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

@pesquallie "You might feel differently if you had been in constant pain for the last 20 months."

I was talking about pain from being stuck with a needle, or from some surgical procedure. I'm sure there are other causes of pain that are difficult to live with.

@tattodice Blessings on the good news. My biopsy is on the 31st at Mayo

@gently opt for a psma pet scan

damuaj, tissue evidence of prostate cancer is required for "necessity" of PSMA with original Medicare in the US.
Cash cost for pylarify alone is 3,000 to 5,000$, with total for the test running $4,500 to 21,000 for the scan depending upon whether you have the PSMA /PET at a hospital or and independent radiology lab.
Some very aggressive cancers grow at low or normal PSA levels.
Otherwise, sure.

@jc76 your biopsy description is identical to mind 4 years ago. I m 77 now.

I am younger, was on active surveillance for 6 years and wanted to take some kind of action. I had the transrectal fusion biopsy, which matched a real time ultrasound image with the MRI taken prior to the procedure. I had some discomfort following it for a few days, which I did not have with the usual biopsy.
I also had the PET Scan, which was very helpful in identifying any masses outside of the gland. My urologist said that the biopsy is #1 in ranking, MRI is second best or #2, and PSA is #3.

@ecurb
I hope we, in fact all, have a continued success with out treatments.

Keep eating mushrooms and green tea like I do, plus 1/2 hour/day gym workouts. My 37 yr. Old daughter still can’t beat me in arm wrestling. lol.

@jeffmarc that’s my thinking also. A biopsy without an mri is mostly useless. They did that with me around 10 years ago. They sample kind of I call Willy nilly. Then told me we didn’t find cancer but that doesn’t mean you don’t have cancer. PSA was rising a little every year. Then no blood test for a couple years. Dr was doing my yearly bloodwork. I said don’t you think a PSA is in order. She said ok we will add that. Came back 6.7. MRI then prostatectomy in March 2026. Probably had cancer working for 8 years.

I think the standard of care now a days if you have a high PSA and/or abnormal DRE,
1st) MRI, if MRI shows lesion(s) then,
2nd) Biopsy,
3rd) PSMA.
These tests should give the doctor & patient a good idea of their prostate cancer.
Of course you also have genomic tests that can be done for a more in depth look at how aggressive the cancer is and help make treatment decisions like if ADT would help, etc, etc