PSA up then down

Did MRI. Came back with homogenous low T2 signal lesion in the left base pi rad 4.

A 4K Blood Score test gives you a better look at you total psa and a few other factors. I would suggest asking about it.

Urology PA seems more interested in biopsy. Also radiologist reading mri didn’t seem to be aware my PSA had gone down. I am looking for someone who will listen

PiRad 4 usually indicates a higher chance that cancer is present; you probably DO need a biopsy; not to sound like a broken record, be sure it is trans perineal so they can access other areas of the gland that is not showing activity on MRI. You could have trouble brewing there as well

I will do biopsy. Just not thrilled with current urologist. Also said they can’t schedule biopsy for 6 weeks. However, seminal vesicles are normal on MRI. Also scrip for MRI said rising PSA, which at this point is not correct.

Some fantastic info on this thread.

@bmweissman you might want to consider somebody who does a fusion biopsy as it utilizes MRI for a more accurate insertion and guidance.

If you are near a center of excellence, you may want to go there for a different Urologist, a biopsy and potentially treatment.

One last note, when you get your biopsy, it to do a telehealth consultation by sending your images, outside even the center of excellence that you may be working with.

doctors are dedicated, but not infallible. Sometimes doctors make recommendations that are inherently biased because of either the institution they work for or the success that they have had with the technology that they are using without considering newer technology,that may be a better decision for you as a patient.

Be aware that DRE only makes contact with that portion of the prostate near the rectum.........the posterior part of the prostate. DRE cannot make contact with the frontal zones of the prostate......the anterior. While a good percentage of prostate cancers appear in the posterior part of the prostate, not all do. Mine was anterior. I went through years of DRE only to find out later that it didn't make any difference. So don't count on it to heavily. It, along with PSA, PSA velocity, prostate density, free PSA, etc. is just one of the variables. My advice, get an MRI. See what it says. Get a second opinion on the MRI reading of the images. Make sure they agree. If the MRI shows something then have a targeted biopsy to insure the region interest is sampled. Don't do a biopsy that is not MRI directed............fused ultrasound MRI biopsy. Your confusion stems from lack of good information. And.........if you're near a center of excellence establish appointments to have all of this performed with/by them. It's too important not to be in trusted, experienced hands. You have time...........calm down and don't rush into something you'll end up regretting.

I had MP MRI which showed homogenous lesion in central zone. No EPE, seminal vesicles normal, no abnormal incidental findings, No suspicious lymphadenopathy in pelvis, no suspicious focal lesions in the visualized osseous. Pi rad 4. Radiologist didn’t seem to be aware that PSA was no longer rising. PCP thinks serial PSA testing and repeat MRI before biopsy.

You could look into getting a PSE test. Takes a blood sample and figures out whether or not you have cancer and need a biopsy It is 94% accurate.

If your PSA problem went away maybe that Pirads 4 isn’t active prostate cancer, that number isn’t comforting however.