Biopsy Decision

@jc76 To quote my doctor: "I've had guys with a very low PSA and serious cancer and I've had guys with a very high PSA and no cancer at all. Both are rare, but they do happen".

This is why we have our current model of multiple tests until everyone has enough information to make an educated and informed decision.

@jc76

Agreed!

A single PSA test result is only one (a poor one at that) of the many biomarkers to consider when trying to determine what to do next.

Staying with PSA testing, your PSA doubling time, PSA velocity and PSA density are more important than any individual PSA test result, to help determine the probability of a man having clinically significant prostate cancer.

Besides mpMRI, many new tests, such as the MyProstateScore 2.0, IsoPSA, SelectMDx, Prostate Screening EpiSwitch, ExoDx (EPI), Prostate Health Index, and the PCA3 tests (I’m sure I’ve missed some) have significant advantages over PSA in predicting clinically significant PCa.

IMO the current problem is that there are so many possible PSA test improvement alternatives, that no particular one is being universally adopted by the medical urological community….in fact some urologists don’t bother with any of the improved tests.

That’s why one must do their own research and REQUEST a particular PSA alternative test, if that’s what you want.

I know PSA is great to look for biochemical recurrence after treatment; but it’s horribly inaccurate as a predictor of PCa for screening purposes.

@survivor5280
From my experience with this it is the rising PSA levels over time versus the actually PSA number.

My PCP (Mayo) did not even talk about me being under normal PSA level it was the steady rise of my PSA test that he did not like and rightfully so.

I read somewhere don't remember there was a spread of PSA numbers being normal based on age. Had never heard of that and glad my PCP was experienced and knowledgeable to address a known concern of a rising PSA level not some docotors referring to a number saying this is okay and this is not. Something will cause a PSA to continue to rise even if normal level.

Could be cancer, could be BPH but needs to be checked and determined why?

Lots of good advice: I too am in the camp of get a PSE test with 94% accuracy and a second opinion, then come back to this site for treatment experiences.

I can’t imagine not getting a biopsy after the MRI spotted a lesion. I couldn’t wait to get in for a biopsy after my MRI showed a lesion. I am probably not the norm but my biopsy was not a big deal. I found it very interesting to see her circle the lesion and tell me she would take 5 samples out of that area and 12 random. 4 of the 5 in the lesion were 4+3 cancer.
I just had a friend who’s urologist suggested waiting after they found a lesion but only a 4.3 PSA. I strongly encouraged him to get a biopsy, especially after my experience and being on this forum for 18 months. He has 3+4 cancer. You want to catch the cancer as early as possible as your treatment options are much more robust. Good luck.

I (70Y) had a slowly rising PSA to 3.8 in Sept 23 and a family history of PC. Got an MRI on the suggestion of my primary care doctor. It showed a small lesion with a PIRAD of 2. Continued to monitor including a free PSA test with a urologist in May 24 that didn't suggest a biopsy. Nov 24 PSA had gone to 6.4. Had another MRI in Jan 25. This time PIRAD 4 and suspected metastases in a lymph node and bone. Biopsy confirmed PC with Gleason 4+4. PSMA Pet in March showed no other involvement. Now on Orgovyx and Xtandi and had radiation. PSA is undetectable and T is 3. Bottom line I followed the guidelines but caught it just a bit late. If I were the OP I would err on the side of getting a biopsy as his original MRI sounds a bit more concerning.

Get ,the biopsy find out what your Gleason Score is, have them do a blood test to see what your testosterone level is then you will know where your at, I have had two biopsy's there not that big a deal.

@cwd21682nd

Not to be argumentative, but a biopsy can be a “big deal”.

I experienced odynorgasmia that took 10 weeks to resolve after my 21 core biopsy. Still have a small (but manageable) issue two years later.

Studies suggests that painful ejaculation after a prostate biopsy, especially when 20 or more cores are taken, is a recognized complication with a prevalence possibly in the range of tens of percent,

Granted this is a “minority report” (for which no one even mentioned was a possibility before my biopsy). I was told “Yeah, that can happen” by my urologist, after I described my post biopsy symptoms.

Hello-If you have BPH, then the big thing to watch out for is if there is also Adenocarcinoma present, since the benign hyperplasia does not metastasize and spread to other areas that can kill you. It enlarges and blocks urine, crowded things out.
I am not a medical dr., but have the killer cancer; so go with your urologist's advice and get the biopsy after the MRI targets where the dr. will sample.

@handera
Sorry to hear your complications. With any surgery (and a biopsy is surgery) can have complications.

Your urologist should have briefed on the complications that can happen even if considered rare.

Can I asked did you have your biopsies done transrectal or transpernial?