Dear retireddoc, thankyou very much for post that is very interesting for me.
In my father's family (6 male brothers) everyone underwent prostate surgery (BPH) at a relatively young age (around 60 years old). Four of them died from various cancers but not prostate cancer; although it must be said that they all died between the ages of 69 and 73.
I started with classic BPH symptoms at 38 and had to have surgery (TURP) at 51. Since then I have always had an annual visit to the urologist and a PSA test every 6 months. I am now 66 years old. The PSA went from 1.6 (January 15) to 3.98 (January 24). No suspicious abnormalities were detected on rectal touch. My urologist, suspicious of this gradual and constant increase in PSA, orders me a multiparametric MRI in 2015, then again in 2021. Both results were negative, without suspicion and without alterations, PIRAD 2.
Despite this result, the urologist recommended performing a biopsy. Since it is a very invasive and sometimes very painful exam, I preferred not to do it and repeat the MRI the following year (2022) with identical results to the previous ones. Today my PSA is 3.98 and given its linear and constant increase I think I can already predict what it will be in one or 2 years...
I have consulted several doctors, radiologists and urologists and the opinions are divergent. There are those who think that in the presence of 3 P-RADS 2 MRI and without variations over the years, it is not justifiable to perform a biopsy just because the PSA increases; this increase would be justified by age. There are those (almost all urologists) who recommend performing a biopsy anyway.
If I understand correctly, it seems to me that your case demonstrates that the increase in PSA can indicate the presence of PC, even if the various MRI scans are negative.
Considering your personal experience, as a patient and radiologist, I will really appreciate your feedback