explanation. How big is your prostate? It should be stated on the MRI and/or biopsy pathology reports.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  4. #14
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    Jan 2018
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    doubleH:

    I'm in a similar situation to you. Several years ago a biopsy showed two cores with small amounts of Gleason 6. My MRI's are negative and all genomic testing has shown very low chance of aggressive cancer. In short, a perfect candidate for AS. However, my PSA continues to rise and now is around 12, which has concerned my doctor. At this point, he's O.K. with AS because I have a very large prostate, which means you have to take the PSA reading in a different light. But at some point, the PSA might get too high. He actually prefers the PHI reading, and that is the one that has him concerned (it's in the 70s).

    The key question I asked my doc is: "Have you ever recommended treatment for someone where biopsies have never found anything more than Gleason 6 and MRI's have been negative?" He said it is extremely rare, but he has had 3 such cases where he recommended treatment, and in all 3, treatment turned out to be the right choice. I didn't specifically ask, but I assume he meant that a post-surgery biopsy showed some higher grade cancer that went undetected. He emphasized that the fact that he remembered each case showed how rare it is.

    So, my message would be the PSA should not be a big concern at this point, but just make sure you've got a good doctor who is monitoring you closely.
    Age 63
    Diagnosed with PC in December 2015 based on saturation biopsy
    2 positive cores, Gleason 6, both under 10%
    Currently on AS
    All MRIs negative, both before and after diagnosis
    Three post-diagnosis biopsies, two negative, one positive, with two cores of Gleason 6, both under 10%.

  5. #15
    Sounds like they are keeping a close eye on you which is good. So far so good, nothing new coming up on the MRI or the 2nd biopsy is really excellent.

    Due to the good chance that a biopsy might miss a cancer "hot spot", a confirmatory 2nd biopsy is a wise idea.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  6. #16
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    High PSA with BHP is typically erratic. A steady high PSA and rising is typically cancer and not G6. My experience was letting it get to 7 was an unwise risk.

    JJO's conversation with his doctor is a good example. Except it is not rare, imo.

  7. #17
    Quote Originally Posted by JJO View Post
    doubleH:

    I'm in a similar situation to you. Several years ago a biopsy showed two cores with small amounts of Gleason 6. My MRI's are negative and all genomic testing has shown very low chance of aggressive cancer. In short, a perfect candidate for AS. However, my PSA continues to rise and now is around 12, which has concerned my doctor. At this point, he's O.K. with AS because I have a very large prostate, which means you have to take the PSA reading in a different light. But at some point, the PSA might get too high. He actually prefers the PHI reading, and that is the one that has him concerned (it's in the 70s).

    The key question I asked my doc is: "Have you ever recommended treatment for someone where biopsies have never found anything more than Gleason 6 and MRI's have been negative?" He said it is extremely rare, but he has had 3 such cases where he recommended treatment, and in all 3, treatment turned out to be the right choice. I didn't specifically ask, but I assume he meant that a post-surgery biopsy showed some higher grade cancer that went undetected. He emphasized that the fact that he remembered each case showed how rare it is.

    So, my message would be the PSA should not be a big concern at this point, but just make sure you've got a good doctor who is monitoring you closely.
    A PHI in the 70s would have seriously frightened me ... last year.

    Johns Hopkins had been using PHI for their AS program for several years, and writing about how much more accurate it was for finding higher grade cases.

    Then, when Bal Carter retired, no more PHI for the AS men. That was a big surprise to me. We already know that you have some cancer. We can monitor it with just PSA. Wow, spin my head around, especially since PHI is not an expensive test. Around $110 as I recall.

    So, maybe your PHI should not cause you to lose any sleep, as long as your other testing is OK.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  8. #18
    Quote Originally Posted by ASAdvocate View Post
    A PHI in the 70’s would have seriously frightened me ... last year.

    Johns Hopkins had been using PHI for their AS program for several years, and writing about how much more accurate it was for finding higher grade cases.

    Then, when Bal Carter retired, no more PHI for the AS men. That was a big surprise to me. “We already know that you have some cancer. We can monitor it with just PSA. Wow, spin my head around, especially since PHI is not an expensive test. Around $110 as I recall.

    So, maybe your PHI should not cause you to lose any sleep, as long as your other testing is OK.
    I believe one concern with the PHI (and similar tests) is that high-grade lesions are missed when a urologist, who would biopsy on the basis of PSA, chooses not to biopsy on the basis of the PHI result. I gather that what you were told about this change in policy amounts to: if the PSA and/or imaging tells you it's time to biopsy (again), then biopsy -- period. There has been back and forth in journal communications on this topic.

    Djin
    Last edited by DjinTonic; 10-29-2019 at 02:30 AM.

  9. #19
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    Jan 2019
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    11
    Thanks all for your helpful comments!

    @ASAdvocate: According to MRI report my prostate measures 4.7 x 3.7 x 4.5 cm and the volume is 41 mL.

    I had an Oncotype test at the end of last year, but the test didn't produce a result due to "to insufficient RNA quality or quantity". My current oncologist maintains that genetic tests are not helpful in predicting which men will show upgrading while on active surveillance.

    @JJO: If I may ask (and I feel very strange asking this), what's the size of your prostate?
    * Age: 50
    * PSA:
    - 1/14/17: 3.3
    - 8/12/17: 4.3
    - 12/13/17: 5.2
    - 3/13/18: 6.0
    - 9/14/18: 7.4
    * Biopsy:
    - 10/8/18: 12 cores, left medial mid: 3+3, 10% involvement, left lateral apex: 3+3, 10% involvement, both positive cores NPI
    * Oncotype DX:
    - 12/13/18: Unable to report due to insufficient RNA quality or quantity
    * PSA:
    - 12/15/18: 12.9
    - 1/14/19: 7.8
    - 6/1/19: 8.5
    - 6/1/19: 7.1 (switching from Beckman Coulter to Siemens method)
    * Prostate multiparametric MRI:
    - 10/1/19: No evidence of clinically significant prostate cancer; mild prostatomegaly with benign prostatic hyperplasia
    * Biopsy:
    - 10/15/19: 12 cores, left medial apex: 3+3, 10% involvement, left lateral apex: 3+3, 5% involvement
    * Under active surveillance

  10. #20
    Newbie New User
    Join Date
    Jan 2016
    Posts
    4
    I know how you feel on the PSA tests that keep going up. In June I tested at 11.7 and last week I test at 11.2. Have no real Idea way it went down. In August and September I was building a 16 by 20 shed and my right ankle keep swell up so I took 1 to 2 pills of Aleve each day. From the 1st of October I took Aleve and was also drinking Apple Cider Vinegar to relieve the muscle cramps I was having. Oct 12 to present I stopped using Aleve but I started take tumric pills to relieve the swelling in my hands and I got some Apple Cider Vinegar pills and have been taking them. My last PSA was on Oct 25.
    PSA 0.5 10/9/2006
    PSA 1.8 11/4/2010
    PSA 4.1 10/22/2013
    PSA 4.4 3/03/2014
    PSA 5.9 10/8/2014
    PSA 7.0 11/8/2014
    Biopsy Gleason 3+3 Prostatic adenocarcinoma involving 2-mm focus of one core, negative for perineural invasion recommended AS
    PSA 5.1 3/31/2015
    PSA 9.0 9/9/2015
    PSA 10.5 11/9/2015
    Biopsy 12/18/2015 Negative on samples tested recommend AS
    PSA 10.5 2/2/2016

 

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