Prostate lesions found, biopsy results, No symptoms

My own research, which has been extensive given my family history (father, grandfather and great grandfather with advanced prostate cancer), indicates that symptoms, if any, normally do not appear until the cancer is advanced (Stage 3+). My total PSA score is low (< 4) after years of taking NSAIDs, cholesterol and blood pressure meds, but my Free PSA is 20. I have some very painful symptoms - so a multi parametric MRI will be done Sunday morning. Additionally, my alkaline phosphatase level is quite high, which is a tumor marker. It would not surprise me to learn I have an advanced issue to deal with. I do hope everything works out for you!

Hi @fredz Two caveats before comments, I'm not a doctor and everyone has to do what they are comfortable with...

"hate to do biopsy"
Well, that's certainly understandable, they aren't fun. Having said that though, I think it's probably time you did something. If you aren't sure there isn't something else going on, maybe go get a second opinion, but, I wouldn't just wait it out at this point without knowing what's going on.

Having been, sort of, where you are. I had symptoms, but those symptoms are the same as BPH for the most part, I could have rationalized that it was that and not had the biopsy. However, now it's playing on your mind (ask me how I know). There's certainly a part of me that said, if "I don't get this checked I can't get the bad news" but for he most part, I wanted to know if it was time to engage and start the fight.

Using the reverse logic, If in the back of your mind, you think it might not be cancer, why not confirm it and calm your mind?

A PSA climb like that is generally indicative of a problem + finding the lesions. It may be that you don't have symptoms because of where the lesions are (not impinging on the urethra perhaps). It's true that this is often a slow moving cancer but I wouldn't give it too much space. I scheduled my biopsy at a PSA of 11.

When I first went in because of the rising PSA my doc did a digital rectal exam and appeared somewhat flummoxed, it felt entirely normal. We talked about 5 minutes and I asked for the biopsy. Turns out the cancer was all inside the capsule of the prostate and that's why he couldn't feel it. The PSA went to 13+ by the time I had the RP.

I'm still not sure if the doctor was really vacillating on the biopsy recommendation or he was waiting for me to ask for it for "buy in" purposes. I like to think he'd have only given me a few more minutes before pushing me towards it.

The only other factors I can think of would be age and general health condition that might play into this decision, I was only 59 and generally in good health so these were the best decisions for me. Everyone is different.
Best of luck to you!

I'm not a doctor either but i know treatment options depends on age and overall health. You could get a Free PSA test done by your urologist. Just a blood test, but if a biopsy is prescribed I was given anesthesia. Just like a colonoscopy. No pain after waking up at all. My biopsy came back positive with a (4+3) gleason so it needed treatment. I was 60 years old and chose RP with DaVinci on August 4th this year. Surgery recovery not bad. Fully continent but i did do some physical therapy for urinary system. My first PSA test post surgery was negligible. Hopefully it will stay that way. Hopefully something else is going on with you but get it fully diagnosed imo. Good luck with everything.

I had a very similar situation in Sept of 2021. PSA was 7.6 Did a retest 30 days later. PSA came back at 11. Finally got into a urologist in Jan 2022.
Biopsy on Feb 14 2022. Cancer diagnosis Gleason (4+3) 7 with moderate to high tumor volume. I demanded another PSA test . It came back at 83.
I'm now fighting "high risk aggressive" prostate cancer. I left local providers and went 2 hrs south to Mayo. Much better care.
WHAT A YEAR.
I still have no symptoms of P. C.. I'm 75 and healthy ( for now).
ANY QUESTIONS ARE WELCOME.

Thanks for your reply, I forgot to mention that I’m 64 yrs old , no family history either , the mri results I tried to attached to my post but I guess it didn’t work , let’s not forget that by that mri result my PI-RADS score is 5 !!

Thanks for reply , so you didn’t go for prostate surgery to remove it ?

Thanks , yes my MRI indicates : prostate gland is enlarged and inner gland has heterogeneous signal intensity that’s consistent with BPH
An oval shape hyposignal lesion in T2W images with 16*7 mm diameter is evident in peripheral zone in right upper-mid portion of prostate in anterior location that shows intense enhancement after contrast injection and restriction in DWI suspicious of prostate cancer .
Small lesion with 6 mm diameter is also noted In peripheral zone in right lower-mid portion of prostate that shows contrast enhancement and restriction in DWI suspicious of prostate cancer as well .
There’s no evidence of any enlarged lymph node

Glad to hear lymph nodes not enlarged. Seems a Free PSA blood test would be warranted and a biopsy. I would go the knockout route for biopsy. Why have any pain unnecessarily imo.

First of all thank you , just a bit above this comment I did write the result of my mri , Drs ( saw two of them already) they just push for biopsy which At bottom of my heart don’t like doing it because afraid if there’s any cancer cell ( either slow growing or else) they spreads to my body when they pick it with needles.
Btw my PSA for the past five years gone from 9 to 12.2 now
🙏🏼

Everyone needs to make their own decision about treatment but personally as scared as I was about finding out if I had PCa I didn't have any reservations about getting the biopsy. Have not heard of PCa spread because of biopsy. You're only 64 so you have another 26 years or so, so why not find out and get treatment? There are many treatment options for PCa and possibly being cured from it. Good luck with your decisions. I know it's difficult.