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High PSA, but MRI is negative. Biopsy or Not?
Prostate Cancer | Last Active: 7 hours ago | Replies (55)Comment receiving replies
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”.
Replies to "I am in similar shoes. I’m 68 and have had a PSA number in the 5..."
@hikerbruce2025, being fit will serve you well. I assume you're a hiker. How did the appoitment with the urologist go? Did you decide to proceed with surgery?
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@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.