Fast Rising PSA post mri showing one pi-rads4

You just may need the MRI reviewed by a different doctor. Hopefully you are going to a center of excellence for this next visit or you are seeing a Genito urinary Oncologist.

If you request another MRI see if you can get it done with a Multiparametric prostate MRI (MP-MRI), That machine can estimate your Gleason score without A biopsy.

You could request a PSE test. It has a 93% chance of determining whether or not you have cancer and need a biopsy.

Jeffmar, suggestion about PSE https://www.94percent.com/ If the doc thinks it is still experimental know that it is not and insurance is paying.
I wouldn't have another MRI, but would prefer the PSMA/PET scan
https://my.clevelandclinic.org/health/diagnostics/psma-pet-scan
I wouldn't be "watching and waiting," though for some it can be an option.

From personal experience I would suggest you find better urologist or possibly even go directly to urologist that specializes genitourinary cancers like Jeff suggested. With PSA rising so fast and lesion seen on MRI there is no time to waste. I personally would insist on biopsy and try to find doctor that is versed in robotic surgery and does transperineal one ( needle going through the area between genitals and anus). You have correct attitude - be proactive and insist on things being done. My husband trusted his urologist too much and now we have a problem. If biopsy finds small changes (referred to as "gleason score" 3+3 anywhere in your prostate, than insist on MRI AND biopsy performed every 2-3 years. Our urologist relied mostly on MRI and only one biopsy was done in 6 years and we missed opportunity to treat cancer sooner.

That’s almost a doubling in PSA…he may suspect UTI (did he prescribe antibiotics?) or did you do anything prior to blood test - offroad cycling or even a very strained bowel movement?
Just giving you some “ifs” but a doubling so quickly is worrisome, so a second opinion is an absolute must.

As far as the PSE test goes if your health plan says they won't approve it you can't get one . Even if you pay cash out of pocket - without your health care provider signing off on it you can't get one ( unless you go out of country and pay cash ) I'm going through the same situation . Most people don't have access to " centers of excellence " which will approve of many new treatment options - unfortunately most large health care providers don't approve of many of the latest tests , including PSE and genomic testing they will tell you they're not approved by the FDA and that their professional organizations guidelines say these newer tests are dubious and have no credible track record .

Yes, you are correct. My urologist would not authorize an RX for a 4K Score…wouldn’t budge!
So I went to my primary care physician, explained the test to him, and he authorized it.
If you have a good relationship with your PCP he’ll probably do it.

Thankyou Jeff! went yesterday to new dr. he ordered another mri, and some sort of "colorguard type test for prostate"? a urine sample was given. is that the pse test?
he also did a DRE and said his gut feeling was no cancer 🙂
im going dm him and ask for the MP-MRI.
great advice!! thanks again 🙂 🙂

If have a PSE and it says you cancer do you really need to do a biopsy can't you just move forward with treament?

i gave a urine sample for a "colorguard type test". is that a pse?
thanks for your help!!

The PSE test does not use urine. The MPS2 test is a urine-based test that helps assess the risk of prostate cancer in men.

The chart I am posting shows that there are three different tests that use urine, there may be more that aren’t included in this list.