Which investigation will help to rule out cancer?

Question

Hello doctor,

I am a 65-year-old with a very enlarged prostate (approx 100 ccs). I had periodic hematuria. PSA has vacillated between 2.7 and 5. Blind biopsy negative. I had two prostate MRI six months apart, one designated pirad 1 and the second pirad 2. I am on flow max and Finasteride. Based on MRI and favorable PSA density, my urologist thinks the likelihood of me having significant prostate cancer is low. How likely is it that the MRI could have missed significant cancer?

Answer 1

Hello,

Welcome to icliniq.com.

With your description, it is obvious that you have a large prostate with lower urinary tract symptoms, which you are on treatment with Finasteride for more than six months. With this scenario, PSA (prostate-specific antigen) should be read as twice the value that is reported as Finasteride more than six months masks PSA by half. In that sense, you have a quite significant rise in PSA. However, two biopsies were negative, with no significant pirad (prostate imaging reporting and data system) value, favorable PSA density proves that there is hardly any chance of you being harboring a significant prostate Ca. However, you need to undergo regular screening for the same because of PSA. PSA alone is not taken as a good predictor of cancer, as it is secreted by tissues other than prostate. In your case, a comprehensive evaluation is clearly in favor of benign disease. Please get back to me in case you have any more queries.