High PSA, but MRI is negative. Biopsy or Not?

I'd think about getting a second opinion on the MRI that has already been done.

I couldn't find the reference just now, but when my urologist recommended an MRI, I asked that it be performed and read by the nearest NCI designated cancer center as opposed to his preferred community imaging center. I felt I would have more confidence in what the report said, if it was done by someone in a high volume center who does a lot more prostate MRIs than anyone in a community imaging center.

My urologist didn't appreciate my questioning the quality of his usual place, but he went along with it once I gave him several references to papers that found a wide variation even among the top flight cancer centers. One paper I remember found a wide variation in PiRads scores depending which MRI report person did the interpretation of the same images, at the same institution, i.e. Stanford. A national organization is or has just recently set up a plan to certify imaging centers as competent in reading prostate MRIs. Sorry I can't give exact references, no time at the moment.

@lookin4answers
My MRI did not reveal lesions or tumors just suspicious areas. I had MRI/Fusion biopsies and confirmed had PC with Gleason Score.

I did not hesitate to have biopsies and wanted to know if PC. PC when caught early is at the cellular level and hard to see on a MRI if still a cellular level. So the biopsies would reveal if cancer or not.

If you ever look at explanation of Decipher score you can see is subjective. Urologist or pathologist looks at normal looking cells compared to abnormal looking cells and grades them with Gleason score. Without a Gleason score or other method to determine if have PC not going to know. A MRI is a wonderful tool but does not look at tissues like a biopsy. A Decipher test is going to look at your biopsies genetically and gives a far better diagnosis of risk level than a Gleason score. Information comes from Mayo Jacksonville urologist, Mayo R/O, UFHPTI R/O, Mayo PCP.

If you have biopsy done transperineally with anesthesia you will have not pain, no discomfort, and no anxiety/stress if done transrectal and being awake. I can pass that on as my experience not talking about others.

Transperineally removes the increased infection rate that transrectal brings. Of course with any surgery there is always a chance of infection and or complications but not the type of infection risk if biopsy is done through rectum.

Get a biopsy. The statistics don't lie. If you have cancer cells now is the time to get rid of them before they spread outside the prostate. The biopsy is the gold standard.

@capatov
If you have come off of the adt, don’t be discouraged if PSA rises. .04 is VERY low.

@handera, I totally agree. Its really easy to forget about living your life because the prostate cancer roller coaster can be all consuming. And it's also interesting the new things you can discover when you start making some changes. For me, blueberries, pomegranates, running and non alcoholic pints of Guinness have been nice surprises! I used to drink a fair bit of red wine but now on occasion I have a nice glass of Pino Grigio with my broccoli sprouts. 🙂

@ezupcic

Always consumed one 7-9 oz glass of red wine everyday.

A PCa diagnosis was not going to change that…not because I think it’s necessarily a healthy habit; but enjoying life is more important than a prostate cancer diagnosis.

That’s why I say any “healthy” lifestyle change must be sustainable…my rule of thumb is the “3 week trial” method.

Anything new feels “strange” until you give it a chance. If, after a 3 week trial, continuation is a real drag….then stop and try something else…if you persist with new potentially meritorious ideas, you’ll eventually find your own groove and get to a point where NOT doing the new healthy habit will be a real drag!

All the best!

On MRIs
I had two and neither detected any cancer.
AND they knew exactly where to look on the 2nd one because of the biopsy! Lol

Yes Colleen, those are all true. Maybe i should have been more clear and typed a bit more explanation.

So if you are plotting your PSA over your life which every man should be advised to do, you will see that when healthy, each man will have a PSA range. Mine was always between 1.1 to 1.9.

So if PSA suddenly starts rising exponentially, could be prostatitis, infection, you had sex right before the test, or cancer.

All of those causes for PSA rise are temporary.

The BPH is where your prostate grows in size over the years. The idea is more prostate, more PSA. On a graph i don’t think this will be an exponential rise, more like gradual rise over the years.

@groundhogy, I agree that persistently high PSA levels require further investigation to find the cause.

However, high PSA (prostate-specific antigen) levels are not always cancer. High PSA levels can indicate a number of prostate issues, including cancer, but also benign conditions like an enlarged or inflamed prostate, urinary tract infection or prostatitis.

Here are a few articles from Mayo Clinic that may be helpful for everyone:
- Mayo Clinic Q and A: Prostate biopsies and elevated PSA https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-prostate-biopsies-and-elevated-psa/
- 5 facts about prostate specific antigen (PSA) tests https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-facts-about-prostate-specific-antigen-psa-tests

YES.. there is only one reason for persistent high psa … cancer!
Go biopsy asap
Be aware the std biopsy is 12 pins
Saturation biopsy is one pin for every CC