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Questions for Urologist

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User
Posted 01 Oct 2025 at 23:39

Hi again

Well, the latest PSA has gone up to 7.4 and PSAd is at 0.245. Its been at or over 0.2 for the last 4 PSA tests, and along with perinural invasion (cancer close to inner nerves) from the biopsy last Feb (Gleason 3+3) the Urologist has already said that such data would suggest best moving to treatment than staying on AS. 

So, I have a meeting later this month to discuss options - and am already leaning towards RP as at (just) under 60 am thinking I may need RT etc in the back pocket for sometime later. 

The specialist urologist (a certain professor in Edinburgh) has come highly recommended from other PCa patients, and he has been very thorough on details and advice since taking on my case in June. 

In relation to RP (or indeed other possible treatment options) what key questions should I be asking on treatment etc at this stage? 

Thanks guys

Gi

User
Posted 02 Oct 2025 at 07:58

Hi, Gi.

I'm not medically trained mate, and you're usually best to heed the advice of clinicians.

I've been going through your old posts and as far as I can gather your position is as follows.

You're 58 years old, you have a current PSA of 7.4 which was 4.7 a year ago, and has been fluctuating. It was once as high as 8.4. You are Gleason 6 (3+3), your tumour(s) cannot be seen by MRI. You've got PNI. You're PSAD is 0.245. Your prostate gland is 31cc which is normal.

Personally,  if I had that diagnosis I would not be thinking of any radical treatment at this stage. To me too much emphasis is being put on PNI and PSAD. As far as I'm aware PSAD is simply a calculation of your prostate size to your PSA level. For someone with prostate problems your prostate is relatively small so your PSAD will be high. 

Your PSA is elevated but not drastically so. More interestingly it's been fluctuating. I appreciate that there has been steady rise but it's unusual for PCa PSA levels to fluctuate, like yours.

Fluctuated rises are often caused by other prostate conditions or UTIs. In your case, you can rule out any enlarged prostate BPH, because yours isn't, but have you been checked out for UTI's or prostatitis?

We've discussed PNI on here before, and although it slightly raises the risk of disease progression, it's not that big a deal. In your case it may merit closer monitoring whilst your on active surveillance.

Before I'd consider any radical treatment, I'd be asking why is my PSA, as you described it, yoyoing?

I'd also be considering leaving things as they are and in 6 months asking for a follow up MRI, and dependent on that, possibly a follow up biopsy.

I would not be considering surgery. To me, at this stage, with your diagnosis, the possible side effects of surgery far out weigh the risk of disease progression.

I haven't got all the details that your clinicians have, nor have I got their expertise, but based on what you've told us, I can't see a reason to rush to further treatment yet.

Best of luck, mate.👍

Edited by member 03 Oct 2025 at 06:51  | Reason: Spelling

User
Posted 06 Oct 2025 at 21:00

Hi Gi,

Most data is open to interpretation. It seems to me,  there's no certainty that one treatment is better than the others, and that's why clinicians often leave the patient to decide.

Good luck with whatever option you chose and please keep us updated. 👍

Edited by member 06 Oct 2025 at 23:04  | Reason: Typo

User
Posted 09 Oct 2025 at 14:58
I see you had a biopsy in February which I assume followed your MRI. Was it a Multiparametric one and was the biopsy a TRUS or Transperineal one? In your position, I would want to know this to help establish how accurate the grading and positioning of the cancer was and to discuss this with those offering treatment options. It might be that your biopsy possibly missed some grade 4 or has increased in area. I would ask for another MRI by the end of this year and then take a view on another biopsy. Normally, a 3+3 is deemed suitable for AS, but your recommended Professor has other ideas in your case and you need to ask him why this is and whether he feels it can be safely left until further MRI/biopsy done.
Barry
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User
Posted 02 Oct 2025 at 07:58

Hi, Gi.

I'm not medically trained mate, and you're usually best to heed the advice of clinicians.

I've been going through your old posts and as far as I can gather your position is as follows.

