Should I ask for a scan?

Hi Neil.

Your rising PSA is obviously a concern to you, as was mine.

I requested a template biopsy after a trus biopsy was initially offered. MPMRI was carried out prior to the biopsy, which assisted in targeting suspicious areas of the prostate.

There are a number of reasons for a raised PSA, not just prostate cancer. However, a template biopsy will give you a definitive answer.

All the best,

Neil.

The first step in your journey - hopefully towards a happy destination - should be to request / insist on a referral to urology and then a multi-parametric MRI scan at 3T resolution. Double check on the resolution!

There does seem to be a tendency towards indolence / ignorance regarding prostate cancer with many GPs, so the fact that you have had a raised PSA over a prolonged period should have rung alarm bells ages ago.

Loads of us here have been symptom-free, yet have cancer. I hope you are not one of us, but please get it checked out.

Best of luck.

Cheers, John.

It's not usually about the urologist - it is down to a) whether your hospital has the equipment b) whether mpMRI is delivered to an adequate standard and c) whether your CCG is willing to pay for it. If the CCG is a problem, going private helps but only if the local NHS hospital has the equipment as private hospitals don't have mpMRI. If your local hospital doesn't have it, or it isn't to the PROMIS standard, you can ask to be referred elsewhere.

Click on the link to view an interactive map of mpMRI facilities / standards:

https://prostatecanceruk.org/about-us/what-we-think-and-do/mpmri

Hi Neil,

At least you got your referral to urology at last. If your GP is as ignorant as he seems to be of your potential cancer risk, you will probably not be on the “two weeks” to consultant route. Do you know if you are?

If you are not, and as you mentioned before about paying for an MRI, if there is a mammoth waiting list, it might be worthwhile investing £200 odd quid to see the best urological consultant in your area privately. He will know where the 3T Hi-Res scanners are and should be able to refer you for an mpMRI on the NHS. Do not accept a biopsy before one. And then avoid a TRUS biopsy if at all possible.

Although in my case the NHS has been brilliant - only post-diagnosis - it was not without quite a bit of pro-activity on my part.

Cheers, John

Edited by member 04 Sep 2018 at 01:47  | Reason: Not specified

ndav123 - Thanks again for the info. I think I’d feel most reassured having a scan with a higher res 3T mpMRI machine, but as my local hospital only has a standard mpMRI scanner I suspect I might just be offered that. If I only get offered a TRUS biopsy I won’t be happy, seems too much like a stab in the dark to me. I’ll just have to play it by ear and see what’s said.

"Two friends told me not to have a TRUS biopsy, as they both had to have a template biopsy afterwards. Although in fairness, if there is a large amount of cancer, a 1.5T scan and the TRUS biopsy would most likely pick it up anyway."

It isn't just if there is a large amount of cancer. If the mpMRI identifies areas of concern at PIRAD 3-5 then a TRUS biopsy can be used to sample the suspect areas. Template biopsy is more important in cases where the scan is indeterminate (or cannot be done for medical reasons perhaps) and TRUS would thus be a shot in the dark.

As long as a scan is not allowed to rule out biopsy, and a TRUS biopsy is never relied upon without a scan, men will be diagnosed correctly. 3T / 1.5T is a bit of a red herring and TRUS v template is an unwinable argument as each case is different.

Edited by member 04 Sep 2018 at 18:57  | Reason: Not specified

All the stressing about what might or might not be offered and what you have a right to as best pathway can be blown out of the water as there are always exceptions. My OH was referred with an almost normal PSA of 3.1, he got a urology appointment through the post and turned up to discover that it was a TRUS biopsy. He had it and then went to work - no warning, no information, no problems, no worrying about it. He was diagnosed with a T1 G7(3+4) and THEN they did the scans. Good job it wasn't the other way round as the scan was completely clear - if he had had that first, he may not have been diagnosed. When they operated, it was in every bit of his prostate and into his bladder - not all prostate cancers show on scans.

Why not give the urology department a ring and ask them what the normal pathway is there? Or contact your local PC support group - they will probably know.

But do remember Lynns OH was scanned in 2009 and things have moved forward a long way with the introduction of MpMRI scans being a game changer. The trial of the 1.5T machines was very positive of course and now with a 3T magnet things have improved again. PCUK are continuing to fund research and promote better practice and hopefully progress will continue. 

Good luck

Clare

LynEre - Good grief Lyn, three men in your life going through a similar thing, I now see where your knowledge and insights are coming from, I hope all is still going well.

Peter sans Prostate - Thank you for responding. Very observant of you to spot the strange drop in the psa readings, it was that drop that took the heat off the whole thing. Strangely enough, after my first reading of 4.8 I was referred to the urologist who after a flow test and DRE asked me why I was even there! That shook me initially as I’d been referred by my GP, but it made me feel like I was wasting their time. Although my levels are rising slowly, it is in the back of my mind now that something might be amiss, so another referral to see the urologist is probably the right thing. I’m just hoping I get the appropriate tests in the right order and I can get it sorted one way or another - we’ll see.

But you did ask!

Chill out, and wait for things to take their course. There are much, much, worse cancers, and hopefully you haven’t even got one!

Cheers, John

It can depend on whether you're referred as urgent. If urgent cancer it should be 14 days.  I read that Stephen Fry and Bill Turnbull created a rush for tests.  You could ask if your GP referred it as urgent and ask him why not.  Going down the private route might end up expensive.

not necessarily - it seems the GP is following the advice of the urologist. For all we know, the uro may have given the GP a threshold for re-referral (10  being the magic number oft quoted here) and once you are under the care of urology, the cancer pathway targets from GP to specialist are irrelevant. I think Neil needs to clarify with his GP or the urology department whether this is a new referral or a re-referral. 

Someone here in the last week said he paid £1500 for a 3T scan, and a friend paid the same for one a couple of years ago. Don’t know what resolution his was.

I think you are getting spooked unnecessarily - your PSA is fairly steady* rather than showing a rapid rise so 10 weeks isn't a long time to wait and it means you can get another PSA test just before Christmas which may allay your worries or increase your weaponry when asking for a scan. 

If you are very anxious, why not just call the urology department or the urologist's secretary and ask whether the appointment can be brought forward?

*Your doubling time is more than 3 years and your PSA increase is less than 0.1 per month which I suppose technically could simply be down to enlargement. That may be part of why your appointment is 10 weeks away. 

Edited by member 17 Oct 2018 at 23:25  | Reason: To add info