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Worrying PSA Test

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User
Posted 09 Nov 2020 at 11:49

I'm new here so hello everyone!

I had a routine PSA test last week (my first ever) which came back 17.5. This was a bit shocking as the indicated "normal"  range on the chart was 0 - 4. So the Dr has put me on fast track appointment and I have an MRI scan booked for Friday 13th(!) followed by a consultation and DRE/Biopsy the following week. 

Upon researching best practice I have realised that the "Gold Standard" for diagnostics is an mp-MRI scan with a 3T machine, followed if necessary by a trans-perineal biopsy. Unfortunately I'm in York and my local NHS only does standard MRI scans and TRUS biopsy. I queried this with the nurse and she said I could refuse the TRUS biopsy but that there is a waiting list of 3-4 months for TP Biopsies due to Covid. It seems odd to me as the last thing anyone wants at this time is someone with sepsis needing hospital care.

I guess I'm looking for some advice. My initial inclination was to book a private mp-MRI before my initial consultation to give a clearer picture of any issues. I suppose if it looks suspicious I could go on to have a private TP Biopsy. Or given that it's a short wait, should I just have the standard MRI, see what the consultant says and take it from there?

I know I probably shouldn't panic unduly at this stage but if something is wrong then it seems to make sense to have the clearest picture possible for diagnosis?

Thanks for reading!

Jon. 

User
Posted 09 Nov 2020 at 12:50

Hi Jon, psa is a bit high it needs investigating. I would not be paying for anything private at the moment unless you have insurance or a lot of spare cash. York NHS are not offering the latest technology but they are offering you good enough diagnostics. I think I would just accept what is offered. I had trus it is a bit worrying but it isn't too big a risk. 

Dave

User
Posted 09 Nov 2020 at 17:49

DawnRazer,

Sorry you're here. 1.5T mpMRI is fine for this stage of diagnosis. Some centres are now doing this with 3T bi-parametric MRI (without contrast), which they argue is just as effective. (RBH@Reading is an example.)

There's some confusion over TP biopsies here, because there are two types.

You want what's called an LATP (Local Anesthetic Transperineal) biopsy, if the MRI indicates a biopsy is necessary. If your hospital doesn't do those, then it's behind the times. It takes same time as a TRUS, so it wouldn't have a longer waiting list, and it's most unlikely any hospital would do both procedures - LATP replaces TRUS. These are both outpatient procedures.

The TP biopsy with a waiting list will be a template biopsy which is done (usually) under general anesthetic, so it needs theatre time with a theatre team. That isn't usually necessary as a first biopsy, unless the MRI shows nothing while disease is strongly suspected and a mapping biopsy is required (a form of template biopsy), or the MRI shows disease in the anterior and the hospital only otherwise has TRUS (which can't reach the anterior).

You don't need to use your local hospital. You can ask your GP to refer you to any hospital in England, although you'll have to work out how to travel there and back. If you are choosing a distant hospital, you probably want to choose one of the main cancer centres. The Christie in Manchester is one, but I don't know if it's your nearest.

User
Posted 10 Nov 2020 at 13:39
Can you delete the name of the consultant or the moderators can do it for you if you are unsure how - it is against the rules of the forum to name medical staff.

If they are suggesting biopsy on the same day as the scan, do check whether it is an image guided biopsy which is rather better than standard TRUS. I would be hesitant to cancel or refuse anything in the current climate, if it is going to cause unnecessary delays to diagnosis.

I think you probably live about 15-20 minutes from me.

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

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User
Posted 09 Nov 2020 at 12:50

Hi Jon, psa is a bit high it needs investigating. I would not be paying for anything private at the moment unless you have insurance or a lot of spare cash. York NHS are not offering the latest technology but they are offering you good enough diagnostics. I think I would just accept what is offered. I had trus it is a bit worrying but it isn't too big a risk. 

Dave

User
Posted 09 Nov 2020 at 13:07

Hi Jon,

Welcome, before I answer, may I ask..How old ? Any symptoms and why a routine test ?

You can view my profile, which includes info on  my older brother who incidentally had had  a PSA value of 18 .   Circa 3 when he decided on RT.

Regards Gordon

User
Posted 09 Nov 2020 at 13:31

Hi Gordon,

 

Thanks for replying.

I'm 62 and generally fit. I was being investigated for stubborn back and rib pain so dr. wanted blood tests to screen for Myleoma and PCa. All bloods apart from PSA came back normal and back and rib pain has since improved so hopefully not a factor. She didn't do a DRE at the time. I sometimes have to get up for the loo once in the night and flow rate is not very good but I've been like that for many years. No other symptoms and apart from obvious stress I feel fine. 

