Elevated PSA: How Soon Do You Need a Prostate MRI?

Daniel Costa, MD, reviews the indications, technical aspects, advantages and limitations of magnetic resonance imaging in patients with suspected or known prostate cancer.

[@mattthomson1689]

I’m seeking fuller disclosure from my team regarding the diagnostic steps taken, including full disclosure of any procedures planned. Also seeking a fuller dialogue toward understanding (reassurances) of the ‘who, what, where, why, and when’ questions Nd answers. All too often, it has been my impression for professionals to inadvertently assume ignorance (on the part of patients) without right to be fully informed, when it comes to bedside manners. Very appreciative for this video, thank you! Learned more in twenty minutes, than over the course of two years of speaking with four physicians about different aspects of prostate issues. The speaker simple lays out the information in a tell it like it is (or may be) manner that I applaud.

[@davidshettlesworth1442]

Thank you for this excellent educational video.

[@jamestyrer6067]

Fantastic information

[@deborahlowry6221]

I had a biopsy it didn't hurt near as much as I was expecting. It was positive. Now waiting a Mr I

[@yelyab1]

What a relief to an engineer. Making a decision with definitive data instead of the “rubber ruler”, the PSA test. If my engineers brought some of the lame interpretation of data I get from my urologist they would have to listen to one of one of my one hour tirades about data manipulation, didn’t you learn anything in engineering school, what did they teach you in high school physics, where your Uranus is (pronounced “your annus ”)?

[@justdoesntaddup8620]

When you wouldn’t stick a needle in your eye or in your testicle why would you let them stick 12 - 21 in your prostate? That prostate is a fragile and valuable organ, be careful how others treat it, particularly when there’s a lot of money for them.

[@indradevpandey8257]

Very informative

[@bigdaddy5948]

Every case is different. In my case the biopsy was uncomfortable but not painful. I passed blood in urine and stool for a few days. I passed blood in seme also. I resumed normal activities the day after the biopsy. No cancer found.

[@petegodfrey5735]

Mine WAS painful. They gave NO anisthetic...I peed blood for a good week... My last PSA was 15...nor do I know why it went up. I have to wait a month before I can get into the urologists...

[@luketimber4679]

@@petegodfrey5735 Pete -Please give me an update when you can. I have a PSA of 10. My urologists wants to do a biopsy. I'm worried!

[@petegodfrey5735]

@@luketimber4679 I will Luke. They are so busy there, I have to wait till Feb. 15th. When that PSA came back at 15, for NO APPARENT REASON, I am taking the supplements, and foods they recommend. I stopped drinking alcohol 3 weeks ago. If you have not been informed about foods to avoid, and foods that are beneficial, I will gladly share. I'm 72, and I'm glad The Lord is on my side. I don't know if I'm going through that horrible biopsy again, if they think it's necessary. Whoever said they were not painful...probably never had one!!

[@luketimber4679]

@@petegodfrey5735 Thanks Pete! Did you get an MRI first, if not are you considering it? I got my MRI scheduled for this Tuesday. I'm 65 btw. I'm in busy Manhattan. My follow-up apt is January 26th. Seems so far away, Was your digital exam OK? Mine was fine -happily. they gave no food suggestions .He really pushed getting the biopsy. I said I want the MRI first. Please keep me posted.

[@petegodfrey5735]

@@luketimber4679 Hood morning Luke. They didn't even OFFER the MRI the first time. I would avoid the biopsy if possible. If they try to do another one on Jan. 3rd, I'm going to request the MRI. Keep the faith Luke...it helps more than anything. Something else you can do, which I'm doing, is maintain an alkaline system. Cancer can not exist in an alkaline environment. I'm doing all that they recommend, other than the fasting. Take care Luke, & God bless.

[@peterkelly5672]

Doc says I have Elevated PSA levels got a MRI with contrast for this week all free thanks to the NHS happy days 😊😊😊

[@schmingusss]

And, what were the results of your MRI?

[@janetw9430]

MRI to get targeted biopsy. Bioppsies can needle seed cancer into other areas as well.

[@johnnyschmidt6945]

Immediately!

[@thomasjones1496]

Have to quit blood thinners 7 days before and 3 days after plus chance of infection and Pain with 30% missing aggressive cancer, When a hammer is the only tool you have everything starts looking like a nail.

[@ThePilotUSA1962]

If you ever to a biopsy of the prostate, don't believe when they say you will feel a "discomfort". Let me the say this clearly: IT IS SIMPLY PAINFUL and there is no other way to describe it! Also, this video was done in 2015 and I went thru all of the new procedures and exams available in 2020 at UCLA. PSA - CT scan - MRI - target biopsy - NM CT scan of pelvis - NM full body bone scan and finally the ONCOType DX .

