Who knows a lot about PSA test results?

On the relational side, (after all I am an MFT etc), I would encourage you to let him be in charge of his cancer, but respectfully and consistently be available to be alongside him, however he prefers. Obviously one of the things that may be happening is the triggering of memories of his previous traumatic journey alongside his wife.
Your own journey in coming to terms with this will likely start with your own history to this point, which may be quite different from his.
Also, please write everything here (on this public forum) in a way that if or when he reads it he will feel respected and not betrayed. It's his story to tell, even though you are part of the story. This might include not using names or identifying facts without his explicit permission, or even copying him on everything you post. (The fact that he is not ready to tell his adult children what he's dealing with is a flag that he might have concerns about who hears what when and how.)
After all, your first challenge is being a trustworthy companion in this unwanted journey, whatever it includes. All the best, and thank you for being alongside this brother in our unwanted fraternity.

This is personal, but went my PSA went up my normally - normal Libido was affected. It is an embarrassment when desire is affected.
I’d let the MRI play out and wait it out.
I can’t help you on the PSA. I’m having same issue. High of 6.7 and recently 3.6 and Dr had no explanation. My Treatment hasn’t started.

PSA alone can be high ( above 4.0) for 3 reasons, BPH, Prostatitis and Prostate Cancer. I would highly recommend the 2 tests I got when my PSA went from 4.27 to 6.24 in 6 months, first was a 4K score blood test, second was a multi parametric MRI with a 3T machine. Both tests confirmed cancer, my 4K score was the maximum at 95 and the MRI was a Pirads 4 and showed a 12mm lesion on the right lobe. The MRI will also give you the prostate size, mine was 50.4CC or 50.4 grams, about the size of a lemon. which is large, but not as large as many have. My Dad had his prostate out at 63 years old, it was 250 grams, about the size of a grapefruit. If your BF has had BPH symptoms like I had for several years, that could be the cause. The 4K score test and MRI will let him know. Then comes the biopsy to confirm cancer, mine was 6 out of 23 needle cores 70% with Gleason 4+3=7 I was hoping for a 3+4=7 which is more favorable, or a 3+3=6 which can barely be called cancer.
I then isisted on having a PSMA PET scan to confirm the cancer was contained to the prostate, that test confirmed the MRI lesion and showed some additional tracer uptake on the left lobe. Here is the deciding test, I had Mayo order a Decipher Test, it came back at 0.38 low risk for metastasis, so I really have to think about treatment. Given my relatively low PSA, and PSA density of .13 so small volume tumor, only 1% of my 50.4 cc prostate, and the low Decipher score, I will probably opt for focal therapy with the least side effects, or I may just concentrate on Ketogenic diet, & exercise, to keep the cancer in check with Metabolic Therapy.

I know that PSA test are helpful to those who treat your prostate. I know that PSA test can emotional challenging to those of us with prostate cancer diagnosis. Why? Trauma. Unresolved trauma. I am thankful for my prostate cancer getting the treatment it needs which is assisted by PSA exams. But, my trauma from my PSA supper bad PSA always returns with each exam. Will I hit 118 again? Hopefully not. But that number implanted in my mind.

So, what do you make of a urologist in this case. Two years after 43 rad sessions, my PSA begins to rise. It's gone from .9 to 2.16 in one year, a 140% acceleration. Previous PSMA shows part of prostate with likely cancer, but nothing spreading. Urologist says Eligard, immediately, no more active surveillance. I agree it's a rapid rise but do all the medical books say the same thing about what immediately triggers the need for ADT?

@tinamaria1, how are you and your boyfriend doing? Any update?

thank you so very much the information you gave about research is something i will share with my BF...I am not ready to let him know I have been consulting on this forum..

he is using Hopkins and we live about 30 minutes away but I will encourage him to still get second opinions...seems his weight loss has stabalized..he has a good appetite too. The only new change is that he now goes pee a lot more like me..lol..I go a lot because I am an athlete determined to drink about 90 plus ounces of h2o ongoing daily..but he actually doesn't drink a lot of water or fluids at all..so we laugh about it..

he has his MRI on friday, we will get the results soon I imagine..

wow..thank you so much for this VERY VALUABLE thoughtful advise..the last thing I want to do is cause him extra stress....I have to remember that I am a person who easily puts my unfortunate personal business out front..it's my way of accepting, dealing, owning my issues..but I realize not everyone is like that at all..

i have one friend who announced it to the world her ovarian cancer and my other closest friend made me and one other lady promise to NEVER tell anyone she had cancer...and it has been 3 years to date she kept it secret..

my bf did thank me for encouraging him to tell his adult kids, who are very loving and he said were very grateful..they have agreed supported that if he does need treatment and is weak, etc., he can move in to my home because I work from home, am an empty nester. I can't work from his home due to my contract with my employer..this way I can help him get to doc visits, eat right etc..we have only been dating about 9 months...so my adult kids think it is a lot to take on, but I am ready to help him if he needs it..his kids are sweet, supportive and can visit 24/7..when he is able to drive he can go to his home and visit with his family

i am talking like he actually has cancer but there is a decent chance he does not have cancer..

he had his MRI on friday, and he wants to schedule his biopsy before hearing his MRI results..so he said he will try tomorrow..

last night when we hung out i did ask him about privacy and how he wanted or did not want to respond or give information to people IF he is going thru treatment that showed obvious exterior changes...so it was good to get that information from him

again thank you for wise advise..wishing you peace

thank you for sharing...will tell you that when a woman truly loves a man..the physical stuff is irrelevant..so i am not even concerned in the least about his ability or libido..etc..we do a lot of fun live activities that bring positive warm experiences to enrich our lives..and they have nothing to do with sex...etc..i realize it's easier for me to say since I am not a man..but this is how I feel if his libido etc. changes..wishing you peace

btw..i removed my photo to further protect his privacy..the name I use is not my legal name either..