Here We Go Again

It is now almost 14 years since my prostate journey began.  My PSA continues to rise.  It could be a sign of an ever-increasing prostate size, consistent with Benign Prostate Hyperplasia.  It could be a sign of cancer.  The rate of increase had slowed down a little for a couple years but is now back on the original trajectory.  My latest PSA was over 6.5, up from 5.5 a year ago.

My local urologist’s assistant referred me for a 3T MRI.  The same type used in the NIH study I joined in 2009 and then for a follow-up three years ago.  In that most recent 2019 MRI, a single lesion was found.  This month, the new MRI confirmed the same lesion is still present.  Both radiology reports classified it as a PIRADS 4 lesion and my interpretation of the report is that the size is similar, about 0.5 cm.

There is still mixed information on correlation of a PIRADS 4 lesion to cancer, but probably less than 50%, depending on the study you find.  These lesions can also be present in Benign Prostate Hyperplasia.   No other significant findings appear to be present in either report.

My local urologist’s assistant has now referred me to a surgeon for transperineal biopsy.  I have been somewhat annoyed that it has been impossible to discuss this directly with either physician.  So, I  sent the images to the great team at NIH who quickly got back to me and said they would take a look and provide another opinion.  Depending on their feedback and whether or not one of the local doctors ever responds to me, I may be back to the NIH, University of Chicago or elsewhere for a biopsy.

Anyway, the latest PSA and MRI results could have been worse, so I am thankful.  On the other hand, I’m not looking forward to another biopsy and the waiting for those results.  I’m also not looking forward to having to travel to get the most optimal type of biopsy from a physician who is willing to provide basic information on the procedure they use.

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