You're 58 years old, you have a current PSA of 7.4 which was 4.7 a year ago, and has been fluctuating. It was once as high as 8.4. You are Gleason 6 (3+3), your tumour(s) cannot be seen by MRI. You've got PNI. You're PSAD is 0.245. Your prostate gland is 31cc which is normal.

Personally,  if I had that diagnosis I would not be thinking of any radical treatment at this stage. To me too much emphasis is being put on PNI and PSAD. As far as I'm aware PSAD is simply a calculation of your prostate size to your PSA level. For someone with prostate problems your prostate is relatively small so your PSAD will be high. 

Your PSA is elevated but not drastically so. More interestingly it's been fluctuating. I appreciate that there has been steady rise but it's unusual for PCa PSA levels to fluctuate, like yours.

Fluctuated rises are often caused by other prostate conditions or UTIs. In your case, you can rule out any enlarged prostate BPH, because yours isn't, but have you been checked out for UTI's or prostatitis?

We've discussed PNI on here before, and although it slightly raises the risk of disease progression, it's not that big a deal. In your case it may merit closer monitoring whilst your on active surveillance.

Before I'd consider any radical treatment, I'd be asking why is my PSA, as you described it, yoyoing?

I'd also be considering leaving things as they are and in 6 months asking for a follow up MRI, and dependent on that, possibly a follow up biopsy.

I would not be considering surgery. To me, at this stage, with your diagnosis, the possible side effects of surgery far out weigh the risk of disease progression.

I haven't got all the details that your clinicians have, nor have I got their expertise, but based on what you've told us, I can't see a reason to rush to further treatment yet.

Best of luck, mate.👍

Edited by member 03 Oct 2025 at 06:51  | Reason: Spelling

User
Posted 06 Oct 2025 at 17:19
Thanks Adrian

mmmm - its a very tricky one!

I went to see my doctor today and she ruled out Prostatitis - no telling syptoms & said the MRI would likely have shown it too (I need to check with the Urologist on that point). I also had a UTI test in early summer after the 8.4 PSA result which was negative.

All studies indicate PSA density of 0.2 or above raises a concern for cancer progression & that may need treatment sooner rather than later.

The mix of data here suggests a more complex finding than normal safe Active Surviellance criteria, with a higher risk of more aggressive disease than the Gleason score alone would indicate - and possibly questions the accuracy of the 3+3(6) grading? Maybe I need another biopsy to settle the matter and put to bed any risks of a missed higher-grade cancer and potential to spread.

Believe me, if I felt it was safe to kick this one down the road for as long as possible I would, but the data and stats are pointing otherwise just now.

Cheers

Gi

User
Posted 06 Oct 2025 at 21:00

Hi Gi,

Most data is open to interpretation. It seems to me,  there's no certainty that one treatment is better than the others, and that's why clinicians often leave the patient to decide.

Good luck with whatever option you chose and please keep us updated. 👍

Edited by member 06 Oct 2025 at 23:04  | Reason: Typo

User
Posted 09 Oct 2025 at 12:36
Quick bump on this Qu, thanks :-)
User
Posted 09 Oct 2025 at 14:58
I see you had a biopsy in February which I assume followed your MRI. Was it a Multiparametric one and was the biopsy a TRUS or Transperineal one? In your position, I would want to know this to help establish how accurate the grading and positioning of the cancer was and to discuss this with those offering treatment options. It might be that your biopsy possibly missed some grade 4 or has increased in area. I would ask for another MRI by the end of this year and then take a view on another biopsy. Normally, a 3+3 is deemed suitable for AS, but your recommended Professor has other ideas in your case and you need to ask him why this is and whether he feels it can be safely left until further MRI/biopsy done.
Barry
User
Posted 09 Oct 2025 at 17:22
Thanks Barry

The 1st MRI in late December was a 'normal' one and the next last July was a mpMRI. The biopsy in Feb was Transperineal.

Good call on maybe another MRI & possibly a biopsy afterwards - I will ask the Professor later in the month

Cheers

Gi

 
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