Could Use Some Advice on Rising PSA

My psa @ 65 went from 4.1 to 2 in 1 month after retest than following year 3.85 than 3.75 so I saw a urologist checked my prostate and said not a concern for cancer at this time, but this year 5.09 after retest 4.9 fast forward to today cancer diagnosis and oncologist appointment next week. I wish I was more proactive last year and should have asked for more testing. Because psa jumped from 2 to 3.85 and just took the urologist word for it that cancer was not a concern.

get tested every 6 mos. if it goes over 3.5 or so, get with uroloogist and maybe get MRI. I dont believe you have a problem- at this time-but would monitor closely. PSA test every 6 mos.

You are doing great asking these questions.

Two general guidelines to prompt visit to urologist are if either of these occur:

-PSA velocity over 0.7 from test to test
-PSA Over 4.0

You have two years of PSA velocity increases.

I recommend scheduling a visit to Urologist in the next few months. They will test urine for infection and perform a DRE.

The DRE will give some understanding if the prostate is enlarged and will see if any lesions are felt.

This will be some starting point information.

At this visit with Urologist, discuss further tests.
-4K blood test (adds more factors than just PSA)
-PSE test
-MRI

I am 61. In 2022, my yearly PSA increased from 2 to 2.8. In 2025, my yearly test was 4.0. This was enough of a jump for me to visit Urologist for the 1st time in July of 2025.

DRE indicated prostate not very enlarged and did not feel any lesions. Since PSA was only at 4.0, Urologist asked if I wanted any further testing. I strongly stated YES. I knew my PSA had been increasing for several years and wanted more info.

4K blood test was rated at low-intermediate risk for prostate cancer. My PSA portion of the 4K test was only at 2.0 (this was 6 weeks after PSA was 4.0 on yearly bloodwork).

MRI a few weeks later, showed a 2cm Pirads5 lesion. Pirads5 lesion is the highest on a Prostate MRI and indicates the lesion is highly likely to be cancer.

Over the past year, I have had two MRI’s, two biopsies, and other tests. I have at least Gleason 3+4 cancer and lesion is along prostate wall.

I have RP surgery scheduled for next month.

Over the past year, I have had 7 PSA tests. Only two of these tests have been over 2.7

One test last year at 4.0 and one this year at 3.3.

All other test have been between 2 and 2.7. I have had two tests at 2.0

You may not have prostate cancer. PSA may be rising for other reasons. You just want to get more tests and more information.

We are all different. Some have high PSA and no cancer, while others have low PSA with significant cancer.

Some have visible benign lesions on MRI and some have no visible lesions on MRI and have significant prostate cancer.

Best wishes and keep asking questions.

@charlesprestridge Good for you to insist on further testing - you probably saved your own life.
Another test is a PSE, which is 94% accurate for detecting the presence of PCa, something the PSA test cannot even come close to.
Phil

I'm a great "over-worrier" myself, and in my experience that happens mainly when I'm not taking action about the worry. Why not see a urologist ASAP? Your concerns seem highly focused on your nether regions, and urologists are the people who are trained to deal with that specifically. Having a doctor tell you everything's all right simply because your PSA is in the right color zone may or may not be okay, but it's simplistic and begs a lot of questions that a urologist could address in better detail. Good luck!

@milkeg73
I would say ditto to the comments regarding the PSE test which can be ordered by your PCP. It was originally designed for potential early stagers. Here is the link to Oxford Biodynamics PSE product page:
https://www.94percent.com/

At 53 your PSA should be under 3 so I would not wait for it to go above 4. Considered elevated above 2.5. With your family history you should be considered high risk of prostate cancer. Prostate cancer that shows up at an early age is usually more aggressive. The PSE test is accurate but expensive ($1000) and may not be covered by your insurance. If your insurance allows self-referral probably should find a urologist. After ruling out BPH and inflammation they will probably order an MRI.

The first urologist I saw about my rising PSA did a DRE. He reported that my gland size was 35, and that it felt normal. A subsequent MRI ordered by a different urologist a few months later found that the prostate was actually 62 cc, and it had a large lesion that was rated highly likely to be clinically significant cancer. A biopsy confirmed that the MRI was correct, and the DRE was wrong.

So in my limited experience, I wouldn't put a lot of confidence in a DRE.

One thing I did when I was concerned about my rising PSA and felt like I wished I had another reading was to order one from Quest myself. It cost me less than $60 at the time. It confirmed the alarming rate of rise.

UT MD Anderson is one of the most highly rated hospitals for cancer care in the US. Their website has a page published in 2024 entitled "Prostate-specific antigen (PSA) levels by age: What to know"
https://www.mdanderson.org/cancerwise/prostate-specific-antigen--psa--levels-by-age--what-to-know.h00-159695967.html
It states that a man younger than 59 should have a PSA lower than 2.5. According to them, the average PSA value for men under 59 is less than 1. When a man younger than 59 has a PSA above 2.5, the webpage states, "it will likely prompt further testing" which at UT MD Anderson is an MRI.

It sounds like you are still being treated by primary care. Primary care docs are not expert on everything. There is a history of bad advice on PSA testing issued by the U.S. Preventive Services Task Force that some primary care docs have yet to sort out. That Task Force issued a recommendation in 2012 to primary care docs to not routinely use the PSA test at all. No urologist was on that task force.

Urologists today say the problem then was there was too much over treatment based on a lack of knowledge about how many prostate cancers could, and should be actively watched rather than aggressively treated. Many say today that the PSA test is one of or the best tests available compared to any other test used in cancer treatment.

Considering what UT MD Anderson policy is, if I were you I would see a urologist at the nearest center of excellence, if one isn't too far away. Even a community urologist might agree with a request for an MRI if you point to the UT MD Anderson policy.

I didn't take my rising PSA seriously for months, until the MRI showed PI-RADS 5 "highly likely clinically significant cancer" was present.

I think this is a reasonable plan. It may not be a problem but getting a PSA test every 6 months is a good precaution to take. Some doctors or on some days just scan your blood tests for measurements outside of normal and don't look at the trend within the normal range.

I also think you should see a urologist. The fact that your grandfather had prostate cancer more than doubled your chance of having it. Most people get it around the age your grandfather was diagnosed with it.

Were there any other cancers in the family line that your grandfather was in?. Is that your mother or your father’s Parent. You are pretty young to have prostate cancer, but I can understand your concern. Other cancers in that family line could point to a genetic issue. Your PSA is low, however, a really good thing.