Do doctors generally assume the worst based upon PSA results?

The MRI will tell you whether or not you have an enlarged prostate. A friend of ours had a huge prostate and his PSA was 50, He had a few different biopsies and they never showed anything. A clear MRI does not mean you do not have prostate cancer, A number of people have talked about the fact that they had clear MRIs, but they had noticeable prostate cancer when biopsies were done.

The problems with urination could be BPH, Hopefully the MRI resolved this issue and figure out whether or not you do have cancer. An enlarged prostate can give you a high PSA, As the doctors have said.

Another thing you could do is get a PSE test. They are 94% accurate to detect prostate cancer in your body. If they find it then you Usually need a biopsy.

20 years ago, there was a tendency to overtreat based on PSA screening results.

The *right* choice would have been just to stop overtreating, but instead, there was a reaction against doing PSA testing at all, and as a result, many health authorities recommended against routine PSA screening for men over 50, and (predictably) the number of prostate cancer cases that are already far advanced at first diagnosis has skyrocketed.

Fortunately, oncologists also learned the right lesson, and don't automatically break the glass and pull the fire alarm because of a slightly-elevated PSA result. As @jeffmarc mentioned, they have many other diagnostic tools available these days (including your scheduled biopsy) to confirm whether that elevated PSA is meaningful or just random noise, and instead of jumping to extreme treatments "just in case", if the other tools don't show anything, they'll often recommend "watchful waiting" instead of ADT, surgery, and/or radiation: you just go onto a slightly accelerated programme of blood testing and imaging, and as long as nothing changes, you're good.

With prostate cancer there is rarely anything assumptive - the “numbers” guide most everything.

Yes, your PSA (11.7 ng/mL) is elevated, but it’s not extraordinarily high. (I’ve known guys in their 50s and 60s with PSAs of 3,000, 7,000, & 11,000 and survived.) My PSA only reached 7.976.

Since you’re already scheduled for a MRI guided biopsy, that must mean you’ve already had an MRI.
> What were those results (PIRADS, etc.)

DRE’s sometimes aren't done these days. With DREs, only the posterior prostate surface is assessed. And even when an irregularity is felt there, 50% of the time it’s benign.

You could have BPH or simply an enlarged prostate; an MRI would show that. (Or you could have a UTI or prostatitis. Remember that a PSA test is not a cancer test. The PSA number itself is similar to a “check engine” light; it indicates that something may be wrong, and further checks should be made “under the hood.” Might be as simple as a UTI; might be BPH; might be more serious, such as cancer. Just need to have further checks. No need to panic, or rush to a quick treatment decision, or get overly concerned.)

If it were me, I would get the MRI; then (depending on the results) possibly get the MRI-guided biopsy.

Thank you (and everyone else) for responding. My urologist recommended going straight to biopsy because the MRI does not rule out cancer and he would most likely do a biopsy after doing an MRI anyway. I have a bit of time before the biopsy date and am considering asking him to send me for an MRI anyway prior to the biopsy. As for my original question about doctors possibly assuming its PC given my PSA level, I may just chalk that up to maybe I am reading into a message that's not there and they're just being blunt.

@thig350 I would ask for a PET scan first...you PSa is not really that high and doesnt at all positively indicate cancer...but should be investigated...even contrast MRI would be a much better first step, IMO..unless you are experiencing lots of blood and DRE indicated nodule...a targeted biopsy might be worthwhile a bit down the road..but it is invasive and may not be necessary

@thig350 I would get the MRI with contrast. You want to know if there is a lesion BEFORE the biopsy. My biopsy was 5 cores out of the lesion area on the MRI and 12 random. 4 of the 5 in the lesion were cancerous. None of the other ones were. They also took a little deeper core out of the lesion area (I assume for a better sample size).

@thig350 Going straight to biopsy is what’s referred to as a “blind biopsy” because it’s just taking blind stabs into the prostate with hopes of hitting something of interest.

Doing an MRI first allows for identification of suspicious areas (and assigning them a PIRADS score - from 1 to 5 - indicating the likelihood of significant cancer being present), and then (if a PIRADS 3, 4, or 5 is identified) doing an MRI-guided fusion biopsy of those suspicious areas (plus a few random areas adjacent to those suspicious areas).

Yes, what your urologist wants to do can be done, but it’s very old-school - the way it was often done in 2012 when I was initially diagnosed with prostate cancer.

Actually, the “strength” of doing an MRI first is that it does not rule out cancer - because its purpose is only to identify possible suspicious areas in as least invasive a way as possible. You want to hold off invasive procedures until necessary.

If you research the modern standard of care for diagnosing prostate cancer, it involves the sequence: elevated PSA —> (sometimes a DRE) —> mpMRI —> MRI-targeted fusion biopsy.

Of course, discuss all this with your urologist.

You say you are going for a targeted biopsy but also say “he's not doing pre biopsy DRE or MRI”. I presume you mean he wants to do a biopsy before an MRI and therefore a random biopsy which makes no sense imo. I had a doc want to do the same thing at a regional hospital here in Japan (biopsy before MRI) and I went to a university hospital pretty much straight away.

Your PSA is elevated but roughly have a 30 to 40% chance of finding clinically significant cancer in a random biopsy.

@thig350 I can only agree with all the men who advised an MRI FIRST before biopsy. Your urologist does not seem to be up to speed on current accepted practices; and if he is THIS out of touch now, I shudder to think what his future treatment of you may hold.
Not saying he’s not a nice guy or a good doctor, but right now you need an excellent one!
Phil

@thig350 yes, I think it is common for physicians to “cover their bases” when it comes to preliminary diagnoses. That being said, it is also common for a patient to react from a perspective of fear or anxiety and assume the worst, even though it was mentioned only as a possibility by the physician. I hope your tests will lead to more clarity for both you and your doctor (s).