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PSA 8.7 but negative biopsy and MRI
RobertD
Posted: Friday, December 08, 2017 10:44 AM
Joined: 10/15/2013
Posts: 11


Son-in-law, 50 years old, has a four year history of rising PSA; 4.2 to currently 8.7. Biopsy was done 6 months ago and had no positive samples. Increase in PSA from 7.4 to current 8.7 in six months. MRI done recently; no presence of cancer. DRE shows normal size prostate. No urinary frequency day or night. No hormone therapy. Is he being misdiagnosed some how? Or is there a population that has higher than normal readings? And even if true, the rising levels are worrisome.
Pre-CK PSA 7.95; 73 grams 9/2012 CK 12/31/12 PSA 6.3 1/30/13 PSA 4.5 5/1/13 PSA 3.5 8/21/13 PSA 4.5 BIG bounce! 10/11/13 PSA 4.1 Starting back down. Whew 11/8/2013 PSA 3.9 1/29/14 PSA 3.3 5/14/14 PSA 1.5 Now we're talking! 9/12/14 PSA .9 3/24/15 PSA .4 9/15 PSA .5 3/16 PSA .5 9/17 PSA .4
radsrus
Posted: Friday, December 08, 2017 11:07 AM
Joined: 10/10/2008
Posts: 4435


This is not uncommon, and often we later find cancer, but sometimes very small amounts of cancer can cause alarming increases in the PSA and can be easy to miss out even the most aggressive saturation biopsies.

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
RobertD
Posted: Friday, December 08, 2017 4:26 PM
Joined: 10/15/2013
Posts: 11


Would a repeat MRI then be in order after another six months, perhaps a PET scan? And ultimately I suppose another biopsy.

Pre-CK PSA 7.95; 73 grams 9/2012 CK 12/31/12 PSA 6.3 1/30/13 PSA 4.5 5/1/13 PSA 3.5 8/21/13 PSA 4.5 BIG bounce! 10/11/13 PSA 4.1 Starting back down. Whew 11/8/2013 PSA 3.9 1/29/14 PSA 3.3 5/14/14 PSA 1.5 Now we're talking! 9/12/14 PSA .9 3/24/15 PSA .4 9/15 PSA .5 3/16 PSA .5 9/17 PSA .4
DXM
Posted: Sunday, December 10, 2017 12:30 PM
Joined: 9/10/2016
Posts: 20


At 73 grams, according to the famous (now retired) prostate oncologist, Dr. Strum, you are "entitled" to a PSA of .066 per gram giving you a PSA of 4.8. Whether this is valid or still accepted, I don't know. But about your biopsy - how many cores did they take? The current standard 12? If so they probably did not sample the Transition Zone, which is hard to get to and can be painful with a needle possibly going through the urethra. In my case, Color Doppler imaging showed suspicion for cancer in the Transition Zone , but on a mpMRI it was equivocal. Apparently, Transition Zone cancers are hard to evaluate with MRI. A subsequent saturation biopsy confirmed cancer (I'm a year out from cyberknife-with-boost to the known lesion - current PSA is 0.1)

DAMorris
Ron Pavluvcik
Posted: Tuesday, January 02, 2018 4:10 AM
Joined: 10/10/2008
Posts: 93


Here is another theory on your negative biopsy result:

As a doc once explained to me, regarding whether 8 or 12 samples in a biopsy should be definitive on presence of cancer:  he says, put your hand into a bag of M&M candies, and pullout 12 of them one by one......sometimes you will not pull a specific color one, say red, of which there are many in the bag....a biopsy, by the law of averages, might just miss extracting a sample or samples that contain cancer.....

Raltrt41
Posted: Friday, March 02, 2018 4:05 AM
Joined: 3/20/2013
Posts: 44


Mr Morris, My path was similar. I had a slowly rising PSA, with family history of PC, and Agent Orange exposure. I had a series of 2 ultrasounds, 12 and 16 core MRI guided biopsies , and finally an enhanced 3T MRI at Johns Hopkins.....they were all negative, but my PSA kept rising. Finally I was referred to Dr Joe Busch, at Chattanooga Outpatient/ Diagnostic Radiologists, in Chattanooga , Tn. Dr Busch did an MRI and identified an area that he thought looked like a Gleason 7.....later he did a 4 core guided biopsy of the suspicious area, and all 4 cores were positive for Gleason 3+4=7. My opinion is Dr Busch is the best diagnostic radiologist for PCa in the country, and he has studied worldwide concerning this disease. Make the trip....see Dr Busch.... Best of luck, Bill Gillespie Georgia
Emily J
Posted: Friday, May 04, 2018 7:35 AM
Joined: 5/3/2018
Posts: 2


My father had a very similar story. Turns out he had an anterior lesion. The anterior part of the prostate is NOT routinely biopsied in the blind biopsy. Furthermore, make sure the prostate MRI is performed according to a prostate protocol not pelvis protocol. It makes a big difference because the images are focused on the prostate and the radiologist can get a better view of the prostate if prostate protocol is performed. Best of luck!

Gleason 3+4 (2.5 cm anterior lesion and additional 0.5cm posterolateral lesion) PSA 12- 17 (for past 4 years)
 

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