Good morning. I'm a retired Radiologist with a personal history of prostate cancer. I wanted to offer my opinion mainly based on my experience and what I have learned during my 3 year journey with prostate cancer.

I believe most urologists consider year over year rate of rise PSA more important than the actual number. A 20% or more rate of rise in a year is concerning.

Contrasted MRI (I interpreted tens of thousands over my 45 year career) is a great test for almost every part of the body, including the prostate. Like most tests, it is not infallible. Current SOC is to obtain an MRI prior to biopsy to guide the biopsy to any suspicious areas. But a "negative" MRI does not exclude cancer in a suspicious clinical setting (nodule on DRE, rising PSA, etc).

Like all of us, we tend to try to rationalize why we don't have cancer. It's scary. But more scary is having cancer and not addressing it early when it's potentially curable. Case in point-From around 2018 to 2020 I had spiking PSA with a max of 5.6. It would rise and then come down. Negative DRE by urologist and a negative contrasted prostate MRI on a state-of-the-art 3T magnet. I even sent a blood sample to Mayo for fractionalization and they sent back results "PSA < 4, considered normal for age" so no fractionalization performed. I wanted to believe I didn't have cancer so I didn't do anything else at the time. My next visit to my PCP showed PSA now 7.5. Time for action. Urologist said repeat the MRI but biopsy no matter the result. MRI now revealed a 1 cm suspicious enhancing node. Biopsy revealed localized G8 cancer. Had RP 8 weeks later. Johns Hopkins upgraded to G9 (G8-10 are all high grade and treated the same). Three months later my PSA went from 0.016 to 0.37. PSMA PET revealed solitary T8 met. Treated with SBRT to the area. Four months later PSA 4.6 (!!). Another PSMA PET showed new positive pelvic node but no activity in treated T spine. Consult with very experienced MO at Johns Hopkins. Immediate triple therapy with Lupron, Darolutamide and Taxotere chemo. Whole pelvic radiation 3 months later. PSA rapidly undetectable and has remained so (one and a half years). Off Lupron after one year but Testosterone still at castrate level.

I believe the best course of action is to find the best, most experienced team of prostate physicians (urologist, MO, RO) at COE and hear what they have to say. Get second opinion. Choose who you believe to be the most informed and experienced and follow their advice. IMO, it is a fool's errand to take advice (no matter how well intentioned) from laypeople on a cancer forum. They don't know your case, they aren't experts in the field and most opinions are based on personal experience or having read some articles in the literature. This is not meant to denigrate anyone; we are all trying to do our best with a difficult situation.

Best of luck.