Rising PSA - next step options

@rcroane56
We on MCC should provide you with our personal experience with the topic and not tell what to do or not do.

My experience with this is similiar to yours. My PSA was still normal 3.75 but had been rising steadily every 3 months of PSA testing (started that around 75 diangosed when 76). My PCP did not like the steadily rising over the years and referred me to urologist (Mayo Jacksonville is my care givers).

The urologist did a DRE and medical exam finding nothing but ordered a MRI with contrast. That MRI showed susupicious areas. So a Transpernial MRI/Fusion biopsies was done revealing 3+4=7 and 4+3+7 and my diagnoses was intermediate risk with radiation and hormome as treatments.

My R/Os (was not a member of MCC then and had no idea what these test were) suggested doing a Decipher tests, PSMA, and bone scan. The PSMA and bone scans were negative. The Decipher test (a more precise genitic test of your prostate cancer biopsies) revealed low risk not intermediate which changed my treatment to radation only no hormone.

So you can see from my experience my journey with this. What you choose to do is your personal decision working with your doctors. If you trust your doctors and they are experienced with prostate cancer asked questions after questions. If you are in doubt get a second opinion.

From your post it seems you have a caring and experienced doctor. Is this a urologist? If prostate cancer is in your family that is something that needs discussion with your doctors. For me I chose to get the MRI and glad I did as I was told caught the disease very early with excellent prognosis of successful treatment.

Thank you. Yes, my doctor is a Urologist and head of the Urology Dept at our hospital. I have been his patient for at least 20 years.

Well, yes, let me chime in and agree that the MRI makes perfect sense!
Having said that, when I had mine recently, the tech very considerately rolled up a pair of foam earplugs for me to insert, as the noise the machine produces is really quite loud! I'm not sure that music head/earphones would suffice.
For me, it was an interesting combination of moving, mechanical and electronic noises, and I treated it as a sort of strange, electo-mechanical sound bath, if that makes sense.
It really was, as commented, a "piece of cake", but then I, too, don't suffer from claustophobia.
Get the scan!!

@rcroane56
I think what most of these guys are saying about getting an MRI makes sense.

I would also immediately call Oxford Biodynamics or email them and request the kit for a PSE test. It is supposed to have a 94% accuracy. Test results give you one of two confirmations, you are either likely to have Prostate Cancer or you are unlikely to have prostate cancer. That test was not available when I started my process in October 2022 at the age of 69 but I would’ve taken it prior to the MRI or definitely before the biopsy.

Over the course of seven years(2016-2023), I had 2 MRIs that showed nothing. My first biopsy in 16 showed nothing. We decided to have a second biopsy in 23 in spite of a negative MRI. It showed two cores of cancer, one at 3+4. I opted for surgery. After the surgery, My pathology report showed a higher grade of cancer. I was glad I had it removed. So far, so good. 🙏 My advice to you is make sure you and your doctor feel confident in the results of all your tests. Best wishes.🤞

No worries on proceeding with MRI. Based on your PSA, I agree with your physician that it will be negative.

All good questions. And it’s great that you’re staying ahead of this.

In addition to testing PSA, if it were me I would also ask them to test the “Free PSA” (in order to calculate the % Free PSA), and also keep track of the PSA Doubling Time:

If they’ll do a PSE test, that provides more accuracy than a PSA test.

I would also check for a UTI, prostatitis, or anything else that might cause a PSA spike.

An MRI is a reasonable next step. It’s not invasive and will provide valuable information. I would not use an MRI to “settle anxiety about continuous testing". But, I would make use of the MRI information it provides AND continue getting regular PSA tests.

Even if the MRI does not show anything concerning, you’ll at least get a measure of your prostate volume, and can then calculate your PSA Density. (Your prostate may be enlarging; at 70y, that can happen.)

Since your father had prostate cancer, consider also getting a genetic (germline) test (to see if you have inherited any prostate cancer related gene mutations). (They say that having a 1st-degree relative with prostate cancer increases the odds of getting prostate cancer by 50%.)

They probably no longer have your biopsy tissue from 15 years ago, but these days there are liquid (urine & blood)-based biomarker (genomic) test that can provide useful information.

Again, I would get the MRI, and continue regular PSA tests, and try to get as many of the other tests that I mentioned (that your insurance will pay for).

Yes. Fully support MRI now.
My MRI at age 72 indicated suspicious areas in the prostate.
And the MRI was the basis for a Fusion Guided biopsy for me, which found significant PCa.
Best wishes.

Good options, I'd go with MRI. Also, keeping track of PSA, watchful waiting, and having these procedures in your medical records are all winners.

I wonder whatever happened to DRE (digital rectal exam)? A well-trained Urologist can tell a lot from just feeling the prostate .... and it's much cheaper than an MRI and faster than monitoring PSAs!