Biopsy results benign. PSA is elevated. What is the next step?

I suspect that an oncologist would be able to get the PSA and PSMA/PET. UCLA has a genuinely fine program. You could call Dr. Wayne Brisbane 310-794-7700. A video consultation won't interfere with payment for more consultations with different doctors. Brisbane is an oncologist I can recommend because he's smart, especially cooperative, congenial and patient oriented.
Don't wait for MDX results because you'll end up waiting for an appointment. The results will be in before you can get in. You don't want a surgical oncologist or radiation oncologist, just a basic oncologist.
Ask Brisbane about the microscopy ultrasound if you decide to contact him.
https://www.uclahealth.org/departments/urology/iuo/research/faculty-labs/dr-wayne-g-brisbane-lab
Hope you don't have cancer!

I think the next step is a deep breath. Take the win for now....get on with life. (that may sound a bit glib, but, I realize having been there, how hard this can be to do)

5.3 is a little elevated of course, how elevated would depend somewhat on your age. There are things that can have an effect on this test, sexual activity, exercise and cycling to name a few. The 4 PRADS rating is concerning, but, it means it's time to get the biopsy, it's based on a percentage it's not 100%, if it was a definitive thing, you wouldn't need a biopsy. It sounds like you have gotten the best biopsy out there and it was pretty comprehensive. If the tests got the lesions themselves, you might be okay.

I hadn't heard of the Confirm MDX test, didn't need to since my original biopsy showed cancer. However, it sounds like you and your team are doing your due diligence for sure.

This type of cancer, particularly in the very early stages is normally very slow going. A 6 week PSA won't hurt but it might not tell you much either. You will also get the other test back inside of 6 weeks, if that's negative, why bother? Knowing what little I know now, I might ask for a three month PSA to add to the 6 month already planned. If the Confirm MDX test comes back negative, I don't think I'd bother. Other than that? I'd keep busy and try keep it off my mind as much as I could. Sounds like you've done all you can.

Also maybe keep in mind, IF the legions are part of a BPH, which is possible it appears, that also can elevate your PSA some.

I don't know anything about medicare, not on it yet.

Best of luck to you !

Thanks for the reply. While I am waiting for Confirm MDX result, I think I will at least call Dr. Brisbane's line to inquire about the scheduling timeline and process.

I see another UCLA Health second biopsy web page.
https://www.uclahealth.org/medical-services/radiology/prostate-imaging/about-us/case-studies/mr-guided-targeted-biopsy

It is targeted for patients with previous benign biopsies. I wonder if this is the same procedure by Dr. Brisbane.

Thanks for a thoughtful reply. Getting a benign biopsy is different than getting a Gleason score. For the latter, at lease you know your path now. For a benign biopsy, it is like going back to square one. The unknow is the hardest.

well done. I hadn't seen that link. I think the microscopy is different, maybe not as useful.

frank1956: If it were me, I would also use my biopsy material for a Decipher test. It will indicate aggressiveness level. It might give you some level of comfort and could serve as a "second type of opinion" The doctors do use the test to help in their decision making process. It uses your biopsy material which, I believe is good for a year, to analyze your biopsy material. I thought the MDX test was a urine test for prostate cancer biomarkers before one has a biopsy?

My urologist did include Polaris test as part of the biopsy procedure. I understand it is comparable to Decipher test. Both are using the tissue to check on aggressiveness of the cancer cells. I asked about the Polaris test results, my doctor said because the cores are all benign, it would not be usable for the test.

Confirm MDX is using the biopsied tissue to test. One urine test that I did before the biopsy which yielded a ExoDx score. Maybe that is what you are thinking. I got 18.77 (normal 0 - 15.6).

Medicare + Medicare Supplement (Medigap) should be good coverage with UCLA.
Best wishes.

Frank1956: thanks for that. I looked it up and it seems as if 30% of people who have biopsies that show negative or benign results potentially have prostate cancer. It also seemed that if the results come back positive, then your plan is to have a biopsy done by somebody else?

When my urologist called me about the results of my biopsy, all being benign, I pressed for the possibility of cancer being missed. He said that the 3T MRI and MRI fusion transperineal biopsy performed on me, all are the latest technology. If he needs to give a percentage, I am 90% clear. But, I still want to be vigilant, and don't want it grow out of control.

If the Confirm MDX results do show that they found cancer, I plan to have a second biopsy done from UCLA. They have even more advanced biopsy methods. If I am so lucky that the Conform MDX is also negative, I guess I will go on an Active Surveillance mode: testing PSA, doing MRI, until something changes, then go get biopsy from UCLA.