60 Yr Old - % free PSA 10%, free PSA 0.26, Total PSA 3.98 in March

My PSA numbers are very similar to yours. Similar age to you. I turned 61 a little over a month ago. Biopsy on April 10, 2026 had (4) cores of 3+4 and (1) core of 3+3. Biopsy in September of 2025 had 5 cores of 3+3. I do not think lesion went from 3+3 to 3+4 in 6 months. I think the 1st biopsy sampling missed the 3+4.

In 2022, my yearly bloodwork PSA went from 2.0 to 2.8 (prior year to 2022). Had two more PSA tests in 2022. One was at 1.8 and the other at 2.7.

Since it was not too high, I did not go to Urologist. 2023 and 2024, yearly PSA were at 2.5.

My 2025 PSA was 4.0. I made 1st available appointment with Urologist. 1st ever visit to a Urologist. No infection and nothing felt by DRE. With 4.0 still not being too high, I was not pushed by Urologist to submit to any further testing. I told him I wanted more tests.

I did 4K blood test (PSA portion was at 2.0) and MRI. MRI showed a Pirads(5) lesion. Biopsy a few weeks later confirmed Gleason 3+3. Active Surveillence was treatment protocol.

Went to City of Hope for 2nd opinion. 3 PSA tests at City of Hope in 2025 and early 2026 were 2.7 (few weeks after biopsy which should elevate PSA) and 2.0 twice.

Scheduled a confirmation MRI/biopsy for April 2026, because MRI was indicating a lesion likely with higher grade than 3+3. This has proven to be the case.

PSA test April 3, 2026 was at 3.6 (bloodwork prior to MRI and April 10th biopsy)

February 2026, PSA was 2.0.

You going to Urologist and having a DRE and MRI would provide information.

My lesion is along the prostate capsule. MRI indicate no visible extracapsular extension, but it is along the wall. If I had not gone to Urologist last year, I would have never known. I do not know why I have only had 2 PSA values over 3.0 and none over 4.0. If lesion extends thru capsule, treatment and spread are more difficult to manage. That is one reason to visit Urologist and get MRI. Finding cancer before it spreads or gets too high of a grade, is important.

Best case for you, you visit Urologist and have an MRI and no lesions are visible. In that case, keep tracking PSA. Maybe get PSA checked 3-4 times per year for a few years.

Best Wishes.

@charlesprestridge

4 years ago at 66 years if age my PSA doubled from 1 to 2. My PCP sent me to a large Urology clinic, DRE normal. I said there is blood (brown spots) in semen. He said not to worry. PSA went up to 2.8 and MRI was ordered, negative, nothing there. I offered to pay for biopsy and there it was Gleason 3/4 and a lesion estimated to be 20 % of the prostate so sometimes low PSA does not equal no PC in a small percentage of us. The Chief Urologist at UC Irvine (a COE) said that about 10% of us get significant cancer at low PSA and/or MRI invisible. The issue is we might get treated late as a result. For me the driving factor was family history of cancer and brown spots in semen.

My PSA numbers are very similar to yours. Similar age to you. I turned 61 a little over a month ago. Biopsy on April 10, 2026 had (4) cores of 3+4 and (1) core of 3+3. Biopsy in September of 2025 had 5 cores of 3+3. I do not think lesion went from 3+3 to 3+4 in 6 months. I think the 1st biopsy sampling missed the 3+4.

In 2022, my yearly bloodwork PSA went from 2.0 to 2.8 (prior year to 2022). Had two more PSA tests in 2022. One was at 1.8 and the other at 2.7.

Since it was not too high, I did not go to Urologist. 2023 and 2024, yearly PSA were at 2.5.

My 2025 PSA was 4.0. I made 1st available appointment with Urologist. 1st ever visit to a Urologist. No infection and nothing felt by DRE. With 4.0 still not being too high, I was not pushed by Urologist to submit to any further testing. I told him I wanted more tests.

I did 4K blood test (PSA portion was at 2.0) and MRI. MRI showed a Pirads(5) lesion. Biopsy a few weeks later confirmed Gleason 3+3. Active Surveillence was treatment protocol.

Went to City of Hope for 2nd opinion. 3 PSA tests at City of Hope in 2025 and early 2026 were 2.7 (few weeks after biopsy which should elevate PSA) and 2.0 twice.

Scheduled a confirmation MRI/biopsy for April 2026, because MRI was indicating a lesion likely with higher grade than 3+3. This has proven to be the case.

PSA test April 3, 2026 was at 3.6 (bloodwork prior to MRI and April 10th biopsy)

February 2026, PSA was 2.0.

You going to Urologist and having a DRE and MRI would provide information.

My lesion is along the prostate capsule. MRI indicate no visible extracapsular extension, but it is along the wall. If I had not gone to Urologist last year, I would have never known. I do not know why I have only had 2 PSA values over 3.0 and none over 4.0. If lesion extends thru capsule, treatment and spread are more difficult to manage. That is one reason to visit Urologist and get MRI. Finding cancer before it spreads or gets too high of a grade, is important.

Best case for you, you visit Urologist and have an MRI and no lesions are visible. In that case, keep tracking PSA. Maybe get PSA checked 3-4 times per year for a few years.

Best Wishes.

@charlesprestridge
Thank you. Did you have a free PSA test done?
My last total PSA was 2.6. My free PSA was 0.26 ng/ml with a % free PSA 10%.

Update: I went to the urologist in Oak Ridge, TN.
He was reluctant, but he ordered an ExoDx and an mpMRI. My MRI is next Monday.
Is there anything I should ask or be aware of beforehand? Or after?

Update: I went to the urologist in Oak Ridge, TN.
He was reluctant, but he ordered an ExoDx and an mpMRI. My MRI is next Monday.
Is there anything I should ask or be aware of beforehand? Or after?

Hi. Have you had an MRI?