My PSA Has doubled. What now?

I will second what has already been said in several of the posts.

Most Urologists believe a 20% year over year increase in PSA is suspicious and warrants further investigation. Yours was 100% in only 6 months. I assume you have had a repeat PSA to confirm and determine if it has continued to rise.

I am a retired Radiologist so I have extensive experience in MRI indications and interpretation. On a more personal note, I had rising PSA in 2019 with a negative contrasted MRI. Two years later after 50% year over year increase in PSA a repeat MRI revealed a 1 cm enhancing lesion that was a G9 on repeat biopsy. I would consider a prostate MRI. As has been mentioned, a negative prostate biopsy doesn't mean you don't have prostate cancer. It only means the random cores of tissue removed don't contain cancer.

Good luck.

just my experience here and not medical advise . I am a member of 4 prostate support groups where we talk about PC and have guest speakers from Doctors , and such . Yes this would be alarming , but it could be BPH too and many other issues like lifestyle before you had actual blood test ( riding a bike, sex, and other things that would aggravate the Prostate) . Sometimes biopsies miss targets and areas of interest - just a fact that happens . A CT,MRI or even a PSMA-PET ( great scanner for PC cells ) may be needed to detect whats going on - yoru Dr can arrange if required . I have had PC now since 2021 . Tested in January , Surgery in March31/2021 . I am feeling fine . hiking with the dogs and wife today up "coal mountain" today , 6 km each way . I will meet her there on my duel purpose motor bike. We have a blast ! Im fine. I know you think the worst when you have those problems with PSA rising - but you will be fine , once you get the proper direction from Dr ! You have a Urologist appointment upcoming . Phone them to see if they want you to come in sooner . Anxiety can be a huge issue with PC and Prostate issues . Make an appointment with your GP now for a consultation , Make note and bring your medical file. with you ( you should have one ! ) . Talk about options, PSA test and what it means and your mental health and how your feeling with this anxiety. Very important your fully open with your GP . Make sure to tell them its a consultation visit - that is usually 45 minutes or more with your doctor in Canada ! Short appointments are like 5-10 minutes . You have things to talk about . Is there a Prostate support group in your area you could talk to and maybe attend in person or via Zoom? Keep us in the loop , God Bless . You have this ! James on Vancouver Island

jayhall - Looks like you have received some great advice form forum members already. From my perspective, I would recommend taking anxiety medicine if needed and talking to others. For me, talking about the prostate cancer diagnosis really helped ground me and let me know that prostate cancer is very treatable. I had a friend whos PSA doubled (PSA went from three to six in about 9 month), but it was not prostate cancer. My PSA doubled twice and was doubling a third time, it did turn out to be prostate cancer - You may ask, why in heck would you not address a PSA that doubled three times. Answer was complete incompetence on the primary care physician's part. I was not retired at the time, worked 10-12 hours a day, and trusted doctors to take the appropriate tests at my annual physical and let me know of any concerns. Unfortunately, I did not own my healthcare at that point. Long story short, this PCP did not say anything to me that my PSA had been rising significantly over a five year period. It was only when I retired and was working to improve my diet (to get off the statin) that a nurse practitioner reviewed my medical records and asked me if I was addressing my prostate problem, and said it could be prostate cancer. I immediately did research on PC centers of excellence, and chose Mayo-Rochester as the hospital I would travel to so as to get the best possible diagnosis and care. After the initial Mayo consultation, I was scheduled for an MRI (several lesions found). A week later, I had an MRI guided biopsy (11 of 17 were positive for PC). I was diagnosed with Gleason 7 (4+3). Immediately after the nurse practitioner told me of my rising PSA, I assumed prostate cancer would be the diagnosis and did a significant amount of research on treatment options. Because I was 55 at the time (about 3 years ago), I decided that a radical prostatectomy would be my treatment plan, regardless of the Gleason Score. I prayed for a GS of 6, but GS of 7 was what I had been dealt.

I like to tell my story line because it shows that everyone is different in their approach. The only thing that should NOT change is doing your research thoroughly and picking a center of excellence for your diagnosis and treatment plan. An MRI/evaluation at a local hospital is not the same as an MRI at a center of excellence. The same goes for the biopsy & treatment. Centers of excellence follow processes and employ personnel that are far superior, thus they are a center of excellence. I personally would not let travel distance inhibit me from getting the best possible care. Your quality of life, for the rest of your life, will depend on the expertise and competence of your doctors/nurses/support staff/... Obviously, your willingness to do the post treatment physical therapy will also have a huge influence as well.

Good luck with getting a diagnosis for your increasing PSA and I pray all goes well!!! Please let me know if you have any questions.

Let me give you my personal experience after 1st advising you to have discussions with your urologist for a repeat TRANSPERINEAL MRI FUSION BIOPSY .
I have BPH and on Dutasteride ( there are similar medications ) to help shrink my prostate . When you are on these medications for a few years , I am on it for 4 years . YOU HAVE TO DOUBLE YOUR LAB PSA RESULTS or even 2 1 /2 times when on it longer term .
After my 1st MRI which showed an increased T2 signal and PI-RADS 5 score , I had the transperineal biopsy .
ALL THE CORES WERE NEGATIVE . This was in complete conflict with the MRI suspicions of prostate cancer. PI-RADS 5 being the worst reading . I immediately requested a 2nd MRI and 2nd Biopsy . The 2nd MRI , at a different clinic , confirmed the 1 st MRI findings .
The 2nd Biopsy results came back showing all cores in the target area Gleason 3 + 3 = 6
Suspecting they may have missed some Gleason 7 - I requested a 2nd opinion of my biopsy slides .
The result of the 2nd opinion . ALL CORES WERE Gleason 3 + 4 = 7
The bottom line . Advocate for your own health . Dr Patrick Walsh in his book " Guide to Surviving Prostate Cancer " is a strong advocate for a 2nd or even a 3rd opinion .

You really did the right thing, becoming proactive about your care. Hard to believe they could all come up with 3+3 and then have it re-reviewed and become 3+4. I wouldn’t wanna go back to that doctor and lab.

Have you considered the mayo clinic? You won’t find those screwups there. You really want a Genito urinary oncologist handling your case. They are specialist in prostate cancer and keep up with all the latest technology. If you get stuck with a medical oncologist, they just can’t keep up, too many different types of cancer they have to keep up with. They can’t concentrate on treating one single area of the body like a GU oncologist.

The pathologist who performed my 2nd biopsy results has analized thousands of prostate biopsyies .
Another look at the Gleason 3 + 4 = 7 results concluded , some very weak 4 in the 3 + 4 . More likely a 3 .
So go with Gleason 3 + 3 = 6 and stay on active surveillance for the moment .
As we know . A prostate biopsy is one of the more difficult to analyise . Thus the borderline different opinions .