PSA increase: Should I be concerned?

What Does your DME refer to? DME usually means durable medical equipment. Don’t see any explanation for what it means with a prostate cancer test.

Did you mean DRE?

https://pmc.ncbi.nlm.nih.gov/articles/PMC3474980/#:~:text=First%2C%20it%20should%20not%20be,study%20by%20Thompson%20et%20al.
Compliments to your PCP. Thanks for posting.

Digital rectal exam only gets at the "posterior" part of your prostate.........that part next to the rectum. It does not get at the anterior part of your prostate..........that part toward the front of your body. While the majority of prostate cancer is posterior, not all is. Mine was anterior and for years because my PCP felt nothing on digital rectal exam, I thought all was good, while it wasn't. Do not go directly for biopsy unless that is your only avenue. In todays world it should be MRI first. If something suspicious shows up on the MRI and resulting report, get a second read of the MRI to make sure two different radiologists confirm a suspicious region of interest. The radiologist who read my first MRI missed the cancerous lesion. I went two more years before a second MRI read by a competent radiologist found the lesion. Once a confirmed region of interest is found, then do a fusion biopsy of the targeted area of interest. Without an MRI to guide a fusion biopsy the urologist is just randomly sampling your prostate using ultrasound and as far as I'm concerned he's shooting in the dark.

Sorry, I left something out that is also very important. If your biopsy shows cancer, the pathologist who read and interpreted your slides will render a grade and Gleason score. Get a second opinion from a center of excellence like Johns Hopkins to confirm. It is this Gleason score along with a Decipher or Oncotype dx test which will be critical in helping you and your doctors to determine a course of treatment.

@teb829 you might want to ask your doctor for a PSE test. It is 94% plus accurate. The PSA test is only about 57% accurate. It is just a blood test that can be added and it takes about a week and a half between the time they send it and the time that it is processed. It basically will tell you if you are likely to have cancer, or unlikely to have cancer. It is a fairly new test approved by the FDA in 2023 but is supposed to be the test before the ext step of a MRI or biopsy. If you have to wait for your urologist anyway, it is a good next step. You can order it through your PCP. The name of the company that makes it is Oxford Bioddynamics.

Great discussions here and right on.
My journey was raising PSA numbers still in normal range. A PSA test is not a cancer diagnosis. It only shows that prostate is making a certain level of PSA. It can be irritation, infection, or cancer.

I was referred to a Mayo urologist who it seems to me now does a more thorough medical exam that not only does DRE, but also testicular, seminal vessels, scrotrum, etc. It was not just a DRE but a thorough medical exam. I thought this level of medical exam was the norm for those having a urologist addressing prostate issues but I can see the norm is the DRE.

Mine medical exam was negative and on to MRI with contrast. Suspicious areas found. A poster was correct a MRI cannot determine cancer. It can see suspicious areas that require a biopsy to be done to determine if it is cancer. I had a MRI/Fusion biopsy done transperineally which came back cancer and worse was 3+4=7 intermediate risk.

The urologist referred me to R/O. R/O went over options but suggested a Decipher and bone scan. Decipher test came back low risk and changed my treatment options and bone scan was negative. At that point I, with the advice of my PCP, did second opinion at UFHPTI who also did a PSMA. I then researched, and made my decision on being informed cancer patient and what was best for me.

My Mayo PCP went over everything with me (basically a 3rd opinion) and we made an informed decision of what was best for me. If I had disagreed, I would have gone on to get another opinion. But my PCP is a fanatic on doing research on prostate cancer. I asked why, and he said so I can provide recommendations to my patients on what is best for them. He constantly tells me even today about new research and information he has found.

I am now a promoter of second opinions, Decipher, and PSMA tests and reserach. And last, but not least, going to an experienced and well renown medical institutions so you can make an informed decision on your care.

Hey jc, not only are second opinions necessary, but they change the treatment in over 75% of all cases of ANY illness.
The more informed you are by different doctors the better you can choose the treatment that’s right for YOU!

My husband went through the same thing. He was 49 years old and getting DRE every year performed by his primary care since he was 40 years old, but dr never did a PSA. At 49, he had a benign, non-urgent lump on his testicle. It was nothing, but I insisted he go to Columbia-Presbyterian (NYC). They said he could have the lump removed anytime. Just fluid filled. They did a PSA and it was 70. At 49 years old, with a 70 psa and later a 10/9 Gleason, his primary care definitely missed it. And perhaps should have been doing PSAs instead of DRE since he was not properly trained to know what to feel. One oncologist said his prostate was 75% tumor and mush. MSK turned him away. Said he was too young and his numbers were too high. Went to NYU and his dr felt he could do a lot and he did. Radical prostatectomy, local radiation. Eventually bone mets. But, he continued to live his life and work (various treatments on and off) for another 10 years, and then had to go out on disability. He survived at home for another 7 years! He got 17 years from that protocol and I understand MSK now follows that protocol. I still think psa should be done at 40 and every year or 2 thereafter. My husbands cancer may have been caught a lot earlier. I think with a 3.3 psa at 73 is a watch and wait, repeat psa annually or more. But burning frequent urination could be a UTI. Wishing him the best...

So sorry for your loss, but thankfully your husband did get 17 more years, which is amazing with that amount of cancer.
Sadly, MSK used to be unwilling to take on any case which might not be successful; didn’t want their numbers to show failures. They did the same thing to my beloved aunt suffering from pancreatic cancer. Gave her a quality of life speech and sent her home to die.
They are now MUCH more willing to take on the toughest cases and their research efforts are world class. Unfortunately, the times into which you are born have everything to do with how - and when - you die.

I'm pretty sure Mayo Clinic turns no one away!