PSA at 5.3

[DragonBits]

Obviously cancer is the biggest concern regarding a rising PSA. But it's not the most likely reason for a higher PSA level. (For whatever reason, I personally never had a fear for cancer.)

But BPH, LUTS, enlarged prostate, needing prostate surgery as a result of this, needing to take Finasteride, having Prostatitis, getting UTIs are all pretty serious.

Just because you eliminate cancer as a cause of a rising PSA doesn't mean you shouldn't do something about it.

 

[OMI100]

Hmmm If the MRI finds NO areas of concern, then why do a procedure that is even less reliable than an MRI. There are risk associated with any biopsy, so why do one if all the indicators are negative? There is active surveillance where you watch your PSA way more frequently, and if it keeps rising you can do additional investigations.
So basically he is telling you that they will do a TRUSS (my understanding a statistical sampling of random areas.... So if the sample is not from a area of cancer or precancer, it will come back negative) to validate the MRI finding???
Just my 2 cents.

 

[OMI100]

More information that you probably did not want to know
"Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy"
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy | Protocol

 

[ocman]

In rare cases, your doctor might massage your prostate and test the secretions.Treatment of Prostatitis

I just had the SelectMDX test done and the doc did massage my prostate, test results in 2 weeks.

 

[ocman]

Hmmm If the MRI finds NO areas of concern, then why do a procedure that is even less reliable than an MRI. There are risk associated with any biopsy, so why do one if all the indicators are negative? There is active surveillance where you watch your PSA way more frequently, and if it keeps rising you can do additional investigations.

Sorry, I don't know what I was thinking...Yes, if the MRI shows no areas of concern, then I won't be doing a biopsy. If there's an area of concern then it will be a Fusion Biopsy.

 

[ocman]

More information that you probably did not want to know
"Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy"
Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy | Protocol

That's high tech for sure...

 

[OMI100]

You guys are complicating matters by not following urology procedures for increased PSA. Get a urinalysis and a sperm bacterial growth test. In rare cases, your doctor might massage your prostate and test the secretions.

Treatment of Prostatitis

"In rare cases, your doctor might massage your prostate and test the secretions."
Been there... Done that.... Massage is a nice word for "squeeze the hell out of your prostate till you are about ready to pass out". Then my URO was like a kid in a toy story look for his glass slides to get some samples Yep... ended up on antibiotics

 

[ocman]

Good news, I took a PSA test yesterday and it came back at 3.5 which is in the normal range. I didn't realize it but just found out that you're not supposed to exercise or have sex 48 hours before the test. Pretty sure that wasn't the case on the other tests but not100% positive. Still waiting for the results of the SelectMDX test. Will keep you posted!

 

[ocman]

Should get the results from the SelectMDX test on Monday.

The Urologist submitted a request for an MRI and Anthem Blue Cross EPO just denied it.

Explanation: Since my doctor said I have a high level of a chemical made in my prostate. An MRI is a way to take pictures of the inside of the body. This test may be used to find new areas to remove tissue for testing if you had a negative tissue test in the past. Your doctor did not tell us that you have had a negative tissue test in the past. As a result, this test is not medically necessary for you at this time. We used AIM Specialty Health Guideline titled Oncologic Imaging to make this decision. AIM Specialty Link

 

[OMI100]

Sounds like gibberish.
Sounds like they are saying if you had a negative standard blind biopsy you could then do an MRI to make sure it was right???
Hope some folks with medical background can explain their position.

 

[SilverSurfer]

Should get the results from the SelectMDX test on Monday.

The Urologist submitted a request for an MRI and Anthem Blue Cross EPO just denied it.

Explanation: Since my doctor said I have a high level of a chemical made in my prostate. An MRI is a way to take pictures of the inside of the body. This test may be used to find new areas to remove tissue for testing if you had a negative tissue test in the past. Your doctor did not tell us that you have had a negative tissue test in the past. As a result, this test is not medically necessary for you at this time. We used AIM Specialty Health Guideline titled Oncologic Imaging to make this decision. AIM Specialty Link

Looks like beginning next week (July 14, 2019) some newer guidelines kick in. See page 78. I wonder if there is value in having a baseline MRI of the prostate for future comparison in case you experience problems down the road. I’m glad I had testosterone tests done when I was in my 20s and 30s because today at 50, and before I started TRT it was good to have to compare. Same goes for my spinal degeneration MRIs.



http://www.aimspecialtyhealth.com/PDF/Guidelines/2019/Jul14/AIM_Guidelines_Oncologic_Imaging.pdf

 

[Deleted member 16042]

It is entirely catch 22 logic which appears designed to be advantageous for the insurance industry. Though in reality, accurate diagnosis up front should save the cost of multiple biopsies when TRUS misses the diagnosis and needs to be repeated, in some cases many times before cancer is found to warrant insurance coverage for MRI. Or perhaps by using a test (TRUS) with so many false negatives it helps to put off insurance having to pay for treatment

first you must blindly fish for cancer with TRUS biopsy which has 25-35% error rate before we will cover you for imaging that can detect with a much higher degree of accuracy that would aid in targeting where to biopsy.

