At 81, high PSA: I don't think I want a prostate biopsy

So we can say definitively and conclusively that his metastatic prostate cancer was NOT CAUSED BY A BIOPSY!!!

Im 79. Excellent health. Had a PSA, 88, on Medicare Annual and was referred to Urologist. The Urologist ordered an MRI. Results: PI-RADS 3, Wedge shaped signal 5mm along posterior, midline peripheral zone, could reflect prostatitis or low grade neoplasm, Density.212. Urologist ordered ISO PSA which came at 8, PSA was 10. Wants Guided biopsy ASAP. He eventually conceded to my wishes of a ISO PSA retest in 5 months - results now pending. Really don't want a biopsy at all. Is there any other option?

I did not want one either. I was only 59. The day before I sat with friends watching a Notre Dame basketball game. The whole time I was whistling in the dark. The next day my wife held my hand and knelt down next to the exam room table. Honestly, it was not that bad. I had transrectal with no complications.

@14810eshimmering
You could get a PSE test, which could give you a 94% accurate reading of whether or not you need a biopsy.

I actually wouldn’t even think twice about having a biopsy at this point. The readings you are seeing point to a problem. It is not infrequent that the cancer is in a spot that is not showing up in the MRI as a lesion, Happens a lot.

I’ve had three biopsies, No big deal. Drove home after and really didn’t feel much of anything. You could make sure you get a transperineal biopsy instead of a transrectal which has less chance of infection, But the chance is very low either way. They can put you under for the biopsy.

@14810eshimmering, the only really great thing about a biopsy is that it can save you from a lot of other situations that you really don't want. 70 to 75 % of cancers develop from this zone. It is also the main area where cancers escape the prostate with the capability of metastasis.
You really have the opportunity to catch this early and preserve important physical functions.
I'd bet you good money that there isn't a man alive who would want to have a prostate biopsy.
I hope you decide to have the biopsy and respond furiously (to me) that you didn't need it at all.

@gently Just took a second ISO PSA test and awaiting results. I will use this second marker to make my decision. If score is same or higher - biopsy. If it goes down - active surveillance. I’m 80 yrs old and refuse to die with a limp dick or pissing in my pants. At my age many friends are living 10 years without treating it.

@tattodice "Honestly, it was not that bad. I had transrectal with no complications.'

Agreed; same for me!

I don't know what there is, to this aversion to needles. I'm 81, & I can't think of a single medical procedure I've had:

1. Aforementioned prostate biopsy (local anesthesia). No pain then or after.
2. Radical prostatectomy (general anesthesia). No pain then or after.
3. Hernia repair surgery (general anesthesia). No pain then or after. The doctor offered me some oxycodone pills, but I never needed them.
4. Kidney stone removal by going up the urethra (general anesthesia). No pain then or after.
5. Ditto for the follow-up bladder exam using a probe going up the same path (uncomfortable, but no anesthesia). No pain then or after.
6. I did say "ouch" when I woke up during a colonoscopy (general anesthesia). No pain after.
7. Cataract surgery (local anesthesia). No pain then or after.
8. Shots in the eyeball for retinal issues (local anesthesia). No pain then or after.
9. And then there are the literally dozens of shots (eg, vaccines), literally dozens of blood lab draws, & literally dozens of whole blood donations, some starting at age five. Oh, & did I mention that my parents did the same, & both lived to be over 100 (101 & 103)?

None of these have been as painful as a typical routine dental cleaning (Steve Martin in the "Little Shop of Horrors" movie notwithstanding).

It's not that I am "tough" or have a high tolerance for pain; I don't. It's simply that I don't approach the above procedures with an aversion they don't deserve.

With rare exceptions, doctors know what they are doing & are not interested in hurting you. They have more education & training AFTER college than most people have BEFORE college.

You wouldn't know that from reading some of the threads here, but it's true.

Ok, I'm stepping off my soapbox before I get hurt! 🙂

@14810eshimmering
You are so reasonable about vigilance. I'd be wanting the relief of knowing, one way or the other. Active surveillance would drive me a little crazy. I hope the score goes way lower.

@14810eshimmering
Having to have a biopsy is not something anyone wants to have. But in my opinion and what I did was to have it done when I was 76.

I insisted on the transperineally with anesthesia. I don't remember a thing and had no discomfort afterward. Would not know I even had the biopsy if did not know I did.

By having the biopsy we caught the P.C. early. When I had it done my PSA was only 3.75. My treatment plan from two major medical institutions (Mayo and UHFPTI) was radiation with no hormone treatments.

The biopsy will help diagnose why your PSA is so high and getting a treatment play to help prevent if from getting worse regardless of being prostate irritation or P.C.