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Active Surveillance and Chasing PSA
Active Surveillance and Rising PSA (Multiple Negative Biopsies)
I’ve been reading many threads here and have learned a lot—thank you all for sharing your experience and knowledge. I wanted to post my own situation and see if anyone has had something similar.
I’m 65 and have been followed by the same urologist since I was 57 for PSA and BPH. My BPH has been well controlled with medication, but my PSA trend continues to be the main question.
Timeline / key results
Age 57: routine annual bloodwork showed PSA 5.2 → referred to urology.
Diagnosed with BPH; started/maintained on medication (including finasteride).
2018: 4K blood test returned high risk (81%).
2018: initial biopsy (16 cores) was negative.
Over the years: PSA checked about every 6 months and DREs performed; all DREs have been negative.
On finasteride: PSA ran steadily ~2.0–2.5 for years.
Most recent PSA: 4.08 (about double the test 6 months earlier).
Took a course of antibiotics to rule out infection; repeat PSA was 3.96.
It had been just over 2 years since my last MRI/biopsy, so I underwent a “saturation” biopsy (24 cores): all negative.
In total, I’ve had four biopsies, four MRI scans, and 73 cores taken. Across all of that, there has only been one finding of low-grade cancer (in 2018).
My earlier MRIs showed a PI-RADS 3 lesion, but the most recent MRI did not note any PI-RADS lesions. (That last MRI was done at a different facility than the prior three.)
My questions
Has anyone had PSA rise like this (especially while on finasteride) despite repeated negative biopsies?
Have you seen differences in PI-RADS reporting when switching MRI facilities, including a prior PI-RADS 3 no longer being reported?
What additional questions or tests would you discuss with your urologist in a situation like mine?
I have a follow-up appointment next week to review the biopsy findings and discuss the plan going forward.
Thanks for listening, and I appreciate any thoughts.
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Your PSA does seem to be pretty high since you double it if you’re on finasteride, Which makes it close to eight.
One thing you don’t mention, is the size of your prostate. Had a friend with a huge prostate, his PSA was always around 50 never found anything with a biopsy he died of something else.
You could get a PSE test to see if it shows that Prostate cancer was found in your body, But the purpose of that test is to decide whether or not you need a biopsy and you already had one or two or three.
Lots of people with BPH have a large prostate so find out what the size of yours is and maybe that will give you some answers.
@jeffmarc
Thanks Jeff, The MRI report called it a bullet volume of 47.5ml.
Jeff is right these 4k snd PSE assist in the decision making process of going forward with a biopsy which you have done multiple times and recently. I believe the PSE might have a little more accuracy than 4K and determine risk a little different Possibly repeat the 4k to confirm previous one or supplement with the PSE. If the PSE comes back similar high risk, i would say something is being missed. Then move to another MpMRI since that has been two years. A lot can change in two years and even your recent saturation biopsies can miss things. It could be a new MRI could identify something in your case for just a targeted biopsy , not any additional random cores. I think with your PSA and 4K and a two year old MRI regardless of the last biopsy should justify another MRI especially if the PSE results corroborate your 4k