[@catfish24]

They should have put you to sleep when they done the biopsy.

[@guitarhillbilly1482]

My 12 core transrectal biopsy was NOT PAINFUL. Your Urologist must have been a hack. Very mild discomfort and if anyone is concerned about pain then have the transperineal biopsy instead.

[@sitdowndogbreath]

But even then they have to put you out longer needles

[@guitarhillbilly1482]

@@sitdowndogbreath that's my very point. If you are put out then you won't feel any pain or discomfort during the procedure.

[@sitdowndogbreath]

@@guitarhillbilly1482 what about after the procedure what kind of pain are you in then? Is Tylenol good or do you need something stronger for a few days?

[@jeffell]

If I need a scan for prostate cancer, I'm getting a PSMA PET scan.

[@drkenchao1849]

why PET better than MRI?

[@robertbutler8004]

When my PSA reached 9 I had my first biopsy a few years ago 12 samples was taken and as it turned out they missed the cancer about 4 months later my PSA remained at 9 so I had the second biopsy this time they took 18 samples and desoverd that I have malignant cancer albeit a very non aggressive cancer and I was told that I might have had the cancer for more than 10 years to have my prostate removed is not an option for me due to my age, I also an cerabal aneurysm and a lung disease that is not life threating. The options that was given to me was radiation therapy or wait and watch I chose the later.My Dr has suggested that I have another biopsy but I asked for a MRI first then we can make an decision on that outcome I don't think my Dr is interested in me having a MRI could be because of the cost we will see what happens going forward!! PS one of my previous Dr's had A PSA of 20 and he had 3 biopsys and was fine.

[@shamrock8561]

I don’t know why he didn’t give you an MRI as the first step instead of a random biopsy this way your biopsy can be targeted to the abnormal area on your prostate. Random biopsies are a thing of the past. I believe MRI’s first should definitely be the new standard of testing for prostate cancer after PSA and rectal exam.

[@thomaslehmann5981]

​@@shamrock8561Maybe he had no access to multiparametric MRI.

[@shamrock8561]

@@thomaslehmann5981 then he should find another doctor. MRI’s show a great image of your prostate which can prevent you from unnecessary random biopsies. I had the MRI which showed 2 lesions and then a targeted biopsy . Got my Gleason score and then I got a genomic test on my biopsy which showed I had a low grade cancer so I will be doing active surveillance for now. My specialist advised me to get no treatment at this time. He felt the treatment would harm me more than the cancer right now. Always get an MRI first.

[@robertbutler8004]

29/4/23 follow up I ended up having a prostate MRI and everything was OK so nowadays my Dr rings me app every 3 months and asks me has there have been any changes so far all good.I will never have a biopsy again for me I will only have a MRI.

[@pouljacobsen8566]

​@@thomaslehmann5981 m

[@tomwilliams4885]

I've had three biopsy's in the past seven years. My PSA is 25 this week, down from 33 last month. My urinary system is shut down. Must use a catheter or my bladder expands so bad it smashes my kidneys flat threatening to shut everything down. My new doctor called for an MRI Monday but insurance has not approved that yet. Hopefully soon.

[@watersbey25]

Take out your credit card and find one that'll do it for $2,000 time to get in debt. Your health comes first.

[@charlesreid8398]

@@watersbey25 Hi Tom, what was your last biopsy Gleeson score? This will determine if you have a high cancer count or a low cancer count. A 3-4 Gleeson score will be considered high and require immediate attention. Hope all goes well for you.

[@ericlrivera3167]

How are things now? I'm 46 and I am suffering from bph and prostatitis. I get a psa in 2 weeks

[@johnreidy2804]

@@charlesreid8398 My Jacki Gleason score was "And a waaaaay we go"

[@thomaslehmann5981]

​@@johnreidy2804tough to find humor in any of this but you did it!

[@iwanttowatchyou]

Is there any update to the info in this video since it was produced three years ago now? What about the use of a 3T MRI, as compared to less powerful ones? I was turned down by insurance, but decided to self pay for the 3T MRI due to concern about my quickly accelerating PSA ( now at 5.7 vs. 3.3 5 mos ago). Expect my next step to be an MRI guided biopsy. Follow-up note - did have the MRI biopsy, and glad I did. Insurance covered it. Now pursuing several 2nd opinions at major metro NY cancer centers.

[@AIRMANBEAR]

HOW MUCH DID THE 3T MRI COST AT THAT TIME .. WOULD INSURANCE PAY EVEN PART OF IT

[@iwanttowatchyou]

BCBS denied reimbursement. Had to "self-pay" out of pocket $700.

