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

Posted by lookin4answers @lookin4answers, Nov 22 3:42pm

I am 68. Watched my PSA gradually go from 4 (2020) to 9.05 (Nov 2025 test). MRI done in Nov 2024 showed no lesions, but enlarged prostate. Urologist wants me to get a biopsy. Stories about patients with similar PSA values (>9) having to endure multiple false negative biopsies is disconcerting. Should I demand to have another MRI done before the biopsy, or is the ultrasound good enough to find the lesions to sample during the biopsy?

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bens1 | @bens1 | 4 days ago

@lookin4answers
You might want to get the PSE blood test which looks at biomarkers. It is 93-94% accurate (vs PSA alone) with a report that states whether you are likely or unlikely to have prostate cancer. Part of Oxford Biodynamics goal is to prevent unnecessary biopsies. The link to their web site and the web page for the PSE test is:
https://www.94percent.com/

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TommyG | @tdgillett | 4 days ago

Other suggestions in this forum are good. You may want to discuss other factors with your urologist if you haven't already done so: Size of prostate can nudge the PSA # up and still be "normal." Even if the MRI doesn't show lesions, one could still have cancerous cells in there which the biopsy could show. Luck!

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climateguy | @climateguy | 4 days ago

Here is a detailed discussion of 2nd opinions on MRI and biopsy interpretation.

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Colleen Young, Connect Director | @colleenyoung | 1 day ago
In reply to @hikerbruce2025 "I am in similar shoes. I’m 68 and have had a PSA number in the 5..." + (show)
Profile picture for hikerbruce2025 @hikerbruce2025

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”.

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@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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kjacko | @kjacko | 6 hours ago

My second MRI, 5 years after my first, also came back clean. We decided to do a second biopsy about 6 months later. I also had an enlarged prostrate(volume of 68) and my PSA was up to 7.7. The second biopsy came back with 2 cores of cancer, one at 3+4. I decided on surgery. The pathology report came back at 4+5. Now 2 years later PSA is still < 0.01. Obviously, I was glad I made the decisions I did. Based on my experience I would highly encourage the biopsy, but my advice is to make absolutely sure you have taken the necessary steps so you feel confident with your decision. Best wishes

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