Should I ask for a scan?

User

Posted 02 Sep 2018 at 10:26

Hi,

New here, 63 years old with no family history of prostate cancer and zero symptoms but a slowly rising psa levels. Had my first psa test four years ago, which I didn’t ask for but it was done by mistake during a well man clinic assessment. The initial 4.8 got me reffered to a urologist who said the prostate felt soft and smooth so watch and wait was recommend. Since then the results have been 4.8, 5.3, 4.2, 5.1, 6.4 with the last two reading being one year apart. My doctor wants to see me again for another DRE, but I’m wondering if I should now insist for an mpmri scan as I’m getting a little concerned - I would be prepared to pay if the nhs won’t cover it. When I say zero symptom, I mean I sleep through 8 hours without needing to get up at all and have a flow like a race horse :-)

Any advice much appreciate.

User

Posted 02 Sep 2018 at 19:41

I was in similar circumstances to you similar age, no obvious symptoms My brother had PC and I requested a PSA test for peace of mind. The start figure was 6.4, told not to worry etc. Tested every six months for the next four years and it crept up each time Even at a reading of 9.8 I was told not to be concerned, 'slow rate of increase' keep monitoring.

The next test was 10.4 and the GP's responses were going along the same lines and I asked for further tests. Urology Consultant, following by biopsy, All samples were positive for cancer and prostate removed within 6 weeks. (in June this year) As far as I know it hasn't escaped elsewhere but in retrospect I feel that it was left far too long, I was too complacent to go along with what the Doc said without doing my own research and finally, that I will be lucky if it was caught just in time.

I would say insist in further checks to give you some certainty and hopefully the chance (if cancer is found) to have some of the lesser treatments before it gets to the high impact stuff.

User

Posted 16 Oct 2018 at 09:16

Colind - All the very best, hope all goes well.

Edited by member 16 Oct 2018 at 09:17 | Reason: Not specified

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User

Posted 02 Sep 2018 at 14:39

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.

User

Posted 02 Sep 2018 at 15:30

Hi Neil,

The intervals between your PSA tests appear to have been long and I would have thought a further DRE and PSA test with in 3 months of the last one could be helpful. There are a number of reasons why PSA can be slightly higher than when previously tested, an infection, sex or certain strenuous activities some 24 hours before blood is taken and also as a man ages his secretion of PSA increases slightly and his Prostate may become excessively enlarged. I think it most unlikely you will be offered a template biopsy as yet based on what you have told us but your GP may refer you to a urologist. Should this be the case I think you will have another PSA and DRE and maybe be offered an MRI scan.

Edited by member 02 Sep 2018 at 15:39 | Reason: Not specified

Barry

User

Posted 02 Sep 2018 at 18:51

Hi 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.

User

Posted 02 Sep 2018 at 19:39

Hi there,

my husband had a PSA of 3.56 at his company medical and no symptoms when he was 53.

the BUPA doctor and the GP agreed he needed to see a urologist.

He saw the urolologist via BUPA who advised an MpMRI scan. The one he had was a 1.5 Tesla magnet ( we knew nothing at this time and were just doing what were told). This can did pick up an anomoly on the prostate which was targeted during a template biopsy and led to the cancer diagnosis.

so a referral to a urologist seems a good plan. Prostate cancer UK has done a freedom of information act on the location / use of the MpMRI scanners in the UK. This can help you decide which clinic to attend should you have a choice under the new choices system.

good luck

Clare

User

Posted 02 Sep 2018 at 19:41

I would say insist in further checks to give you some certainty and hopefully the chance (if cancer is found) to have some of the lesser treatments before it gets to the high impact stuff.

User

Posted 02 Sep 2018 at 21:16

ndav123, Old Barry, Bollinge, Claret, stukno

Thank you all for taking the time to reply, it’s very much appreciated. I would like to insist on a multi parametric MRI scan at 3T resolution but if the urologist refuses, because our local hospital doesn’t do it, what can I do? Could I still get one privately if I pay?

User

Posted 02 Sep 2018 at 21:49

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

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 02 Sep 2018 at 22:43

LynEyre - Many thanks for the help and link. Looks like my local hospital does do mpMRI but not to PROMIS standards, is this a big issue? If it is, what do you think are the chances of being referred to my nearest PROMIS standard hospital which is 35 miles away?

User

Posted 03 Sep 2018 at 11:56

Just back from seeing my GP. After the DRE he said prostate feels small and smooth but still referring me to the urologist as the rising psa is a concern. I asked if I could opt for an mpMRI before a biopsy but he suggested an MRI would be unlikly to reveal anything on a small smooth prostate so should go straight for a biopsy - I’m not sure about this, is this right or am I getting fobbed off?

User

Posted 03 Sep 2018 at 13:11

You are being fobbed off - the size of the prostate doesn't affect the ability of a scan to show cancer. Very small clusters of prostate cancer cells could be missed in any type of scan but then a biopsy could miss those as well.

But see what urology say before you prepare for a fight - your GP could just be a little bit behind the times.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 03 Sep 2018 at 14:48

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

User

Posted 03 Sep 2018 at 19:47

LynEyre - I suspect you’re probably right about the GP just being bit behind current thinking on mpMRI, I’ll reserve judgment until I hear what the urologist has to say.

Bollinge - Thanks for the tips. To be honest, I didn’t even think to ask how long the waiting list might be but least I’m now in the loop. I’ll definitely enquire about a 3T scan whenever I get to see the specialist, I suppose I could give it a few weeks then chase the GP for a likely date.

User

Posted 03 Sep 2018 at 20:25

No!!! Don't give it a few weeks ... a fortnight max :-/

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 04 Sep 2018 at 00:11

Hi Neil.

I have a small prostate with normal DRE... according to exam May 2018. Four weeks later - different doc - my prostate felt firm on one side. Who was right? Subsequent Mpmri did show 'insignificant' shadow areas. Template biopsy was positive. Go with your own feelings and don't be fobbed off.

In 2015 my psa was 6.1 and mri normal. I will be having this mri looked at again, once my surgery is out of the way.

All the best

Neil

User

Posted 04 Sep 2018 at 07:42

LynEyre - Ok I’ll chase it up if I haven’t heard anything after a couple of weeks - I guess I’m just not used to being pushy with the NHS.

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.

User

Posted 04 Sep 2018 at 10:12

Originally Posted by: Online Community Member

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.

Do you know your local scanner is only 1.5 Tesla resolution?

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.

Cheers, John

User

Posted 04 Sep 2018 at 17:06

Bollinge - To be honest, the only detail I can find on my local hospital is that it has two mri scanners. The map that LynEyre kindly provided the link for simply states that mpMRI is provided but not to PROMIS standard - not quite sure what that means though.

User

Posted 04 Sep 2018 at 18:47

You hsve been misled by rhetoric - Promis standard has nothing to do with 1.5T or 3T. In fact, the Promis project was done with 1.5T machines.

Promis standard is about offering mpMRI before biopsy rather than after. Some of the hospitals that have mpMRI but not to standard may only offer it after biopsy or in non-standard cases such as high PSA with low volume kiw grade cancer detected at biopsy.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 04 Sep 2018 at 18:55

"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

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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