What next?

When my PSA got to 6 my PCP sent me to a Urologist who did my first Biopsy. Get yourself an appointment with a Urologist ASAP and get them to review your blood work. Logical next steps would be a PSE test and a Biopsy, If your Urologist has not heard of a PSE test insist on one.

First find out how much higher. If it’s just a couple of Tenths of points, it may not be critical since it’s a slow growth. They do go by the doubling rate and if it’s just a fraction of a point difference, that’s not much of a doubling rate, since it’s been a year and a half since the last test, If it’s a point or two, then hit Mayo Clinic for sure Because even with a slow doubling rate, you are above the normal PSA.

When my PSA started going up, the next step my urologist did was a 3T MRI with contrast. The PSE test @jayhall mentioned is also another potential next step, although I think the MRI is probably more common. Best wishes.

PSA numbers alone do not give much info.
Even aggressive cancers do not always have fast nor big rise ! You should go to an urologist and not just any urologist but the best one you can find in your area. He should perform detailed exam and order MRI and also check for free PSA and possibly PSE. If there is anything seen on MRI you should have MRI image guided transperineal biopsy done ( try to avoid transrectal and "blind" one).

Without any doubt, consult your urologist and see if they can give you a PSE before a biopsy as that is 95% accurate in reporting prostate cancer - the biopsy will still be needed if that test comes back as positive, but if it doesn't then you might just go on active surveillance at first. But, like @jeffmarc mentioned, the doubling rate + a PSA of over 4 are usually your "check engine light" and it's time to pull that dipstick and see what's going on.

Get to a urologist (Mayo is a good place to start) and they will likely order an MRI. An MRI will make the biopsy much more targeted and may rule out the necessity of a biopsy.

I want to thank you all for your responses! Makes me feel much better!

You’re still very early in the process…..miles to go before you have the full information.
First, be familiar with your:
> % Free PSA
> MRI (PIRADS) results
> PSA Density
> Biopsy (Gleason score) results
> Biomarker (genomic) test
> Genetic (germline) test

Make sure you don’t have a UTI, prostatitis, and that you didn’t do anything in the days/hours leading up to your recent PSA test that might have caused it to spike.

Remember that PSA is not cancer-specific. The PSA number itself is similar to a “check engine” light in a car; it indicates that something may be wrong, and further checks should be made “under the hood.” Might be as simple as a UTI; might be BPH; might be more serious, such as cancer. Just need to have further checks. No need to panic, or rush to a quick treatment decision, or get overly concerned.

You have urology appointments set up to discuss with your Doc ? Interview both your Urologist and a Radiation Oncologist as well . You didnt mention your Gleason - I was looking for that and other image work you maybe have done ? At a PSA in around 5 , you have something likely brewing, but unsure....could just be a swollen prostate too . Let us know when you get a chance . James