Raised PSA on first test

It's been over a year since I posted my results which at the time I was obviously very happy about. things now however have tken a bit of a turn. A few weeks ago I decided to do something about my flow other than continuing taking Tamsulosin and Finasteride which I really don't like taking. I got a referral to see if I was a suitable case for a urolift procedure which involved going private through my work PHI scheme.

I had the initial referral and was then booked in for a flexible cystoscopy to check if I had a medial lobe which might prevent the procedure from being possible. That went ok but my consultant has strongly recommended that I have a trans perinial template (fusion) biopsy because he wants to satisfy himself that the TRUS biopsy results were accurate. He has indicated that with the PSA results I have been getting (between 5 and 9) and the relative size of my prostate that there is some cause for concern about the results of the previous biopsy.

I have agreed and also got the MRI image and records from the NHS hospital so that a template can be produced but I was more than a little horrified about the records which described the following.

"The prostate measures 50 x54x 30mm

36 mm maximum diameter lesion arising from the peripheral zone at the mid and base of both sidesinfiltrates the transitional zone and shows restricted diffusionin keeping with significant tumour. No extension beyond the prostate gland. Intermediate suspicion of focal prostate cancerat the mid prostate level within the transitional zone on both sides.

Normal seminal vesicles, No enlarged pelvic lymph nodes, No malignant bone marrow signal change

Conclusion

Strong suspicion of significant tumour within the peripheral zone on both sides with intermediate suspicion of transitional zone tumour on both sides

biopsy is recommended. If biopsy confirms carcinoma the provisional radiological staging would be T2c NO MX"

This was before the TRUS biopsy which was the 12 cores and came back on the Histology report as No malignancy, Plan: PSA surveillance

My PSA has remained "stable" within a range of 5-9 since my first high level around 20 months ago but I now feel pretty concerned about the above which is probably why they didn't tell me exactly what was contained in the results. I was keen to get a further PSA test done before the biopsy and am due to go for that later this morning and have the biopsy booked for 10th August. I can see why my current private urologist wants to investigate this further but I do feel a bit angry that the biopsy I had to endure really doesn't seem fit for purpose and I now have to give my poor old prostate another battering. I'm also concerned another year+ has gone by and if there was malignancy then this will presumably worse now.

If anyone can offer any advice or share their similar experiences it would be appreciated!

Thanks

Hi LynEyre and thanks for the response.

I was certainly under the impression that the cores were taken from the "grey area" but my new uro who is very highly respected because I did my research before choosing him has indicated that a TRUS rectal biopsy is a bit of a lucky dip compared to a template fusion biopsy and he is concerned about doing a urolift procedure whilst not entirely convinced that my first biopsy is a conclusive result. It does seem unlikely that a lesion measuring up to 36 mm could be missed in a prostate sized 50mm x 54mm x 30mm but I kind of share his concern about the initial view that there is a strong suspicion of a significant tumour.

I think I need to have the biopsy again just to if nothing else get my initial result validated. I had the blood test earlier so at least I will have the result of that back before I have the procedure and that if not raised further should hopefully reassure me I don't need to expect the worst. If it is negative again then at least I can look forward to the urolift which apparently can be done on me as I don't have a significant medial lobe. Fingers firmly crossed!

I would indeed. I am generally a positive person but do fear the worst. I will post by PSA result when I get it early next week. That's the bit I can't get my head around, if there is such a significant lesion then why has my PSA not been ever increasing? If the PSA isn't a reliable factor in determining whether or not my lesion was getting any worse then why was active surveillance the suggested course of action?!

Also, it could have grown significantly bigger in the 15 months since I had the MRI and may not now be contained. Or I suppose if it is still the same size and benign then that would explain a similar PSA.

So may questions whirring around in my head!