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Opinions welcome - diagnostic tests inconsistent with each other.

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User
Posted 11 Oct 2023 at 19:20

My husband had PSA test June 22 - the reading was 3

test July 23 - shocked it was 20.15

referred on 2ww

bone scan and MRI completed blood taken 25/8 psa 5.8

 call after MDT to say suspicious area and recommend biopsy

 biopsy and psa test and DRE on 21/9

letter arising from MDT saying bilateral changes and pirads 5  stage at t2c/t3

met with consultant yesterday who said PSA from blood taken 21/9 was 2.8, so less that 2022. 

 

one core from 29 showed low grade cancer and Gleason 6

very shocked given the MRI report and PSA 20.15

dr felt the 20.15 could have been lab error, or inflammation or infection. He wasn’t treated with antibiotics so if that’s the case it would have fixed itself, also no symptoms.  The dr who did DRE hadn’t noted he did it nor his findings. 

We asked how much of prostate showed suspicious area he said most of it, and the MRI would suggest advanced cancer -   the biopsy result was inconsistent with the MRI.  

Given option of AS RP and HT/RT and will see oncologist in a few weeks for more information

the worry we have is the complete inconsistency between the MRI and biopsy 

No symptoms of infection at all.

We understand the problem of over treatment, but given MRI a fear that if radical treatment doesn’t follow that things could be worse than biopsy suggests. 

also worry whether 3 monthly PSA tests and an MRI after 12/18m is adequate. 

Currently reading all the leaflets and compiling a list of questions 

 

We know only my husband can decide but wonder what those further along think about this.

 

 

 

User
Posted 12 Oct 2023 at 15:16

Wow, what a journey for you both so far! You mustn’t know whether you’re coming or going. 

I’m not able to give you any advice I’m sorry but hopefully this will push it up the list so more people will see it and respond.

We (my husband) had differing opinions at diagnosis to do with bone mets, it was really significant as it changed pathway from treatable to curable.

Such a high PSA and then big drop would seem like infection, really hope that is the case and it has just cleared itself.

I would definitely say if you’re not going ahead with treatment then monitor it very closely to try to see just what is going on.

Best of luck to you both 

Elaine 

User
Posted 12 Oct 2023 at 15:55

Hi

I had inconsistent results too. My original diagnosis was 3+4=7, 10 positive cores from 18. I was told AS not an option and chose to go for RP. The surgical team reviewed my results and decided it was actually 3+3=6 (although they said 11 cores from 18) and therefore AS was indeed an option.

It does raise concerns doesn't it, that with something so important (to us at least), they can give you conflicting information.

I have decided to give AS a go until I at least get the first 3 month review out of the way. This will actually be 7 months from my last PSA test, as it took an age to get diagnosed once referred. My PSA rose from 5.2 in April, to 5.9 in May, so 7 months on I have no idea what to expect, but logic says it will possibly be nudging double figures if it rises at a similar rate. If so, I will ask to start treatment. I figured I should go with the most optimistic of the two opinions at first, to give myself the best chance of avoiding treatment/side effects for a while. I am assuming if they were wrong, and it is slightly more aggressive, then this will be borne out by the PSA result and I can revert to plan A.

Not sure if this helps, but wish you both well with your decision making and subsequent monitoring/treatment.

Ian.

User
Posted 12 Oct 2023 at 16:08
I feel for you given so much inconsistent information.

Firstly, prostate cancer, unless very advanced, does not give any symptoms or pain.

The very high reading was, as the Dr suggested, either a lab error, or more likely a temporary UTI that cleared up.

The MRI results are fairly good at seeing lesions and suspicious areas that should then guide the surgeon to take the core samples.

I would certainly be asking the oncologist/urologist to explain the significant difference between the MRI and the Biopsy results.

However, remember that 12% of men get PCa and if caught early enough it is very curable. If there is any cancer there then it is not going to go away and so you should be considering what treatment options he/you would prefer if you have the choice. But definitely interrogate them at your next meeting.

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User
Posted 12 Oct 2023 at 15:16

Wow, what a journey for you both so far! You mustn’t know whether you’re coming or going. 

I’m not able to give you any advice I’m sorry but hopefully this will push it up the list so more people will see it and respond.

We (my husband) had differing opinions at diagnosis to do with bone mets, it was really significant as it changed pathway from treatable to curable.

Such a high PSA and then big drop would seem like infection, really hope that is the case and it has just cleared itself.

I would definitely say if you’re not going ahead with treatment then monitor it very closely to try to see just what is going on.

Best of luck to you both 

Elaine 

User
Posted 12 Oct 2023 at 15:55

Hi

I had inconsistent results too. My original diagnosis was 3+4=7, 10 positive cores from 18. I was told AS not an option and chose to go for RP. The surgical team reviewed my results and decided it was actually 3+3=6 (although they said 11 cores from 18) and therefore AS was indeed an option.

It does raise concerns doesn't it, that with something so important (to us at least), they can give you conflicting information.

I have decided to give AS a go until I at least get the first 3 month review out of the way. This will actually be 7 months from my last PSA test, as it took an age to get diagnosed once referred. My PSA rose from 5.2 in April, to 5.9 in May, so 7 months on I have no idea what to expect, but logic says it will possibly be nudging double figures if it rises at a similar rate. If so, I will ask to start treatment. I figured I should go with the most optimistic of the two opinions at first, to give myself the best chance of avoiding treatment/side effects for a while. I am assuming if they were wrong, and it is slightly more aggressive, then this will be borne out by the PSA result and I can revert to plan A.

Not sure if this helps, but wish you both well with your decision making and subsequent monitoring/treatment.

Ian.

User
Posted 12 Oct 2023 at 16:08
I feel for you given so much inconsistent information.

Firstly, prostate cancer, unless very advanced, does not give any symptoms or pain.

The very high reading was, as the Dr suggested, either a lab error, or more likely a temporary UTI that cleared up.

The MRI results are fairly good at seeing lesions and suspicious areas that should then guide the surgeon to take the core samples.

I would certainly be asking the oncologist/urologist to explain the significant difference between the MRI and the Biopsy results.

However, remember that 12% of men get PCa and if caught early enough it is very curable. If there is any cancer there then it is not going to go away and so you should be considering what treatment options he/you would prefer if you have the choice. But definitely interrogate them at your next meeting.

User
Posted 12 Oct 2023 at 16:51

Hi,thank you for replies.

We did ask the urologist about the inconsistency and there was no real explanation save to say the 20.15 could be an error. Not likely that biopsy missed anything as the suspicious area was most of the prostate. 

seeing oncologist next week will see what they think. 

 

 
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