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High PSA, but MRI is negative. Biopsy or Not?
Prostate Cancer | Last Active: Dec 8, 2025 | Replies (55)Comment receiving replies
Your urologist may have good reasons to suggest a biopsy including perhaps the PSA change in the last 12 months or results of a digital rectal exam. And, I am not suggesting that you ignore your urologists advice.
But, you could ask to have one of the relatively new genomic diagnostic tests that are much more accurate and definitive than the PSA in indicating the presence of prostate cancer. My cancer was found due to having an ExoDx test which led to a biopsy in spite of a stable PSA, normal DRE, and normal MRI. There are other tests now that are better than the ExoDx - the PSE test seems to be the best currently available. I would ask the urologist to prescribe a PSE test as a next step, and then proceed with a biopsy if the results of that indicate the presence of prostate cancer.
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@rider51 thanks for the reply. My urologist first mentioned the newer urine and blood diagnostic tests last year, but then dissuaded me from them during my visit last week, when he was pushing for a biopsy. After researching some of these tests, it seems to me that they should be part of the clinical progression, especially for someone like me, who has had a MRI that showed nothing (it is a year old now). I'm thinking I should get something like ExoDx AND a new MRI before I go for a biopsy.
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@rider51
Thanks for the comment!
I’m intrigued about your statement:
“My cancer was found due to having an ExoDx test which led to a biopsy in spite of a stable PSA, normal DRE, and normal MRI.”
If you don’t mind me asking, What was your ExoDx result and your biopsy determined Gleason score?
Did you get a Decipher score?
Did you have treatment or did you choose active surveillance?
The reason I’m asking is a friend has a similar prebiopsy situation and received an elevated ExoDx result and is trying to determine if/when to proceed with a biopsy.