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

@14810eshimmering Wow, my ISO PSA dropped to 7 and total PSA stable at 10. No symptoms. Think I’ll remain on active surveillance and redo MRI and ISOPSA in 6 mos. Maybe ask Dr for antibiotics to treat Prostrtitis to rule that out.

@vtduckman1
Re getting a PCa biopsy at 81 -- first why are you hesitant?

If its a distaste for the procedure, you can get multiparametric MRI instead. Not as invasive, but an MRI is an "interesting" (as in quite stressful for claustrophobes) thing unto itself at the best of times.

If its distaste for likely treatment (removal, radiation, ADT etc). at least get your genetics analyzed. If you have the "right" allele(s), you might be a candidate for immunotherapy (eg Keytruda.) I have a brother-in-law with the right genes for that and seems to be painlessly cured just by that, didn't need radiation etc despite a stage 4 diagnosis.

If you've already had PCa and this time around it is likely to be very aggressive and all you want is palliative care, OK.

If PCa runs in your family, if mine is anything to go by, you might live well into your 90's if it is treated using current best SoC.

Never give up the ship

@derf4223mc
More about Keytruda
keytruda can work very well (large durable response) in the few percent of us with MSI-H/dMMR or very high TMB.

My PSA was hovering around 10 at age 90, but had risen considerably over a six mont(4+3) and opted for biopsy. It was positive for cancer. Had a PET scan which indicated cancer was limited to the prostate. After exploring both photo and Proton radiation I opted for Proton and underwent 42 sessions. At the same time I had four months of ADT (Orgovyx). Only side effects were fatigue, muscle weakness, joint pain, increased frequency of urination and weak stream. Also experienced minor, hot “flushes.” Not so strong as to warrant being called a full-fledged “flash.“ in summary, having had the biopsy, plus what followed, makes me feel more confident for the future than would have been the case had I just sat back and “observed“ in some sort of surveillance program.

Everyone's cancer journey is unique to your specific situation. The biopsy tells you your level of damage. Your decision to treat or not to treat the cancer comes after the biopsy. I had a cousin whose PSA was 14 at age 82. Two biopsies showed no cancer. He died at 88 of a stroke. I never had a PSA over 2.3. At 70 years, a new urologist found a small lump, did a biopsy and found low Gleason scores, Stage one.
Recommend "wait and see". Second opinion was the same. I elected to remove the prostate. Upon removal four months later, Gleason scores were the high, stage 4, terminal.
Two urologist and one biopsy were wrong. Get two biopsies to confirm findings. I've lived, for some reason, to 80 with that wrong advice. After removal and new diagnosis of stage 4 terminal, they recommended Proton radiation therapy. They had to stop short of the scheduled 39 sessions at 35. I developed radiation cystitis and enteritis. Now after 10 years the cystitis became chronic and the enteritis (not officially diagnosed) has caused me untold bowel issues. I had 30 HBOT treatments which has helped significantly.
The moral to my story is get the biopsy and get another one for verification. Do your research. Then do what's best for you - accept and live with the outcome. Good luck.

https://www.nfcr.org/media-coverage/the-novel-isopsa-test-significantly-reduces-unnecessary-biopsies-while-increasing-the-diagnosis-accuracy-of-prostate-cancer/
Question is what is the cost, and is it more expensive and provide more diagnostic value than an MRI ?

If it were not for the cost shouldn’t this test be ordered with each PSA test ?

@tattodice
I get PSA tests every month, I think an MRI would be impractical. The cancer just doesn’t grow that quick even three months is probably too often.

The MRI is an expensive test and takes a long time so They only do it when they feel it is clinically necessary

@rikaconga4u, welcome. That must've been a gut punch to find metastasis 10 years after your prostatectomy. Where was the metastatsis found? What is next for you?

I was surprised since when I had the RP done in 2016 they did not mention metastasis, only to keep an eye on PSA levels. Eleven years later the science of PC has traveled pretty far, particularly in terms of patient survival years and decreased side effects. OMPC is my diagnosis and I am currently dealing with anxiety attacks while wearing a face mask to have SBRT on my left clavicle as only bone metastasis so far. Permutter Cancer Center will later continue with radiation Tx. to prostate bed and Lf. and Rt. hip lymph nodes that I have been told are microscopic. I am currently taking Nubeqa in efforts to side-step the side effects of hormone Tx. which I have read can be quite quality of life destructive.

Its sounds like you don't truly care because of your age, and I certainly 'get it', but short of a PSMA-PET scan (which they'd probably deny you without a biopsy), I don't know that you'd ever know for sure, any other way?

However, I recently posted this on another thread . . . "I have a very close friend (now age 97), who was told (probably mistakenly), that he had cancer over 15-years ago, but who presently has no known cancer, with a validated PSA of 174. Fact! And yes, he has BPH, with moderate difficulty urinating, and is on a BPH medication."