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Biopsy recommended, is this correct next step?
Prostate Cancer | Last Active: May 29 3:44pm | Replies (26)Comment receiving replies
Wow, I am impressed that I received so many high-quality responses, and so thoughtful, especially on a holiday.
Thank you all so much!!
To address the several points:
The biopsy was offered as an option vs active surveillance, they were not pushing it. I zoned into the biopsy option because I am scared of cancer, I’ve seen a lot of it in my family. Biopsy seems a limited risk way to determine what is really going on given the PSA results (high but quite variable with no satisfactory explanation). Then I started second guessing myself. After reading these responses, I am feeling more assured on pursuing the biopsy, understanding the point that transperineal is better/lower risk.
I was unaware of the PSE test, I have researched that and will bring that into the conversation with the urologist (DRE’s seem to be out of fashion, both my urologist and my GP state that they prefer other methods of risk identification and stratification, MRI, ExoDx, etc.)
Jim18 asked the rate of change, here’s my PSA history
4/7/26 = 7.4 retested with no sex 5+ days
3/27/2026 = 8.3 (sex day before);
11/19/2025 = 6.4
5/5/2025 = 7.1
3/12/2025 = 5.8 (Free PSA 1.12, % free PSA 19.3)
4/24/2024 = 3.4. Urinalysis also clear; ExoDx test “4.34 score, well below the 15.6 cutoff”
2/2024 = 4.3 (Free PSA .74. % free PSA 17.2);
6/2023 = 3.18
3/2022 = 2.1
2/2022 = 7.2 pushed it down with Doxycycline and Avodart/Dutasteride
12/2020=3.4
10/2019=2.3
1/2018 = 3.5
3/2017 = 1.8
12/2015=7.0 (then retested and went down, I do not have those results)
12/2014=1.3
Thank you all for your thoughtful comments!!!
Replies to "Wow, I am impressed that I received so many high-quality responses, and so thoughtful, especially on..."
@stevemcdonald
Your results of the MRI are not really significant for prostate cancer as you know. Your PSA on the other hand is pretty high Though there are other things that can cause a High PSA. Your prostate is large, And that could be part of it. BPH issues can raise your PSA as well.
Between the Large prostate and BPH that may be your only problem. Have they given you antibiotics for the BPH, or have they determined there is no infection involved? That could resolve it and also drop your PSA. It could be that you really only need treatment for BPH, This is something you need to discuss with a urologist.
A radiation oncologist at Mayo said that he doesn’t like working on a Prostate larger than 75 cc, Yours does exceed that. Getting rid of the BPH can get it down below 75 ml..
You don’t mention your age and that is another factor in PSA.
While you had an EXODX test the PSE test is much more accurate. Check out the results of it in the slide I included. You should get another test because the results can change over time. If the PSE test finds you do not have prostate cancer. You do not need a biopsy.
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@stevemcdonald Your high PSAs in 2015 and 2022 were caused by some type of infection/inflammation. PSA does not go down that much if it was being produced by cancer. The free PSA is in the gray zone (>10 & < 25). Your ExoDx was taken with a PSA of 3.4 two years ago so that does not mean you do not have cancer today. It would be better if a target could be identified vs totally random biopsy so another mpMRI would be useful. The random part of my biopsy identified a single 3+3 core at 5% involved, good for active surveillance. However, the targeted lesion had all 3 cores at 4+4 with 30% involved creating a very different treatment plan. This was with a PSA of 7.7, 18% free. I had transrectal with local and had no issues during or after procedure. Drove home a few minutes after the biopsy.