Upcoming biopsy / psa levels

Greetings and welcome. I think curious might be a better description than concerned, at this point but, I don't like the 12/2/24 - 8/18/25 portion and would want to know what's up. Not sure I'd go straight to biopsy, though. Maybe something less invasive like MRI first, if possible.
Good luck! 👍

Standard of care for a rising PSA is to get a MRI, preferably a mpMRI (multi-parameter MRI) before a biopsy. If your MRI results then indicate that a biopsy should be performed, there are different types of biopsies. Also, there are now blood marker tests, such as the PSE (https://www.94percent.com/ test that can tell you with a 94% accuracy if you have prostate cancer. In summary, there are several less invasive steps you can take before a biopsy and your urologist should know this.

I agree with previous posters. Going directly to the biopsy seems rushed and raises concerns that your urologist is $$$ focused.

Check if you have a center of excellence close to where you live and go there. They will very likely do the mpMRI first. Also ask about PSE or IsoPSA.

The jump of your PSA from December 2024 to August 2025 is more than 100%. This is what they call a high doubling rate. When somebody has a high doubling rate, they usually want to do a biopsy since the doubling rate implies there is a problem..

Another PSA test is really not the solution unless you are having BPH issues or have been told you have an enlarged prostate Since December. That can cause your PSA to go up.

As others have said an MRI is usually what should be done first. That is becoming more of a standard of care than just jumping to a biopsy.

Well after researching, i was thinking the same thing, and that a MRI should come first, so i asked the doctor. He stated the big jump, and wants to go and find out now, and not wait. I can say when my levels went down into the 2's, it was them having me totally off testosterone, so it goes down when im not on TRT, but I guess not low enough to warrant in the safe zone.

When i went to the uroligist for the rectal exam, he said everything felt normal, so no enlarged prostate at this time.

@mpersonne The response by the doctor is illogical. The standard of care is for an MRI, ideally mpMRI, prior to a biopsy. MRI's can be performed quickly. There is a reason that the best prostate cancer doctors in the world developed the standard of care methodology.

Per the latest guidelines, only if a mpMRI or a biomarker test (e.g. PSE) shows "High suspicion for clinically significant cancer" is the next step to perform an image-guided biopsy. NCCN Guidelines Version 2.2025, Further Evaluations and Indications for Biopsy.

encourage all male health care providers to encourage annual PSA testing.

If a urologist chooses to perform a biopsy, it should be a MRI-fused biopsy in order to provide you, and him, with the best statistically relevant data.

I'm a little confused here, did you call off the biopsy you said was "now scheduled me for a biopsy next week" in your first post?

At the risk of being alarmist, my doc said the same thing, "everything felt normal", and it was the DRE from hades. I almost went over the other side of the table...

Almost 4 years later, an RP and Salvage Radiation with ADT under my belt, turns out I was Gleason 7. Granted my PSA at that time was 11 so the MRI / Biopsy decisions were a little easier to make.

I'm in agreement with the rest of the group here. It's not time to be alarmed, but it's not time to ignore it either. With that high(ish) doubling rate, I'd want an MRI at least. After everything "felt normal", my MRI with contrast diagnosed me as a PI-RADS: 5.

Could an enlarged prostate cause that PSA jump, I think so, but I'd want to know.

Best of Luck to you!

@web265
Let me clarify. Ive been going to my primary doctor for TRT treatment, and all the psa levels listed above is from my primary doctor. Since my levels have been up and down, he referred me to go see a urologist, and wont prescribe TRT until urologist reports are done. It took a month and a half before they could see me, so it was just recently i had my rectum exam, and he said it felt normal. He then proceeded to say lets set up for a biospy in the coming weeks, which is set up for Nov 18th. I asked was he going to take another blood sample, just to see if it had come down, since i havnt been on Testosterone for almost 3 months, and he said it wasnt necessary. I then proceeded to ask should i have an MRI first, and he said he wants to go and be certain from the beginning, so with me being a newbie, im following my doctors orders. Now that its been almost 3 months since my last visit with primary care doctor, my 3 month follow up was due yesterday, so i kept the visit, and had them run labs again, for im curious to see if my psa has come down, and possibly to normal. If my psa has dropped, im questioning if i should keep the biopsy appointment, or demand a MRI, even if i have to go get a second opinion.

@mpersonne YES, CANCEL THE BIOPSY!!! The all caps were to make sure you understand the importance of the MRI and WHY you need one.
On a very basic level, prostate biopsies without MRI are like playing pin the Tail on the Donkey wearing a blindfold - and a hood! You don’t know where those biopsy needles are going except that they’re in the general area according to a sonogram.
MRI not only shows if lesions are even present, but ranks them according to size, which is a measure of cancer volume.
Secondly, a good urologist will use this MRI(with sonogram) to specifically target this suspicious area and know for certain that he is getting the samples he needs; you can puncture the prostate repeatedly and still miss the cancer, OK??
When your urologist says he has to do the biopsy without MRI ‘to be certain’ nothing could be further from the truth…Get AWAY from this guy ASAP and find yourself a reputable doc who uses fusion guided prostate biopsy, preferably using a transperineal approach…Best of luck,
Phil