MRI for elevated PSA

My husband is almost 73, so that might be a factor. We will see the doctor on Tuesday and ask for clarification. Thank you.


Finally got an MRI. It showed a 1 cm "suspicious lesion". He'll have a biopsy on the 18th. How likely is it to be prostate cancer or would it be metastatic bladder cancer? Could also be nothing?

First of all, it is great that you are being an advocate for your husband.

I am sorry to hear about the delay of MRI, but I would not worry much because your husband is already on BCG treatment. CT scan and MRI are used to check to see if BCa has spread outside of bladder. In my case, it was CT scan. Columbia University Urology website says MRI is preferred over CT scanning for some patients with reduced kidney. Only your urologist knows why he or she had chosen MRI. MRI takes longer and it costs more than CT scan.

PSA
I would not think PSA value is the only reason for MRI or even if it is a reason. Your urologist can answer the question. PSA testing has become controversial. Even when PSA level is low, the patient can have prostate cancer. Even when PSA level is high, the patient does not have prostate cancer. Also, even the patient may have prostate cancer, but it can be very very slow-growing cancer and can live without a problem. I used to go to a local prostate cancer support group. Anyway, the evidence, the study paper says, 75% (27 out of 36 patients) of Intravesical BCG treatment developed higher PSA level. 40% developed to 6.97 and above. Yes, the paper says
those 40% came down to 3.86 but does not say if it is average. Also none of 36 patients had prostate cancer.

American Cancer Society's site says only 1 of 4 men with PSA level between 4-10 may have prostate cancer. Most of those men are not under BCG treatment. www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html

Also, the pathology report says your husband is T1Hg. It has not gone to the muscle layer. So, it has little chance that BCa has spread to the prostate.

Dizziness :

BCG is live bacteria in liquid form. When it is instilled into the bladder, bacteria infect the inner wall of the bladder, which invokes our immune system and attacks bacteria and bacteria-infected cells. This causes inflammation and sometimes bleeding. Consequently, the side effect includes bleeding, frequency in urination, fever, fatigue, etc. So, I know from the forum that several people experience dizziness also. The good news is that he is able to go through BCG treatment as there are some patients who give up BCG treatment because of severe side effects.

About the fall.

I am sorry to hear your husband' fall. But I am also glad that it was just a bruise on his rib. I had a fall from a bike just a year before they found my cancer in my bladder. I cracked 4 ribs and developed hemothorax / pneumothorax. I had to stay in the hospital for 2 weeks. No more mountain biking, so my family said. I am 73 years old, so now I am just riding a bike on the flat surface with my dog in the dog trailer these days.

Take care. I have a hunch that everything is going to be okay with your husband.

We still don't have insurance clearance for the MRI, not sure why it's taken this long.

His PSA has been elevated since January 2019 and the last PSA was 5 months after his last BCG, so I'm guess that's why they are investigating?

A side question-has anyone experienced dizziness with BCG? He did on the last day of treatment last week and had a bad fall in the middle of the night, bruised a rib.

The study done in 2000 says that they have observed 75% of Intravesical BCG patients saw the elevated PSA level. The report says it will go back to normal level after 3 months. Consequently, the report recommends NOT to perform prostate biopsy which is quite invasive procedure when PSA level goes up during Intravesical BCG treatment.

Its great that your husband will get MRI done anyway as it can clarify your concerns.

pubmed.ncbi.nlm.nih.gov/11025701/#:~:text=Conclusions%3A%20Intravesical%20BCG%20therapy%20is,such%20patients%20and%20PSA%20monitored.


Best wishes

My husband is almost 73, so that might be a factor. We will see the doctor on Tuesday and ask for clarification. Thank you.