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

@jeffmarc Thanks for your reply. I am new to all of this, and haven't heard of PSA density. Having said that, if I use my latest PSA measurement and the estimated prostate volume from my 12-month-old MRI, I calculate a PSA density of 0.17. Unfortunately, nearly all the diagnostic tests I've done so far over the last few years put me in the "grey zone".

@rider51 thanks for the reply. My urologist first mentioned the newer urine and blood diagnostic tests last year, but then dissuaded me from them during my visit last week, when he was pushing for a biopsy. After researching some of these tests, it seems to me that they should be part of the clinical progression, especially for someone like me, who has had a MRI that showed nothing (it is a year old now). I'm thinking I should get something like ExoDx AND a new MRI before I go for a biopsy.

@rider51

Thanks for the comment!

I’m intrigued about your statement:

“My cancer was found due to having an ExoDx test which led to a biopsy in spite of a stable PSA, normal DRE, and normal MRI.”

If you don’t mind me asking, What was your ExoDx result and your biopsy determined Gleason score?

Did you get a Decipher score?

Did you have treatment or did you choose active surveillance?

The reason I’m asking is a friend has a similar prebiopsy situation and received an elevated ExoDx result and is trying to determine if/when to proceed with a biopsy.

You may have seen this, but a friend of ours had a huge prostate and had a PSA of around 50. He had multiple biopsies and they never found anything. That was his case.

I know of other people that have had high PSA’s large prostate and nothing found in the MRI but when I biopsy was done, cancer was found.

You could do a calculation of PSA density. You divide the PSA by the number of cc of the prostate. The result is greater than .15 then you probably do need a biopsy. If it’s less than that, then you may not. Something to talk to your doctor about.

Your urologist may have good reasons to suggest a biopsy including perhaps the PSA change in the last 12 months or results of a digital rectal exam. And, I am not suggesting that you ignore your urologists advice.

But, you could ask to have one of the relatively new genomic diagnostic tests that are much more accurate and definitive than the PSA in indicating the presence of prostate cancer. My cancer was found due to having an ExoDx test which led to a biopsy in spite of a stable PSA, normal DRE, and normal MRI. There are other tests now that are better than the ExoDx - the PSE test seems to be the best currently available. I would ask the urologist to prescribe a PSE test as a next step, and then proceed with a biopsy if the results of that indicate the presence of prostate cancer.