[@kitkatkiller1]

Carl Form

[@jeffjones9813]

What did the 3T expose as your condition? Why not just get a 4Score blood test and if it comes back negative for aggressive cancer just go on with life as is?

[@iwanttowatchyou]

jeff jones I had the 4k test which came back with a score of 8. Subsequent biopsy came back with 11 out of 16 samples with cancer. Gleason 10 for 3 of them.

[@craftrunner]

I have just had a blood test, for a swollen prostate, the PSA came back and my doctor said it is 518, is there such a large number. I hear of numbers like 5, 7, 10 etc. Do I need another test to see what's happening. My doctor is referring me to a urologist. Oh i am 72 Thank you

[@shamrock8561]

My PSA is 4.8 and my urologist retired but told me I should get an MRI because it slowly creeped up over the years. He referred me to another Urologist in his practice who got the results back from my MRI and said they found 2 abnormalities on my prostate and he would like to do a biopsy. My question is should I just have him only biopsy the 2 abnormalities ? I really don’t want to get clipped 12 times. The more you get clipped the more chance of complications like bleeding and infections. Very nervous that if the 2 spots are cancerous he may spread it somewhere else by clipping other locations on my prostate.

[@shamrock8561]

It was actually 1 spot in the middle of the prostate. His office personnel gave me misinformation .

[@islandnard]

@@shamrock8561 what was the outcome

[@shamrock8561]

@@islandnard ,I got the biopsy done last week and I am presently waiting for the results. It actually was 2 spots. I will respond to you when I get the results. He took 10 cores with an MRI guided ultrasound targeted biopsy only in the area of suspicion. I should actually be getting a call today about the results. 🙏

[@ebayerr]

@@shamrock8561 : What were the results?

[@shamrock8561]

@@ebayerr ,it is cancer. 3+4 Gleason score. Researching treatment options. It’s between cryotherapy or radiation. Not sure what I want to do yet. Cryotherapy sounds great and my sister in law actually works in the office of a top world specialist who performs the treatment. Just doing more research on the cure rates of both treatments right now. I have some time to research since 3+4 does not spread fast

[@mactheslovac8673]

Judging by all the coughing in the room I would say a lot of these physicians need a chest x-ray

[@dakota236]

Can Androgel 1.62 cause a raise in your PSA ?

[@EvangelismforGod]

If that’s for testosterone treatment it can. My urologist had me on testosterone treatment and it raised my PSA. Once I stopped my PSA went down.

[@charlesblumenstock9160]

I agree taking a supplement can raise psa in my case too much grn tea I had to get trans rectal ultrasound not a comfortable test it seemed extra was a clinical era

[@williamosorio1849]

rectal color ultra sound show you everything

[@tomslick2058]

Pronto.

[@dodjohvidehpobedih]

My current psa is around 50,45

[@johnreidy2804]

Holy cow poop that is one high PSA. So what happenned?

[@soufienetchantchane2839]

Please stop biopsy for prostate before IRM ! Never trust PSA alone .

[@vonfields6889]

Stop it??

[@somers2020]

@@vonfields6889 He means don't do the biopsy before an MRI.

[@bobm2331]

@@somers2020 Not everyone can tolerate a MRI. Unfortunate but true.

[@johnreidy2804]

@@bobm2331 They have open MRI's no problem for claustrophobics friend

[@sitdowndogbreath]

I don't like MRIs either but that's more tolerable than a biopsy that goes through your ass You understand me! Plus need to find a Target on the MRI go to the biopsy

[@johnarmitage5516]

Is stalking via I-phone legal ?

[@leehicks3317]

This was absolutely the worst pain I have absolutely ever had in my life. They give you something for infection. Then they stick you with 12 or more needles that is the worst pain that you will ever experience in your life. The pain is emminse. Be ready for the pain

[@nvan78]

Not my experience at all. Noticed some discomfort when the probe was first inserted; other than that not really bothered. Heard a click when the needles were taking a tissue sample, but felt no pain. Have had two biopsies, always with a numbing gel and same experience. Walked home from the hospital as I live nearby as well. :)

[@janardhanlakkadi7727]

QQQq

[@catfish24]

They put you to sleep now before they do a biopsy you will know nothing about it.

[@samcole431]

No pain at all with mine

[@cwdgoff]

a Person I love very much has a 62 PSA is 61.1 with a % PSA of 9.1 Three years ago his PSA was 2.4 Does this not seem high and within a short time? Trying to get insurance to approve his Fusion guided Biopsy. His Dr. did a DRE and said it was Hard. Not large but Hard Should I be very concerned about him?

