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Brothers diagnosis

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User
Posted 07 Jul 2025 at 22:49

Hi all.

I went through the initial stages of PCa diagnosis a few months ago and got the all clear.

Last week my older brother (I'm 60 he is 63) told me his PSA was 84. 

He was given a referral to urology and immediately got a call from a "patient navigator" who would guide him on his journey.

Today he saw the urology consultant who did a DRE.  He said from what he could feel, my brother has prostate cancer.

He said there was no need for an MRI scan and gave him hormone tablets, but told him not to start taking them till he had had a biopsy next Monday.

I'm really confused as this is not anything like I experienced at the same hospital only a few months ago. 

I thought an MRI scan would show the extent of the problem in his prostate. 

It's also different to the way things seem to be done after reading stories on here.

It's concerning that he was given a patient navigator before he had even seen anyone at hospital. 

Am I being paranoid, or is there something I may be missing in the way my brother is being treated? 

Seems all the things I thought would happen haven't. 

Any advice or explanation very welcome please.

Mick 

 

 

User
Posted 08 Jul 2025 at 01:30
Hi Mick,

Good that you are considered clear of PCa but are being monitored.

As regards your brother, a PSA in the eighties means there is a strong chance of PCa but is not always the case. However, the DRE assessment would have added to this probability. Nowadays, in this situation is more likely that an MRI would be given before biopsy. Interestingly, when I had my diagnosis back in 2007 with a PSA of 17.6, I had a TRUS biopsy before an MRI scan followed by a bone scan which was quite usual at that time. However, not every hospital works the same way or may proceed differently on the basis of how an individual presents. This could be the case with your brother and a decision taken to omit the MRI.

Barry
User
Posted 08 Jul 2025 at 07:52

Hi Mick,

As Barry says there have been cases of high PSAs that have been caused by none cancerous conditions, but unfortunately, normally it is an indicator of clinically significant prostate cancer.

I can't understand why thy aren't doing an MRI. I thought mpMRI scan images showed any suspicious areas, and whether they were prostate confined. I also believe that they use the images to guide and target the biopsy. A targeted biopsy must be more accurate than using a fixed standard template?

This research seems to support my view:

https://pubmed.ncbi.nlm.nih.gov/31022301/

It concludes:

[Among the diagnostic strategies considered, the MRI pathway has the most favourable diagnostic accuracy in clinically significant prostate cancer detection. Compared to systematic biopsy, it increases the number of significant cancer detected while reducing the number of insignificant cancer diagnosed]

Does your brother know what sort of biopsy he's getting, TRUS, which I think are being faded out, or LATP biopsy done under local anaesthetic or GA?

If your brother is diagnosed with PCa it slightly increases your risk. Is there any other family history of the disease? My dad and younger brother had it, and I have advised my two lads, who are now in their forties, to be aware that they may be more at risk.

My PCa experience has shown me how important it is to have an accurate first biopsy. It's on that that, any further treatments are decided. If my boys ever need diagnosing, I'd advise them to have an MRI and LATP under GA.

I hope his biopsy results are favourable. It's great to see that you're doing your best to look after his interests.👍

Edited by member 08 Jul 2025 at 08:15  | Reason: Typo and additional text

User
Posted 08 Jul 2025 at 08:28
He will be having a transrectal under local the same as I had.

Maybe as his prostate is very large and knobbly they can forego the MRI scan and just biopsy blind as the targer area is the whole of the prostate.

But the obvious concern is has the capsule been breached.

Time will tell.

My concern about any increased risk to me is that when I had my tests we didn't know about my brother. I know that would probably have made a slight difference to the way I was assessed, but not much.

I also have it in my mind that they only took three samples from two suspect areas of the prostate. That seems quite a low number based on other people's experience. And the phrase keeps on playing in my mind; "They can't tell you that you don't have cancer, just that they didn't find it in the tissue they tested "

Thankyou both for the replies so far.