It is obviously ridiculous.

 

[DragonBits]

Dragon, thank you so much, your response is very complete! I certainly will not be trying HCG!! And if you could update this thread with your new PSA test I would be in your debt. Us 60's guys are all in this. I do take some DHEA, like 12.5mg micronized, I see you had it down on your list.

My PSA history.

2.1 = Back in 1996, no TRT
2.28 = 2011 Nebido
2.78 =2012 Nebido
2.8 = 2/2018 No TRT
2.4 -= 4/2018 No TRT
3.9 = 9/2018 Nebido + HCG +DHEA + pregnenolone
4.2 = 10/2018 Nebido only
3.9 = 12/2018 Nebido + Ultra Prostate
3.9 = 12/2018 Nebido + Ultra Prostate
3.4 = 2/2019 Nebido + Stopped Ultra Prostate
3.4 = 3/2019 Nebido _+ DHEA + pregnenolone
3.2 = 4/2019 Nebido + DHEA + pregnenolone + Progesterone Cream
3.7 = 6/2019 Nebido stopped DHEA Stopped pregnenolone Still using Progesterone

There were other things going on, like in May 2019 I stated to use a progesterone cream to aid mainly in sleep. DHEA and Pregnenolone never seemed to aid in anything other than raising blood serum levels of DHEA, I was in range at 95 ug/dl before DHEA and after taking 25 mg a day DHEA serum levels rose to 450 reducing it to 12.5 mg a day DHEA was 234 ug/dl. since it doesn't seem to affect me in any way and my PSA started to rise again I stopped to see what would happen.

The OTC progesterone cream has some obvious effects, I sleep better, my blood pressure is lower (it was never high), I am more calm (which is a bit subjective). I started with 1/2 teaspoon, then 1/4 teaspoon, now I don't use a lot, only 1/8 a teaspoon, too much and I started to feel groggy during the day.

I measured my serum level of progesterone after a few months of the cream, it was 0.5 ng/ml, which is at the top of the normal range. I never tested progesterone serum before using it. But keep in mind, using a progesterone cream has a lot different characteristics on serum levels Vs injections / pills, you would have to google it if you are curious, it's complicated.

I will likely lower the amount of the cream even more, the jar says 22 mg progesterone per 1/4 teaspoon, but who knows about absorption rate.

Of course the progesterone could be affecting my PSA score, or it could be something else, or it could just be a random variation.

 

[DragonBits]

It is entirely catch 22 logic which appears designed to be advantageous for the insurance industry. Though in reality, accurate diagnosis up front should save the cost of multiple biopsies when TRUS misses the diagnosis and needs to be repeated, in some cases many times before cancer is found to warrant insurance coverage for MRI. Or perhaps by using a test (TRUS) with so many false negatives it helps to put off insurance having to pay for treatment

first you must blindly fish for cancer with TRUS biopsy which has 25-35% error rate before we will cover you for imaging that can detect with a much higher degree of accuracy that would aid in targeting where to biopsy.

It is obviously ridiculous.

Well, I wouldn't mind doing an MRI only assuming insurance paid for it, while I am reluctant to do a TRUS biopsy with only a rising PSA score to go on.

So perhaps this discourages a number of men from even doing a biopsy at all?

Piratically speaking, one must find a middle ground between unlimited medical spending and maintaining health. Call it whatever you want, but for instance when you are 95 in good health with a life expediency of 2.8 years, should you get a knee replacement? How much spending is too much?

When they say it's all about the benjamins, that is universally true.

 

[ocman]

I don't have the results for the SelectMDX test in front of me but the doctor called on Friday and said:

40% chance of non-aggressive cancer which equals Gleason 6 or less
14% chance of aggressive cancer which equals Gleason 7 or higher

I'm going to call the insurance company on Monday regarding the denial of the MRI.

 

[ocman]

I filed an expedited appeal earlier today with Anthem Blue Cross regarding the denial of the MRI. They just called and said they would have an answer in 72 hours.

 

[ocman]

Ok just got the call from the doctor they approved the MRI.

I called UCI Medical Center and asked about the MRI, they said you just get put in a machine like a donut using contrast (like a regular MRI). I thought there was a thin wire inserted into the rectum and they took pics? @Orrin Israel

 

[OMI100]

Nope.... Standard MRI . Not sure of the post you saw that talked about a wire? The MRI scans the lower pelvic area and captures a LOT more than just the prostate. It gets all the area around it. They inject a special dye to get a clearer picture of your organs, etc.

MRI with contrast vs without: which is best? » Southwest Diagnostic Centers of Colorado Springs, LLC

 

[ocman]

So, the Standard MRI is the one they would use if they do a Fusion Biopsy at a later date?

 

[OMI100]