[@justdoesntaddup8620]

Hi , yes , he should have the MRI , this will identify the size and location and these days the radiologist can give a quiet accurate prediction of the grade

[@catfish24]

Did you read your comment it doesn't make sense. Is he 62 years old or 61.5 years old or is that his psa numbers which is probably a impossible number for a psa that high.

[@donw3861]

@@catfish24 PSA has been over 3000 in one case. I think he's referring to total PSA and free PSA.

[@charlesblumenstock9160]

I agree a hard prostate is not normal it's going to be checked out biopsies are not popular I know in similar situation trying to get out of inning

[@stanfreeman6380]

Had my PSA checked and it came back at 11 pretty sure what that means but that will have to wait for now having to deal with a mass showing up on lung X-Ray and 2 CT scans.

[@percimasangkay-dpa2670]

11 is high, a biopsy is next. That is serious*

[@fredcornelius909]

What if my score went from 5 to 10 on one month ?

[@arthro9259]

you may have prostatitis. PSA won't go up that far that fast if it were cancer. i still say go see a urologist.

[@karimaogden3875]

What Arhro92 says is true according to Dr. William Catalona (Urologist), the foremost authority on the PSA test since he is the one who introduced the PSA as a screening tool for Prostate Cancer in 1994. Before that, in 1986, it was only used to monitor men who had already undergone PC surgery. Read info on this link www.drcatalona.com/qa/faq_psa.asp. I came across this info recently during my research due to my husband having a screening PSA of 4.89 in March 2018 which then jumped to 6.0 in August. His doctor suspected he could have prostatitis and and prescribed Antibiotics (Bactrim) which lowered my hubby's PSA to 5.1 a week ago. Granted, it is still high but the fact that it dropped dramatically in one month is an indication that my husband most likely has Prostatitis or BPH (Benign Prostatic Hyperplasia) a.k.a "Enlarged Prostate". His PCP however didn't do a DRE but referred him to Urologist for further tests. Hopefully, he won't need a biopsy! Hope the info I gave you will help you!

[@johnphillips4017]

See

[@Kepss1222]

Hello, did your psa go up again? Was prostititis? My father's PSA numbers tripled in 6 months out of no where. From 5.3 to 14.9.

[@JA-gz6cj]

@@Kepss1222 hey did your father have prostatitis?

[@zach9620]

youcan get the mri but say no to biopsy

[@sentimentaloldme]

I had the biopsy done 8 years ago...12 samples taken very uncomfortable...when i went for the results they wanted to do a repeat (12 more samples)...I said no...I'm still alive...Recently my P.S.A. was over 8 ...This time they sent me for an M.R.I. scan but told me that they would also have to do another biopsy (not looking forward to it)...Also my friend had to go in for a different procedure on the prostate. They found cancer cells on the prostate despite his P.S.A. levels at 0.47. I'm thinking these P.S.A. Levels mean nothing...

[@kervilou5905]

@@sentimentaloldme yes

[@janetw9430]

PSA can rise just from taking a poop before blood work.

[@tomslick2058]

Or constipation. It pushes on the prostate. Just like a psa can rise from a DRE.

[@sagrammyfour]

NO NO NO. Elevated PSA--MRI with PIRAD Score--then possible biopsy,. If biopsy+, OMSA, the XRT (Proton Cyberknife)

[@tomslick2058]

Don't do rectal psa. Find perineal. Ist a piece of cake and more reliable. Plus get a mri first.

[@johnrdibona109]

Order mpMRI when PSA is elevated beyond age norm and %free is low and +DRE and familial history.

[@teeduck]

How about never. Everyone dies. Comfort care is all you need

[@johnreidy2804]

Ha I kind of like that attitude. 96% of almost everyrone who has prostate cancer lives an additional 20 years.

[@zach9620]

its money maker

[@kervilou5905]

yes !!!

[@kervilou5905]

business

[@patricksullivan3919]

Never is the answer. Let dead dogs lie.

[@domenicv7962]

NO DIGITAL EXAM......NO DAMN WAY !!!! NOT FOR ME !!!!

[@disappointedman6234]

Biopsy is very very bad idea. I nearly died of pain and discomfort for 3 months because of PSA of 12. Biopsy causes prostate cancer. Had to have prostate removed to ease the pain now have to live with side effects for rest on my life. Don't do it

[@markgriffith2473]

No. You either have cancer or not . The side effects or risk of sepsis septs of the biopsy is real but low and it uncomfortable up to the injection of lidocaine , the biopsy itself was not painful in my personal experience ( everyone experiences are different).