Mick

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User
Posted 08 Jul 2025 at 01:30
Hi Mick,

Good that you are considered clear of PCa but are being monitored.

As regards your brother, a PSA in the eighties means there is a strong chance of PCa but is not always the case. However, the DRE assessment would have added to this probability. Nowadays, in this situation is more likely that an MRI would be given before biopsy. Interestingly, when I had my diagnosis back in 2007 with a PSA of 17.6, I had a TRUS biopsy before an MRI scan followed by a bone scan which was quite usual at that time. However, not every hospital works the same way or may proceed differently on the basis of how an individual presents. This could be the case with your brother and a decision taken to omit the MRI.

Barry
User
Posted 08 Jul 2025 at 07:52

Hi Mick,

As Barry says there have been cases of high PSAs that have been caused by none cancerous conditions, but unfortunately, normally it is an indicator of clinically significant prostate cancer.

I can't understand why thy aren't doing an MRI. I thought mpMRI scan images showed any suspicious areas, and whether they were prostate confined. I also believe that they use the images to guide and target the biopsy. A targeted biopsy must be more accurate than using a fixed standard template?

This research seems to support my view:

https://pubmed.ncbi.nlm.nih.gov/31022301/

It concludes:

[Among the diagnostic strategies considered, the MRI pathway has the most favourable diagnostic accuracy in clinically significant prostate cancer detection. Compared to systematic biopsy, it increases the number of significant cancer detected while reducing the number of insignificant cancer diagnosed]

Does your brother know what sort of biopsy he's getting, TRUS, which I think are being faded out, or LATP biopsy done under local anaesthetic or GA?

If your brother is diagnosed with PCa it slightly increases your risk. Is there any other family history of the disease? My dad and younger brother had it, and I have advised my two lads, who are now in their forties, to be aware that they may be more at risk.

My PCa experience has shown me how important it is to have an accurate first biopsy. It's on that that, any further treatments are decided. If my boys ever need diagnosing, I'd advise them to have an MRI and LATP under GA.

I hope his biopsy results are favourable. It's great to see that you're doing your best to look after his interests.👍

Edited by member 08 Jul 2025 at 08:15  | Reason: Typo and additional text

User
Posted 08 Jul 2025 at 08:28
He will be having a transrectal under local the same as I had.

Maybe as his prostate is very large and knobbly they can forego the MRI scan and just biopsy blind as the targer area is the whole of the prostate.

But the obvious concern is has the capsule been breached.

Time will tell.

My concern about any increased risk to me is that when I had my tests we didn't know about my brother. I know that would probably have made a slight difference to the way I was assessed, but not much.

I also have it in my mind that they only took three samples from two suspect areas of the prostate. That seems quite a low number based on other people's experience. And the phrase keeps on playing in my mind; "They can't tell you that you don't have cancer, just that they didn't find it in the tissue they tested "

Thankyou both for the replies so far.

Mick

User
Posted 08 Jul 2025 at 09:00

Originally Posted by: Online Community Member
I also have it in my mind that they only took three samples from two suspect areas of the prostate. That seems quite a low number based on other people's experience. And the phrase keeps on playing in my mind; "They can't tell you that you don't have cancer, just that they didn't find it in the tissue they tested "

I can recall, I'm not sure if it was you or not, of seeing a post about a 3 core biopsy. I thought at the time, that's not thorough enough. 

My first biopsy was TRUS, 14 cores, and they still managed to miss any of the more serious grade cancer.

Apparently it's okay to just have three cores taken if the MRI doesn't suspect anything too untoward. It's a balance of cores against biopsy time and side effects. Call me a cynic, but is it really to save cost?

https://pubmed.ncbi.nlm.nih.gov/33273160/

[ In men undergoing in-bore MRI-guided prostate biopsies, 3 targeted cores per lesion provide an optimal trade-off between detection of clinically significant tumors and biopsy duration.]

Edited by member 08 Jul 2025 at 09:01  | Reason: Typo

 
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