High PSA, but MRI is negative. Biopsy or Not?

I was admitted to the hospital on 3/26 for renal failure caused by urine retention. They did a CT, MRI, and two ultrasounds. An enlarged prostate was mentioned in all reports but absolutely no mention of possible malignancy or apparent lesions.

Fast forward 3 weeks and urology pretty much insisted on biopsy based on PSA of 30+ and my continued inability to void completely without a catheter. Result - Gleason 9 (5+4) with 10 of 12 cores @ 100% involvement. Because the entire prostate was malignant, there was no contrasting image for them to see. It all looked the same. My conclusion based on my experience, if you want to be sure if its cancer or not, poke it and get a sample. Short of that, it's all a WAG.

Might redo the PSA. Hope your journey goes well.

@lookin4answers
Per my urologist a MRI looks for suspicious areas. It cannot determine if cancer. When my MRI/Fusion biopsies were done it revealed suspicious areas. My urologist gave it a 79% chance of being PC.

Having biopsies is much more accurate diagnosis of your PC and going to give you a Gleason Score. You cannot have a Decipher test without having a biopsy. Those biopsies are what is sent to Decipher for risk rating.

You mentioned pain and discomfort. There are two methods (offered by my Mayo urologist). One is transrectal usually done while you are awake and is through the rectum. It does come with higher risk of serious infection and also anxiety and stress of being awake.

The other is transperineally. It is usually done with anesthesia and you are not awake or aware of what is being done so there is no pain. I had my biopsies done transperineally as did not want the additional risk of infection nor did I want it done through my rectum and also wanted to be under anesthesia as have PTSD and anxiety/panic disorder so very important to me no to worry, stress out, feel pain or discomfort. I felt nothing after procedure was over. If someone had not told me it was over I would not even know it had been done.

There are many new tests out there can be done in addition to biopsies but a MRI is only going to show suspicious areas, tumors', things like that that does not give you a cancer diagnosis.

I had excellent Mayo urologist, excellent R/Os at both Mayo and UFHPTI, and excellent PCP. The information I passed on to you in this post comes from those medical experts.

@rider51
Here is that chart, but I don’t think it includes tests that Came out recently. I’ve included a second chart which has some newer tests

@rider51
I’m surprised you liked the tests that tell you whether or not you probably have prostate cancer, but you are not having a decipher test which will tell you your chance of reoccurrence.

Wouldn’t it make sense to get that test so you know if biomarkers in your system are showing there is more of a problem then A PSA test will show you.

I went 3 1/2 years after my prostatectomy before my PSA started rising. It would’ve been nice if a decipher test has been available 16 years ago. It would’ve let me know I’ve had a higher chance of having reoccurrences, And I’ve had four.

@jeffmarc Very useful. Thanks.

I am in similar shoes. I’m 68 and have had a PSA number in the 5 range for probably 7-8 years. My regular doctor was never overly concerned because I have an enlarged prostate and have had for a long time. However over the last two years my PSA number went to 6.8 and then 8.6. I was referred to a urologist but before seeing him my regular doctor ordered an MRI. I had the MRI done on 9/12 and it was negative. However, upon seeing the urologist he strongly urged me to get a biopsy because of the percentage jumps of the PSA number. He said that because of those jumps I had a 20% chance of having cancer. I did the biopsy on 11/5. Twelve cores were taken and prostatic adenocarcinoma was found in six cores (3 cores were Gleason 3 + 3, which I understand are not usually concerning; 3 cores were Gleason 3 + 4). I now have another appt. With the urologist to consider what action to take. He told me over the phone that active surveillance was not something he would be comfortable in suggesting. I’m reading and talking to as many people as I can about their own personal journey and issues like side effects from the different treatments (surgery, radiation, etc). I am very fit, no issues other than the 2X normal size prostate and peeing twice a night fun. I’m looking hard at a prostatectomy for various reasons. Good luck and positive thoughts for all fighting this “fun”.

@hikerbruce2025
While you had 3 cores At 3+4 what was the percentage of carcinoma in those three cores and what was the percentage of four in those three cores?. If the percentages were very low 5% or 10% 4 then it is not an emergency, If it’s a high percentage, it could be something you need to treat right away.

My biopsy showed a 3+4 but when I had a prostatectomy, it was 4+3. Some people I know had 4+5 after a prostatectomy, but only 3+4 in the biopsy. They can only get about one percent of the prostate when they do a biopsy.

It should be interesting to hear what the urologist recommends. You should also see a radiation oncologist to see what other options you have If the urologist recommends surgery.

Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). Those can mean that the cancer is much more aggressive than it appears from the Gleason score.

@kikito1
You can get an MRI second opinion in the United States are about $250 if I remember correctly.

Here is a video about the company and procedure
https://ancan.org/
ProstatID is the procedure .

Founder and Developer, Randall Jones, PhD, explains the technology and its uses in the video.

More info
https://botimageai.com/prostatid/

@jeffmarc I've thought a lot about this and am getting further convinced that before I schedule a biopsy, I will insist on the EpiSwitch PSE test, then if PSE says cancer is present, I'll get another MRI to find lesions, and then schedule the biopsy so they know where to target the needle.

Thanks to all here for providing me with some insight and direction.