Connect
Biopsy recommended, is this correct next step?
70 years old, seeing a top urologist at a well-known medical center. I am being recommended for a biopsy and before I do this, I am just looking to check with this community if this is the correct net step. I have had PSA >4 since 2/2024, most recently 7.3 on 4/2026. Lots of variability in the PSA over the past decade. MRI 9/2025 results: “PI-RADSv2.1 Category 2 - Low (clinically significant cancer is unlikely to be present). Heterogeneous peripheral zone without focal lesion. Findings of BPH.”. Prostate volume 82 ml vs 25 ml typical. ExoDx 5/2024: “4.34 score, well below the 15.6 cutoff for higher risk of high-grade prostate cancer”. Haven’t had a DRE in years.
I look forward to your recommendations on any questions that I should be asking and if this community feels that a biopsy is the correct next step. Thank you!!
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
After thinking about it my choice of words calling biopsies barbaric was wrong. It was to late to edit my post. I don't want to discourage anyone from getting a biopsy. Biopsies are one of the necessary tools for doctors to get the whole picture of a patients diagnosis.
PS, I had a transperineal biopsy under local anesthetic and it wasn't that bad. My MRI showed a lesion so it was definitely necessary.
-
Like -
Helpful -
Hug
1 ReactionWhen you do the biopsy be sure to ask the urologist for a decipher test which will let you know if it is fast or slower growing.
-
Like -
Helpful -
Hug
1 ReactionHi,
If it was me I would stick with the MRI’s until one showed something, then go with the biopsy in that suspect area. Could be you just have BPH which can raise your PSA. DRE might not be a bad idea…….
Dave 3+4
-
Like -
Helpful -
Hug
1 ReactionPART 2 I wish to 'withdraw and revise' my previous statement. If you repeat the mpMRI get it on a 3 Tesla resolution machine from GE, Siemens or Philips. If the kidneys are good gadolinium dye helps. Immediately ask for disk copy but authorize and direct that thee digital file be sent to an Artificial Intelligence MRI second reading service. I used Deepviewimaging.com ---30---
....what occurred after was result of a cat jump onto my keyboard. It was from an article in Barrons about 'concierge medicine'. I put the feline felon in detention for ten minutes and then commuted her sentence. ( LOL ) ---30--- means the end in Printing runs.
This may be useful - https://aspatients.org/the-pathway-active-surveillance-guide/
Kevin
@copyman My PSA has been abnormal for a year. The urologist and I decided to start doing the PSA , total and free blood test. It will give the urologist more information before I decide on a biopsy. It has already come handy for the urologist and me to make better and more logical decisions going forward.