Continue PSA surveillance or have a Prostate MRI?

I have been in a similar situation. I turned 71 in May. My PSA has been on a roller coaster for about 5 years. I had a biopsy a number of years ago which was negative. In 2021 I changed urologists and she recommended an MRI, also negative. This winter my PSA went up to 7 and she recommended a biopsy. I got a second opinion and it was recommended I get an MRI first. It came back negative. My urologist noted that the MRI only examines about 80% of the Prostate. After some discussion I had a biopsy in August. I had 14 cores taken and 1 showed cancer, 3+4=7. I’ve met with two different surgeons and both agreed removal was the best option. I have surgery in 3 weeks. Hope this helps. Best wishes!

This is my understanding. All cancer cells have DNA. You can have prostate cancer in bones, lungs, etc. Despite where it is its still prostate cancer cells. Bone, lung cancer cells, etc have their own dna

JMHO A PSA of 7 is pretty low, esp at 72yrs. IDK about your insurance costs but I would definately recommend MRI over a biopsy.

True a biopsy is the only way to 'know', but a (3D) MRI (w/contrast) much less traumatic (too me) and will give you an idea of the extent of 'weirdness'

In fact the MRI results can be used to guide the biopsy if you go that route. If you do opt for a biopsy I found the bang-for-buck being in-office with nitrous. It cost me $80 but much less 'uncomfortable' than 'numbing' and waaay less expensive / time consuming than anesthesia.

I met w/a very renown urologist who said he never saw anyone "die from prostate cancer". IDK if I understood this correctly but I think his point was, in some cases, the treatment can be worse than not doing anything.

If I understand correctly, obviously some cancers metastasize and kill - maybe it's not prostate cancer at that point?

IDK

I am going to clear this up soon and if you care will share the clarification

Your story about the urologist of renown reminds me that when my father was actually hospitalized for the final time with metastatic lung cancer, his cancer doctor never showed up in the hospital. Perhaps the urologist of renown could consider a similar strategy?

From cancer.org "Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 41 will die of prostate cancer. Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497009/ "Prostate cancer is the second most frequent cancer diagnosis made in men and the fifth leading cause of death worldwide...."

I was diagnosed in 2016 as a result of a biopsy with a Gleason of 3+3. I had 3 more biopsies over the next couple of years. My urologist had resisted ordering a MRI as he wasn't comfortable as to their effectiveness. However, i 2018 he felt that the quality of the MRI's had improved. The MRI showed suspicious cancer in the anterior zone of the prostate which is not the normal location of the cancer and my PIRAD score was 5. He ordered another biopsy with 16 snips, including the anterior zone and it produced a Gleason score of 3+4 which led to a RP in April 2018. Post surgery my Gleason was a 4+3 and while my PSA after surgery was undetectable < .008, it slowly started to rise and after a PSMA-PET scan in January 2022 I had salvage radiation with two shots of Zoladex. The good news is that my PSA post SRT is still undetectable. While I continue to suffer from incontinence and my bowel movements post SRT have deteriorated; I can live with that. My testosterone level is still extremely low but I am okay with living with one diaper and a pad per day. In the meantime, at age 81, I still participate in my twice weekly exercise class and I am still golfing, playing squash and I am getting ready for another ski season on Whistler Blackcomb.

Thank you for sharing your story. It encourages me to stay positive for hopeful outcomes. Best wishes to you in your road ahead and on the Whistler slopes! I live in Atlanta now but enjoyed the times earlier in my life when skiing out West in Colorado and California. I have Peripheral Neuropathy since 2008, so cold and snow don't pair well with my PN. Perhaps I'll explore some high-tech products that could enable me keep my numb toes warm enough to take on a few downhill runs again. I'll dream of gliding down that power in the Rockies again!

Yea, hard to argue those fact but I thought I was clear - IDK if I heard correctly & am planning to clarify.

There are very different types of prostate cancer, really aggressive to slow growing.

The point is the gent's 72 w/a 7.x PSA prob isn't a reason to freak out, rather to weigh things out.