Jon.

User
Posted 09 Nov 2020 at 13:36

Hi Dave,

Thank you.

I have read that the risk of sepsis is 2-4 percent for TRUS as opposed to 0.2 percent for TP biopsy. I just wouldn't want to take the risk in the current Covid climate.

Jon.

User
Posted 09 Nov 2020 at 14:55

You might be able to elect to travel to wherever there is a 3T mp-MRI machine, but if it sees a bloody big tumour, then it’s a moot point whether to have a TRUS or transperineal biopsy, as they will both detect cancer, although I and several friends advise against the former.

They give you a course of antibiotics whatever biopsy you have, and the problem with either is if you get sepsis and end up in hospital on intravenous antibiotics for ten days.

Anyway, it’s all got to be done, so come back here when you have the MRI (of whatever resolution) result.

If there is a tumour showing you should have a bone scan as well.

Best of luck.

Cheers, John.

Edited by member 09 Nov 2020 at 14:55  | Reason: Not specified

User
Posted 09 Nov 2020 at 15:39

Yes, I think those figures are about right. I can understand your desire to avoid the risk with covid being a complicating factor. 

Dave

User
Posted 09 Nov 2020 at 17:29

Originally Posted by: Online Community Member
the "Gold Standard" for diagnostics is an mp-MRI scan with a 3T machine

 

It might be gold standard but you will have hell on trying to get a 3T machine - I think there are still only two 3T scanners in England? What you want is to be at a hospital working to Promis standard - PCUK has an interactive map showing where the hospitals are. Promis standard is mpMRI with 1.5T. 

We have a small number of members here from York / Selby and most seem to opt for treatment at St James' Hospital anyway so you may be as well just asking your GP to refer you to Leeds rather than York now. Not sure that going private is going to be much quicker.  

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

User
Posted 09 Nov 2020 at 17:49

DawnRazer,

Sorry you're here. 1.5T mpMRI is fine for this stage of diagnosis. Some centres are now doing this with 3T bi-parametric MRI (without contrast), which they argue is just as effective. (RBH@Reading is an example.)

There's some confusion over TP biopsies here, because there are two types.

You want what's called an LATP (Local Anesthetic Transperineal) biopsy, if the MRI indicates a biopsy is necessary. If your hospital doesn't do those, then it's behind the times. It takes same time as a TRUS, so it wouldn't have a longer waiting list, and it's most unlikely any hospital would do both procedures - LATP replaces TRUS. These are both outpatient procedures.

The TP biopsy with a waiting list will be a template biopsy which is done (usually) under general anesthetic, so it needs theatre time with a theatre team. That isn't usually necessary as a first biopsy, unless the MRI shows nothing while disease is strongly suspected and a mapping biopsy is required (a form of template biopsy), or the MRI shows disease in the anterior and the hospital only otherwise has TRUS (which can't reach the anterior).

You don't need to use your local hospital. You can ask your GP to refer you to any hospital in England, although you'll have to work out how to travel there and back. If you are choosing a distant hospital, you probably want to choose one of the main cancer centres. The Christie in Manchester is one, but I don't know if it's your nearest.

User
Posted 10 Nov 2020 at 11:56

Thank you all very much for taking the time to reply, I really appreciate it.

Sounds like I might be getting too hung up on the 3T mp-MRI but I got it from this article - prostate-cancer-diagnosis-the-pathway. I will wait and see what the consultant says next week after the scan and if a biopsy is necessary I'll request a LATP which will mean refusing the TRUS biopsy done on site the same day. I do know that Leeds has a good reputation for PCa and have the name of a consultant there so I might request to be transferred. It's only 30 mins away.

Thanks again!

Edited by member 10 Nov 2020 at 16:22  | Reason: Not specified

User
Posted 10 Nov 2020 at 13:39
Can you delete the name of the consultant or the moderators can do it for you if you are unsure how - it is against the rules of the forum to name medical staff.

If they are suggesting biopsy on the same day as the scan, do check whether it is an image guided biopsy which is rather better than standard TRUS. I would be hesitant to cancel or refuse anything in the current climate, if it is going to cause unnecessary delays to diagnosis.

I think you probably live about 15-20 minutes from me.

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

User
Posted 10 Nov 2020 at 22:32

Hi 

Thanks for background info.  Considering you have had only a single PSA test, I agree discuss findings from MRI before any biopsy.   

Regards Gordon

 
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