Dear retireddoc, I greatly appreciated your answer, full of wisdom, common sense and great humanity. Thank you very much!
I would just like to make a couple of clarifications. My PSA increased from 1.6 to 3.98 over 9 years, from January 2015 (1,60) to January 2024 (3,98). Thats makes an average growth rate of 20% each year. In all these 9 years I have repeated the test about every 6 months and it has always shown a fairly regular and constant growth, I could say linear, and probably I can guess how much it will be next July. Certanly you are right: urologist are concern to the rise most that to the absolut value.
My MR scans were performed with a multiparametric technique, T2, with and without contrast, and with a superficial and transrectal coil. The study was carried out in a highly qualified center and by a highly experienced radiologist. I live in the North of Italy and here most of urologists send their patients to this radiologist because recognized as very good. Anyway I know that the only way to be 100% certain about the presence of cancer is to wach cells under the microscope. That means biopsy!
Yes! You are right, until now I have procrastinated on the biopsy because I am afraid that it will be very painful. Many friends who have done it say they have suffered real torture. From their experiences it seems that the local anesthesia performed was not effective at all. In Italy it is usual to perform many medical procedures (childbirth, gastroscopy, biopsies) without anesthesia or sedation. Deep sedation, which would allow these procedures to be overcome without the slightest pain, must be practiced with the continuous assistance of the anesthetist, who however is a rare figure and therefore used only when truly essential. But there was also two other reasons
First of all, it is my understanding that PSA is not exactly cancer marker. Rather, a marker that can increase for many other reasons, prostatitis, infections, inflammation, hypertrophy... . perhaps this is why its use is at the center of numerous controversies, even by its own inventor, Richard Albin. I have heard some doctors say that PSA is a terrible indicator, but it continues to be used only because there is nothing better. Something like democracy which is the worst form of government except all the others.
Second. Let's say I take a biopsy now and the result is “No cancer”. Well! But the trend of my PSA already suggests that in a year this will rise to 4.8 and in 2 years it will be 5.8. And suppose that a new MRI showed no suspicion or no changes compared to previous ones? What to do at this point? A new biopsy every year?
However, now the correct choice is certainly to follow the advice of urologists and do a biopsy, even with 3 negative MRI scans. If, as I hope, the result will be "no cancer", I will try to live peacefully next year and then we will think about it. Now I have to look for a place where they do the biopsy under sedation.
I wish you all the best in your journey along this new experience, no longer as a doctor but as a patient. I hope to find you still here in a year.