Positive ExoDx urine test with negative MRI

I had an Exo with a score of 55. I had BPH with a volume of 68. My first biopsy and MRI in 2016 were negative. My PSA went up and down for a number of years. In 2022 PSA was 7.7. Another MRI came back negative. We decided on a second biopsy: two cores of cancer; one at 3+4. I decided on surgery. Surgeon says he feels confident he got it all. Also, I had ZERO incontinence issues. Pathology report came back at 4+5. Two years out I still have PSA at < 0.01. Based on my experience, get the biopsy. Whatever you decide, make sure you feel as best as possible that your results/scores are accurate so you feel confident about your treatment decision. Obviously, through out my experience, they weren’t. Best wishes.

Thank you!
Best regards
Dave

I'm 56 years old, my PSA was 1 in November 2024, in 2025 it was a 2.5 still in the normal range. My main doctor was concerned so they referred me to a Urologist. My appointment was in December of 2025 and they tested my PSA which came back 1.3. They still recommended the ExoDx test which came back at a 27.3. The next step the Urologist gave me was an option of MRI or biopsy. They told me that the biopsy was more accurate then the MRI. I chose to do the biopsy yesterday, January 22nd, 2026. Yes, it was a little uncomfortable, but not terrible. Today I feel pretty good. I'm waiting to hear back with the results which is 1-2 weeks. My prostate was 43 cm3, average is 30cm3-35cm3. I have a lot of cancer in my family, every single relative (4 grandparents and 3 aunts and uncles has died of cancer or have cancer now, except for my paternal grandmother who lived into her 90's). Thanks for all of the posts it really helps a person who is going through the same thing.

@derbydog71
You really should get genetic testing soon. Were any of those cancer’s breast or prostate or pancreatic cancer? That does increase the chance of a genetic issue. My father died of prostate cancer, but my mother gave me BRCA2 Which resulted me in having prostate cancer at 62. My brother got it 77 because he didn’t have BRCA2 But did have a father that died of it. My mother never had any problems, but both of her sisters had breast cancer, and one of my cousin died of breast cancer.

If a direct relative has prostate cancer, it increases your chance of it by over 100%.

Let us know the results of your biopsy. My first biopsy with a rising PSA showed nothing but the second one showed I had prostate cancer.

@jeffmarc
I did get a genetic test done about 2 years ago, everything came back normal, nothing concerning. My father died at 68 years old from pancreatic cancer, his brother died at 42 years old from bone cancer in the 1970's, their father died of prostate cancer at 82 years old (untreated, stubborn German farmer from WI), their mother lived into her 90's without any cancer symptoms. My mother's side, her father died of lung cancer at 68 years old (no smoking), her mother died of colon cancer at 75 years old (heavy smoker), her sister died of lung cancer at 71 years old (heavy smoker), her brother has prostate cancer right now and they removed it at the age of 79 (diagnosed at about 77 years old), and my mother had her kidney removed about 6 years ago at the age of 76 from cancer, she is 82 years old now and doing well.

@derbydog71
Good to hear your genetic test showed nothing. My German grandfather died of pancreatic cancer in his 40s. His 3 daughters must have gotten BRCA2 from him.

With all the cancer in your family, it’s surprising you that you don’t have anything genetic. At least that way you don’t have to worry about your children having anything passed down, Though the fact that both your father and you have prostate cancer, increases any son’s chance over 100% of getting it.

I'm in a similar situation. Fluctuating PSA for the last year. From a high of 8 to a low of 4. Two MRI scans in 2025. First was a Pirads 3 and second was a Pirads 2. No focal lesions. Characteristics of BPH. Prostate density 0.10 with an enlarged prostate of 70 ml. Currently I'm doing PSA's every 3 months and MRI every six months depending on PSA results. If numbers worsen I'll biopsy but with nothing to target I'm monitoring at the moment. My father had prostate cancer at 62. Had surgery in the early 1990's and lived until 86. Ultimately from a heart attack.

Thank you for all the discussion. My case PSA 4.6, last November Mp MRI negative PIRADS 2, digital exam nothing of note, PSA density .07, ExoDx 68.5. Older retiring doctor wants to Biopsy asap. Agreed to another mp MRi and wants biopsy. I really don’t want the biopsy and he assures me no worries with biopsy. Not sure what to do. Suggestions and info appreciated.

@nyywc1
I was in a somewhat similar situation about 3 years ago:
I had a history of a fluctuating PSA during annual exams and had several biopsies which were all negative, including one after an MRI showed a PIRADS 4 lesion. I had to change urologists at one point and during the first visit workup with the new urologist (stable PSA, normal DRE) I mentioned that I had heard of the newer diagnostic tests that were showing better results than the PSA. The urologist suggested I have an ExoDx test which came back elevated - I believe my score was 36. The urologist suggested an MRI which was completely clear, and at that point said it was up to me whether to have a biopsy just to rule out any cancer or not. I went ahead with the biopsy, which was a 24 core saturation biopsy, and two of the cores showed 4+5 cancer cells with 5% involvement of the cores. I had a prostatectomy 6 weeks later and the post-surgery pathology downgraded the final Gleason score to 4+3 with tertiary 5.
I am really glad I had the ExoDx test and that I went ahead with the saturation biopsy, as I am quite sure that it would have taken considerably longer to diagnose my cancer if I had not had the ExoDx test.

@nyywc1
I had three transrectal biopsies 16 years ago. The first one didn’t find anything the second one found 3+4. The third one was to check and see if I had seminal vesicle invasion, I didn’t.

While they were a little bit uncomfortable, they were no big deal. I drove myself home and had no issues after the biopsies.

Don’t be fearful about this, There’s a lot worse treatments in the future if you have prostate cancer and it sure is worth finding out if you do.

You could get a PSE test and see what it says. Very accurate and can tell you whether or not prostate cancer is found and you need a biopsy.