PSA levels at 4.3 to 4.8

You should have a biopsy done if they find you have PIRADS 3 or Higher tumors found in the MRI. You can also get a PSE test to tell you if there Is cancer in your body, If it finds there isn’t, you don’t need the biopsy? It’s possible that the MRI doesn’t see it and the biopsy can miss it So the PSE test can be very useful.

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.

@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.

I'm not a medical professional, but I think @jeffmarc hit the most important high points. A couple of additional things for consideration. 1) The percentage of free psa can also provide additional information on the likelihood of prostate cancer. 2) you can always get a second independent reading of your mri if you desire it. 3) If you do end up getting a biopsy, try to get a fusion biopsy (if it's an option for you). That's the latest technology where they use the MRI image to increase their odds of actually getting samples from the tumor. I actually had to drive 5 hours to get to a place that had that offered a fusion biopsy when I got mine. 4) prostate is one cancer where you have many more options and better outcomes if they catch it early. If you get to the point where a biopsy is indicated and recommended by a urologist you trust, then you should follow their advice. Best wishes.

@jeffmarc
Great ,thanks. I will see the Radiologist-Oncologist after the PSMA test result next week, so I will discuss with him all the available options.

@housedivided14
Your Gleason score is just above normal (below 4). Do you have BPH? It can be the reason your PSA is slightly high.

Have you had your MRI already or planning on one? That MRI would show suspicious areas or not. Mine showed suspicious areas and biopsy was done confirming PC.

You indicated having a PSMA test done. That is an important test to do mine was negative no PC outside of prostate,

You are meeting with your R/O. Asked he/she your questions and have all of them ready. What is your R/O advising about biopsy. Most of the time the PSMA is done after (mine was) after a diagnosis of PC. Without a biopsy (which you have not had done) specific cell under a pathologist has not been done thus you do not have a Gleason Score which is the score you need that can help your urologist, and R/O recommend other test they feel you need to get the most accurate diagnosis and treament plan.

Unless I have read you post wrong you have not been diagnosed with PC yet. Is that correct? Thus your journey with this is going to be based on what your urologist and R/Os want to proceed with to give them the results that need to make recomemenation to you.

@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

I have not been diagnose with prostate cancer yet. They want to do a biopsy on me. I hear that's a painful and not very pleasant.
I 'am looking for other options than the biopsy or should I have the biopsy done and go from there?
This involves a rectal swab and then wait 2 weeks and then have the biopsy done.
any other advice on this would be very helpful, as I'm very nervous and highly stressed out on this.
Thank you.

if i may play doctor. 4 is the borderliine for normal PSA, ......you need to think........there are biopsies and there are biopsies. such as, ones with seven samples into the P and those with two. alot depends also on attitudes of your clinic/docs. mine were" be least invasive." also , prior to my biopsy thru my bronchia (PC confirmed) taken on node in my lung were a CT scan disclosing small node suspicious, another lung scan in 6 months showin growth, then scan with sugar based contrast injected lighting up my P. and finally an MRI specific to PC. noone talked about manual P biopsy until cancer confirmed and the lung surgeon chose bronchial tube biopsy because she didnt want to CUT......so DUDE, educate yourself! GET ANGRY

@housedivided14... i forgot, its the "MRI PROSTATE SPECIFIC SCAN WITH CONTRAST"