Biopsy or not?

I’m still waiting to get my biopsy now. My Private primary care doctor put me on Cipro a week ago. In that time the VA tested my PSA again. The current results were 1.78, their previous results in Aug were 2.30, the result before that was 1.60. This reflects an increase of .20 increase from April of 24 to Feb of 25. But the bizarre thing is on Cipro my PSA dropped and my minor symptoms of strong urges to urinate disappeared with the Cipro, and no urge to get up at night and urinate. Plus my PSA dropped like a rock…strange.

Here’s another interesting point: when the VA labs tests me their results came back at the same time as 1.60 and my private Doctor results from LabCorps come back at 2.2. The deviation between the two labs results is stark

I am struggling with same thing. PSA 12/23 was .9 and 12/24 was 2.0. PCP suggested see urologist. PSA dropped to 1.4 over a month later. Urologist still suggested MP-MRI, which showed homogenous lesion in central zone, but lymph nodes clear, no focal lesions, no extra prostatic extension, no incidental disease or abnormalities and seminal vesicles normal. Came back as Pi -rad 4. PCP didn’t understand that since PSA was dropping. This is all so confusing. PCP suggested follow up PSA and MRI.

How did you know you had chronic prostatitis?

Your low PSA which now is not doubling, may mean you don’t need treatment

Before doing a biopsy, you could get a PSE test. It is 94% accurate. It can tell you whether or not you have cancer in your bloodstream and need a biopsy. The test is a lot easier on you than a biopsy, and may tell you that you don’t need one.

Did they ever mention BPH when you talked with them about your diagnosis? Your symptom list sounds like BPH and the fix is always antibiotics.

BPH can cause your PSA to rise. Yours dropped so it sounds like it may not be anything, with a PSA that low.

A major difference in your PSA number may not be a real problem, Usually, you want to go to the same lab to avoid these issues. Did you ride a bike around the time you went to LabCorp?

I have 1cm lesion as seen on the MRI. I also have and diagnosed with BPH, and prostatitis. That’s been an ongoing battle for 10 years. If I could my prostate removed tomorrow I probably would. It has given me a lot of problems. I have to carry Cipro when I travel in case of a flare up

I’ve had multiple flare ups and diagnosed with by several Urologists

I am going to ask about PSE. Funny that doctor never mentions it. I don’t want to have needless biopsy. For first PSA test I was a few weeks off of marathon training and did hard run that morning. Second test I didn’t run for 3 days. I thought BPH was enlargement which I don’t have. My urine was clear when they did second PSA. Seeing urologist this week and getting second opinion on MRI through insurance. I am completely asymptomatic. The only thing is that when my PSA doubled to 2 I was getting up more at night. That has subsided. Thanks

Sorry about that. The symptoms I had were getting up at night more around the time of higher PSA. First urologist I saw didn’t even do a physical exam and that I should just come back in 3 months.

Try to pass on my experience with this. My R/Os advised me to have my PSA tests done at same lab each time I had it done to prevent different lab discrepancies. Said can have it done at any lab but make sure the same one.

Your PSA is not bad at all. And you mentioned you have BPH which would explain even the number you are at. It also suggest you BPH is there as antibiotics addressed your symptoms and you had improvements. BPH is symptoms. It does not always mean your prostate is enlarged as could have infection and irritations causing the BPH symptoms.

I had a MRI with contrast. It will only show suspicious areas it cannot diagnose cancer. I wonder if your urologist has talked to you about waiting to see results of MRI to see if a biopsy is justified. Things usually go with significant PSA rises over time, MRI/Contrast, Biopsy if MRI/contrast shows need to have one, then treatments if you have cancer or just BPH.
Good luck!!

Agreed on several fronts and thank you, my primary care Doctors want to do more imaging and follow my PSA. My urologist did a follow up urine bio test that was suspicious. On the basis of the urine test coming back Ww are doing the biopsy. My number 1 concern is failing to follow up, having something and it spread before we can kill it. I understand how slow prostate cancer is but a couple of friends have died from it. Many others have survived it. It’s crazy how many people I know have it. I think the odds are it’s nothing. I’m hoping for the best and expecting the worst. I’ve had so many past prostate problems I’ve kind of been waiting for this thing. I’ve had severe prostatitis, BPH with symptoms, and two infections since 52, I’m now 64 and in excellent health.

Thank you again