Prostate problem but not cancer "yet"

They found my cancer after two biopsies and my PSA was 12 at the second biopsy. Have you had a PSE test? If not the next logical step would be a PSE. If it were me I would get a second opinion.

I can't give medical advice, but if it were me, I'd look for a doctor who took it a bit more seriously. In addition to annual PSA testing, a digital rectal exam (unpleasant as that is) seems sensible in your situation, as would be some genetic testing (that's what the "E" in the "PSE" test @jayhall mentioned is: it's just a regular PSA test plus some extra epigenetic screening to filter out false positives). Germline testing for mutations like BRCA1 and BRCA2 would also be a cheap and non-invasive way to assess your future risk, and requires nothing more than a saliva sample (it didn't cost me anything to have it done at Invitae, but I don't know if the Ontario healthcare system paid something for me).

I will give you my example. I found an oncologist after some review. Private practice. My PSA had recently been done and was( .9). I was having trouble with urgency to pee. I went in he did a full exam, pulled new PSA test and consulted with me about doing a biopsy. He said the exam revealed the prostate had slightly elongated shape to it. He felt a biopsy would then rule out any issues. Came back cancer. Agreed only 3+3 but I did have cancer. My point would be I had cancer with a < 1.0 PSA. I would be pretty suspicious.

Yea, i expected a rectal exam but nope...he seem to lose interest after checking my chart and seeing/remembering ive had 3 biopsies and the last was computer MRI guided...with images..etc..
So im thinking second opinion also...

Don’t forget that Finasteride works by shrinking the prostate. However, by shrinking your prostate, one of the side-effects is that your PSA is artificially reduced by the same percentage.

If your PSA was 16, if (hypothetically) Finasteride reduced your prostate by 50%, then for a PSA of 8, you have to multiply it by 2 to get the corrected PSA (of 16). That may have happened to you, such that your next PSA of 10 was an artificial number due to the Finasteride that you then have to multiply by 2 to get the corrected PSA (of 20); and your recent PSA of 11 is actually 22.

(That happened to me. When my PSA hit 5.0, I started on Finasteride (due to urinary issues). My next PSA (6 months later) was 2.7. But, I knew to double that to get my corrected (true) PSA number of 5.4.)

If this is what’s going on with you, then your medical team may have to take a closer look to see what’s really going on.

With that elevated of a PSA, if it were me I would request PSA tests every 4-6 months.

> Are you also tracking your PSA Density?

> How old are you?

> When you mentioned “No cancer,” what specifically did the MRI indicate?

> Same with the biopsies, what specifically did they indicate for each sample taken?

I’m no doctor but if I was in your shoes i would be looking for a second opinion at a center of excellence facility like asap if nothing else try to figure out why the PSA is high.

Zzotte

68 years old
All biopsies show no sign of cancer
Yes because of the effects of finasteride (sexy time)
I quit it for a month or so and then did the test and thats when it went up.
So that is what they are warning us about that finastride can cause your cancer to be the worse type? Or i guess give you false hope that your dropping PSA numbers means your beating it but reality its getting worse and you dont know it..with the lower PSA numbers
Glad im finding another Doc...made the appointment today 7/29

Finasteride only improved my urinary issues; I had no negative “sexy time” side-effects.

The warning about Finasteride increasing the risk of high-grade disease came out of a 2003 study.
> https://www.sciencedirect.com/science/article/abs/pii/S0959804905005186

Later detailed reviews of those 2003 findings somewhat cleared that up:

> https://www.cancer.gov/news-events/cancer-currents-blog/2019/prostate-cancer-prevention-finasteride-parnes

> https://www.nejm.org/doi/full/10.1056/NEJMc1809961

> https://pmc.ncbi.nlm.nih.gov/articles/PMC2844801/

My first MRI and biopsy in 2016 showed no cancer. PSA fluctuated between 5 & 6. I also had BPH. Another MRI in 2023 showed no cancer. I decided on another biopsy which showed 2 cores of cancer, one 3+4. I decided on RP. Surgery went well with no incontinence issues. However, my pathogen report showed cancer was 4+5. My advice to you is to get another opinion and do EVERYTHING you can to make sure you have results that both you and your doctor are comfortable with. Best wishes

I'd get a second opinion, nobody WANTS that kind of exam and no doctor enjoys giving it!
and insist on a PSA test!