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PSA levels at 4.3 to 4.8: Should I have a biopsy after MRI?
Prostate Cancer | Last Active: Nov 5 1:53pm | Replies (16)Comment receiving replies
Hi, I am 66y old, my PSA was 3.0 in 2021, 2.9 in 2022, than 3.7 in May 2024 and last was 4.9 in July 2025.
Urologist scheduled the biopsy. Result: T1c tumor based on rectal exam, 2 cores of biopsy 3+4, 1 core 4+3, 9 remaining cores benign. Gleason score 7, and Group Grade 3. I am already scheduled for PSMA PET/CT scan for next week. Doctor recommendations so far but not conclusive yet: Radical prostatectomy (robotic surgery) or EBRT radiation with ADT therapy. Right now my mind is spinning. I am still in denial, but I am already scheduled for the second opinion at Major Hospital Cancer Center. Please don't ignore your situation and do all the necessary test and take your time to make sure that you know what need to be done. Best wishes.
Replies to "Hi, I am 66y old, my PSA was 3.0 in 2021, 2.9 in 2022, than 3.7..."
@cadman2025 Be sure to get Decipher test, which checks for aggressiveness.
This score will determine whether you even need ADT at all.
Also, look at your biopsy report and see if it mentions things such as cribriform cells or intraductal carcinoma; these findings are less amenable to standard radiation treatments and may require a boost of single seed placement before five sessions SBRT.
All of these factors combined really do dictate the treatment these days. It is no longer simply surgery versus radiation - but surgery versus what type of radiation. And even what type of radiation with or without ADT.
I know your head is spinning since we’ve all been through it; but settle down and do a little homework and you will be much happier with your decision. Best,
Phil
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@cadman2025
At today’s PCRI conference they discussed the fact that SBRT radiation is just as effective as EBRT.
If it has not spread outside the prostate, you can get it done in five sessions instead of 20 or more. It is much preferred to get MRI guided SBRT.
SBRT is now considered a standard of care option for prostate cancer in the United States
• SBRT is supported by multiple high-level studies:
• HYPO-RT-PC
• PACE-B
• UCLA-Led General Consortium Study
• UCLA-Led SHARP Consortium (high risk disease)
Apparently, the fact that SBRT uses a higher level of radiation is really beneficial in killing cancer cells.
They did mention that if you have seeds implanted they can get even more radiation at one time. It is very effective and can cause fewer side effects.