PSA levels at 4.3 to 4.8

@housedivided14
I think I had mentioned this in previous post that you don't have a diangosis yet. You may not even need radiation or surgery. Many things cause PSA to rise like BPH, infections, irritation, etc.

You mentioned biopsies. There are two main ways they are done. Transrectal, and Transpernial.
Transrectal usually is not with anesthesia but not saying it is not ever done that way. Thus you are awake and the biopsies are done with your awake. Some tolerate this very well with little discomfor and some have a lot. It is why you need to do what is best for you not what others did.

For me I wanted mine done transpernial and with anesthesia. It is not deep anesthesia but you will not be aware of the procedure. I had no pain prior, during, after and don't remember a thing.

Transrectal also comes with increased chance of infection. The infection can be serious and require hospitalization (from my Mayo urologist). The infection rate increases from 1-2% depending on your medical providers informatoin they use. I was given 2% increase others have listed 1%. For me I did not want an increase in infection and the transpernial infection rate is so much lower my uroloigst says very very rare.

The rectal swap is to see what bacteria and germs are inside your colon, etc. This gives the surgeon, uroloigst, etc. what antibotics to give you.

I would look for a uroloigst that does the procedure tanspernial with anesthesia. With that like I decided for me was best you will have no pain, not aware of procedure and removal of the 1-2% increase in infection rate.

Don't be stressed out. We all went through the nervousness and stress of this. You are starting your journey that most of us now have completed and can guide you of what we did and why.

You don't even have a Gleason Score (Degree of your cancer) yet or diagnosis of cancer. So your journey may end with your biopsies. For me I wanted to know if had cancer and doing the biopsies was not something I hesitated with. And would not even know I had then unless I knew I did.

If your biopsies come back postive now look into (with discussions with your urologist and R/Os,) additiional test like Decipher, PSMA. But don't worry about them right now as your biopsies may come back negative and you will not be joining our group. Your PSA is still quite low and very close to normal. Without seeing how much it has increased over time and how many test you have had it could be nothing more that HPH or an infection, irritation.

Think positive and look at biopsies as something to give you the information you need not something you should fear. And chose transpernial with aneesthesia if worried about pain and increase infection rate with transrectal.
So my post to you is I hope you don't join our group and your biopsies are negative.

@jc76 Thank you so much for the information. I will check with my urologist and see in they can do the transpernial with anesthesia. I hope my biopsy is negative. I hope my results from my biopsy are negative, and I don't have to join this group.
Thanks again,

@heavyphil
Thank you for your advice and help.
Here is the extract from my PSMA PET scan result today and what this SUV 4.6 in prostate Gland means?
EXAM: PSMA PET/CT VERTEX TO DISTAL THIGH
HISTORY
: Initial treatment. 66 year old male with C61 malignant neoplasm of prostate, unfavorable intermediate risk. Staging prior to treatment.. PSA up to 4.9.
PET/CT REQUESTED FOR
: Initial treatment strategy.
RADIOPHARMACEUTICAL
: 9.9 mCi F18 DCFPyL IV (PSMA)
TECHNIQUE
: This is a combined PET/CT scan. PET is performed from top of skull to knees after a 62 minute uptake phase. CT is performed without oral or IV contrast.
Physiological distribution of tracer is seen within the salivary glands and lacrimal glands, blood pool, liver, spleen, pancreas, ganglia, bone marrow, bowel, kidneys and urinary tract.

SUV reference:
SUV max parotid/salivary glands: 18.1
SUV max right hepatic lobe: 9.3
SUV max descending thoracic aorta: 1.3

PSMA - expression score:
High (3) SUV parotid/salivary glands
Intermediate (2) SUV liver
Low (1) SUV blood pool

THORAX: No increased uptake in the lungs or mediastinum. No suspicious pulmonary nodules. No pleural or pericardial effusions.
ABDOMEN/PELVIS:
Evaluation of prostate bed: There is a focus of abnormal uptake with maximum SUV of 4.6 in the posterolateral right lobe (slice 279) at the mid gland level. No involvement of the seminal vesicles.
Evaluation of lymph nodes: No increased uptake in pelvic, retroperitoneal, or abdominal nodes.
No increased uptake in the liver or spleen. Liver and spleen are not enlarged. No hydronephrosis. No adrenal nodules. Pancreas is unremarkable.
BONES/BONE MARROW: No increased uptake in the skeleton and no suspicious lytic or blastic lesions.

IMPRESSION:
1. PSMA avid malignancy in the right lobe of the prostate as above. No evidence for extraprostatic disease.

Thank you for the opportunity to participate in the care of this patient.

@cadman2025 It looks like all the cancer is localized in the gland…VERY good news!
Now the Decipher score will show if ADT is needed if you choose radiation of any kind. Intermediate unfavorable may still not need ADT if all the cancer cells can be eliminated.
If you opt for surgery - and the pathology remains the same - you just might be done. However, if the path is upgraded to more aggressive, or cells are found in the lymph glands ( regardless of low SUV) you ‘may’ need additional treatment in the future.
I’m not a medical doctor and certainly not an oncologist, but it seems from a layman's POV that your PET scan looks better than you feared. The cancer is definitely there, but very treatable…Best,
Phil

Do whatever will provide clarity for you if that is what you are looking for…best of all good things for you…

??? Most importantly: what does your urologist say that (s)he wants to do? Your PSA values are at the upper end of the normal reference range. .."depending on your age". The following ranges are considered within normal based on the age brackets shown:
Age 40 - 50: 0 - 2.5 ng/ml
Age 60 - 70: 2.5 - 3.5 ng/ml
Age 70 and above: 3.5 - 4.5 ng/ml
So...the question is "how old are you?" If you are in your '70's, then your values are within expected "normal" range. But if you are in your 40's to '50's, I would recommend talking more with your urologist or internist who can refer you to a urologist.