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Biopsy Number 5: What is going on?
I'm 62 and active. My prostate saga began in 2016 with an elevated PSA of 4.9. This is how my PSA has progressed:
03/2012 1.4
8/24/2016 4.9
09/28/2016 5.4
11/02/2016 5.3 12/04/2016 5.3
05/26/2017 5.8 Switched from running to rowing March 2017
11/26/2019 10 01/02/2020 10 12/14/2020 9.8 01/10/2022 13.1 06/14/2022 14 01/13/2023 8.5 08/10/2023 14 05/06/2024 15.5 10/21/2024 11.7 01/07/2025 9.8 06/02/2025 12.3 07/09/2025 16.9 02/26/2026 7.5
My biopsies:
01/01/2017 - Neg
03/02/2020 - Neg
07/28/2022 (Fusion BX) - Neg
08/18/2025 TP Fusion BX - Positive Gleason 3+3 (2 of the 10 cores positive.)
From the path report:
Prostatic acinar adenocarcinoma, Gleason score 6 (3+3), grade group 1, involving 3% of submitted tissue (1/1core, with 0.5 mm size of carcinoma)
and the other positive core:
Prostatic acinar adenocarcinoma, Gleason score 6 (3+3), grade group 1, involving less than 1% of submitted tissue (1/2 cores, with 0.2 mm size of carcinoma on involved core).
Pre-biopsy MRI report:
PIRADS 2- Low (clinically significant cancer is unlikely to be present).
In a few weeks I go for and MRI and biopsy number 5.
I included the switch from running to a rowing machine because of the big jump in PSA a few months after the switch. Have no idea if it’s related. I always take a few days off of rowing before a PSA test.
The first three biopsies were not at Mayo. I switched to Mayo so I could get a transperineal biopsy.
Any thoughts about what the heck is going on? Thanks!
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You are having a great run staying ahead! Keep it up. Good luck with your upcoming MRI and Biopsy that they continue the same as in the past. You are staying diligent with your AS.
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Hug
1 ReactionYou might, looking forward,
might want to check out Dr. Brian T. Helfand MD PHD.
If you might be thinking of a type of surgery google PCAq with his name. I just had mine done, Aquablation Chicago, at Highland Park Hospital. Then again I also had BPH, 3+4, PSA 2.93, PI-RADS-4, two locations, bilateral prostate cancer , stage ll, decipher.46.
He has made great podcasts as you will see. Likley an excellent contact.
Ray Detor 585-259-9308
Thanks! How did your procedure go?
Just looked at my post and realized the formatting of my PSA history got messed up. Fixed it.
03/2012 1.4
8/24/2016 4.9
09/28/2016 5.4
11/02/2016 5.3
12/04/2016 5.3
05/26/2017 5.8 Switched from running to rowing March 2017
11/26/2019 10
01/02/2020 10
12/14/2020 9.8
01/10/2022 13.1
06/14/2022 14
01/13/2023 8.5
08/10/2023 14
05/06/2024 15.5
10/21/2024 11.7
01/07/2025 9.8
06/02/2025 12.3
07/09/2025 16.9
02/26/2026 7.5
@tommm
Do you know how big your prostate is? A large prostate along with BPH could cause the high PSA issues you’ve been having. I know somebody who had a huge prostate, his PSA was always around 50 but a biopsy never found anything. Have you had any BPH problems? Have they ever put you on an antibiotic for your prostate? Those can affect your PSA.
A PIRADS 2 Barely Calls for a biopsy.
Good to hear you’re having another MRI before the next one.
Sometimes the cancer is in a spot that is not detected by the MRI. You can get a PSE test to see if you have cancer in your bloodstream and then a biopsy makes more sense. The PSE test is 94% accurate. If it finds something then they should do a much more thorough biopsy, more cores, To see if there’s something anywhere in your prostate.
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Hug
1 ReactionVery good tracking of your numbers.
> With each of your earlier PSA tests, was anything going on in the day(s) leading up to the PSA test that might have caused the PSA to increase?: UTI, prostatitis, sex, extreme physical exercise, etc.
> Did your doctor ever do a DRE immediately prior to the PSA test?
> It was after your switch to rowing that your PSA jumped from 5.8 to 10.0 (and has stayed elevated ever since.). A rowing machine (due to the sitting position) might put more pressure/irritation on the prostate than running would (similar to riding a bicycle for a great distance). Just not sure…..
> You had a biopsy a year ago. You’ve basically been on Active Surveillance since then. Your upcoming biopsy is considered a 1-year “confirmation biopsy” just to see if anything has changed. If no change, then (if it were me, I would) continue Active Surveillance
At this point, you know that you have a Gleason 6 (which by itself is nothing to worry about).
> Do you know your PSA Density? That might be in your MRI report. (See if it’s within range. Your elevated PSA might be due to an enlarged prostate.)
> At your next Total PSA test, also ask them to test your Free PSA. (Then calculate to see if your % Free PSA is within range.)
> Ask for a biomarker (genomic) test. There are a dozen of them to choose from (Decipher, Prolaris, OncotypeDx, etc.). These tell more about the tumor itself.
> Ask for a genetic (germline) test. (Have you had a family history of any solid tumors? They sometimes share gene mutations.)
The purpose of collecting more information is to insure that nothing more serious is lurking unseen that the biopsy is missing. With each test showing nothing of concern allows you even more time to collect more information and learn more about the status of your disease (as well as learn more about treatments should that time ever come).
(I followed the same path and was on active surveillance for 9 years before deciding to have treatment. See my attached PSA tracking chart.)
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2 Reactions@brianjarvis
Brian thank you for sharing your journey. It is so good to read the journey everyone has been on and what they are doing. I am so glad you are doing so good keep up the good work.
@jeffmarc Thanks for the reply! I do have BPH, but my PSA is still out of range for the size of the gland. I will definitely ask about a PSE.
@brianjarvis Thank you for your detailed response! Gives me a lot to think/ask about.
@tommm
I’m not sure if there is a lot of diagnostic value from a 5th biopsy. The MRI I understand. I would be looking for an explanation of possible reasons why your PSA dropped so significantly in the last 8 months. That’s rather perplexing.
Am I reading it right that in 4 biopsies, the only cancerous area that was identified was a less than 1 mm 3+3? Just my opinion but the change to rowing and subsequent PSA bump (and continuing to be elevated) is suspicious.
Anyway, all the best/with any and all future testing.