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PSA rise to 4 - hereditary prostate cancer

User
Posted 19 Jan 2022 at 20:14

Hi,
I’m new here. A concerned 50 year old from a family where all my male relatives have had prostate cancer - father, uncle, grandfather etc. - some got it in their 40s. 
So my PSA has been checked for the past 10 years. It’s been a healthy 0.50 - 0.60 but then went up to 2 when I started a bladder cancer treatment a couple of years ago. Now I’ve finished with all that and am NED but my PSA has now gone to 4 in three months. 
A couple of lesions were picked up on MRI too as part of the bladder cancer follow up. Both were PIRADs 4/5 but biopsies showed nothing. 
My GP wants to wait a few months repeat. Is that reasonable? 
Thanks for any advice!

User
Posted 19 Jan 2022 at 20:14

Hi,
I’m new here. A concerned 50 year old from a family where all my male relatives have had prostate cancer - father, uncle, grandfather etc. - some got it in their 40s. 
So my PSA has been checked for the past 10 years. It’s been a healthy 0.50 - 0.60 but then went up to 2 when I started a bladder cancer treatment a couple of years ago. Now I’ve finished with all that and am NED but my PSA has now gone to 4 in three months. 
A couple of lesions were picked up on MRI too as part of the bladder cancer follow up. Both were PIRADs 4/5 but biopsies showed nothing. 
My GP wants to wait a few months repeat. Is that reasonable? 
Thanks for any advice!

User
Posted 20 Jan 2022 at 10:25
Template takes a lot more samples from a wider area so is more likely to catch something in its net.
User
Posted 20 Jan 2022 at 10:29
The Template biopsy is one where they use a grid (template). Where this happens before MRI many needles may be used so that the Prostate is covered in a uniform patten so any tumour over a predetermined size is hit. When the Template biopsy is done after MRI fewer cores may be taken and these concentrated on suspicious areas of concern, but still using the grid. This grid is used to plot where the needles take cores, a bit like a map reference. The TRUS biopsy is more random.
Barry
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User
Posted 19 Jan 2022 at 22:57
Sounds like they are doing all they can. Was it a template or trus biopsy? If you haven't had a template biopsy maybe ask for one next time?
User
Posted 20 Jan 2022 at 08:36

Thanks Francij. I’ve had two lots of biopsies after mpMRI of the bladder found the lesions (last year and the year before). Think they were TRUS (Koelis?). They only took 6 biopsies. Is that normal? Is template where they take many more - also random ones?

Yes, it looks like they are on the ball but with my family history and bladder cancer history, I’ve become a bit nervous. 

Edited by member 20 Jan 2022 at 08:46  | Reason: Not specified

User
Posted 20 Jan 2022 at 10:25
Template takes a lot more samples from a wider area so is more likely to catch something in its net.
User
Posted 20 Jan 2022 at 10:29
The Template biopsy is one where they use a grid (template). Where this happens before MRI many needles may be used so that the Prostate is covered in a uniform patten so any tumour over a predetermined size is hit. When the Template biopsy is done after MRI fewer cores may be taken and these concentrated on suspicious areas of concern, but still using the grid. This grid is used to plot where the needles take cores, a bit like a map reference. The TRUS biopsy is more random.
Barry
User
Posted 20 Jan 2022 at 12:56

Thanks Barry. That is really helpful. My last biopsies were from an awkward area in the lowest part of the apex. The surgeon said it would be difficult to biopsy. Didn’t fill me with much confidence. 

But, I suppose if I had a template biopsy, as you describe, it might pick up things that don’t need attention. 

I think I’ll go with the flow and give it some time before a new PSA test. Presumably things don’t happen that quickly?

 
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