PSA dissapointing

You could get a PSE test. It will tell you whether or not prostate cancer is detected in your body and that you need to get a biopsy. At this point, it doesn’t look like there is a real problem, but that test could tell you for sure that there is something you need to investigate.

Frequently the MRI doesn’t show prostate cancer that is in other areas of the prostate. We’ve seen it many times.

Everyone has to make their own decisions.

I am 61 and have had two biopsies in the past year. I was put to sleep for both and they were very easy procedures.

From what I have been told by Doctors, some men have no mri-visible lesions and have Gleason 3+4 or 4+3 cancer. Some have low PSA and cancer and some very high PSA and no cancer.

Guidelines and general recommendations are good for many cases. Some of us will fall outside the “usual cases”.

Over the past 15 years my PSA increased from 1-2. This matched my age and did not raise concern. 2022 PSA increased to 2.7. Repeat tests were between 1.9 and 2.7. 2023-2024 stayed in 2.5-2.8 range. In 2025 yearly test was a 4.0.

This jump was enough for me to visit urologist for 1st time in my life. Prostate not enlarged and no lesion could be felt. Urologist was not alarmed witb the 4.0 PSA value. Repeat PSA at his office was 1.98.

4K blood test was barely high enough to be in the low-intermediate range.

I pushed Urologist for an MRI. My MRI showed a 2cm Pirads5 lesion. Even with MRI, Urologist was not pushing a biopsy due to low PSA and 4K. I pushed for biopsy last September that had 5 Cores of 3+3 with 2 cores over 90% 3+3.

Since biopsy was 3+3, two Urologists said AS and see you in 6 months.

Radiation Oncologist was more concerned. Her experience indicated the lesion was likely a higher grade and in my case along the capsule wall.

I pushed for a follow-up MRI/Biopsy this April and it showed 4 cores of 3+4. One core was 100% cancer and 40% 4.

My PSA is still between 2 and 2.8 on all but two tests. One last year at 4 and one this year at 3.4.

If you have concerns, getting a biopsy will provide information. If Biopsy shows no cancer (hopefully), you can continue PSA and MRI’s until that information changes.

Best Wishes.

@charlesprestridge
appreciate your response.

@charlesprestridge
I suppose we all have numbers in our heads that if and when we hit them then it's time to do something more than active surveillance. I track prostate density and if that goes beyond 0.15, PSA above 10, Free PSA below 10%, Pirads scores between 3-5 with suspicious areas, then an MRI guided transperineal biopsy is the next step. I think for me I really need to argue for the PSE and the MPS2 more persuasively because I find that some PCP's and Urologists are just not interested in utilizing tests that are not standard of care yet even though they have been shown to be effective.

I had no visible lesions on my prostate in the MRI, and it was normal size, but my cancer had already metastasised to my spine when we discovered it at age 56.

Some types of prostate cancer (~5% of cases) hit young and escape the prostate quickly. They can even go from normal to metastatic in the year between routine PSA screenings.

The "it develops slowly, you'll die of old age first" common wisdom may apply to the majority of prostate cancer cases, but definitely not to all of them.

@ezupcic

You’re exactly right!

Being your own advocate means insisting (or being thoroughly convinced otherwise) of what you have learned through your own research and experience as to next steps.

Many simply go with SoC advice because they don’t know of any viable alternative. It’s also the safest path for the physician who isn’t receiving any pushback from a patient.

I won’t even consider another biopsy until or unless I have a MPS2-AS test ….or my doc convinces me of an even better predictive biomarker test for an AS man wanting to know the odds of his PCa being upgraded upon submitting to another biopsy.

…but that’s just me….

When I look back to the time when I was considering whether or not to agree to a biopsy, I see a guy who was ignoring what the two urologists I had seen to that point believed. Both suggested a biopsy as the first thing that came to their minds. The rest of their suggestions were the kind of things they say to patients who are new to the idea that anything like cancer could be a problem they'd be dealing with, or to patients who don't want their prostate subjected to what sounds like an awful way to treat any organ. How about a repeat PSA test said one. We could do an MRI said the other. Both had seen enough to have ordered a biopsy right away.

You don't say what your urologist has told you, or what you believe your urologist actually believes. In my case, they post after visit reports, and a clinical note on the EPIC MyChart after each visit. The clinical note contains specialized language but it tends to describe exactly what their understanding of what is happening is.

I believe he thinks I would "benefit" from a biopsy: Transrectal and blind since based on my last MRI there were no focal lesions to target. He was actually reluctant to order an MRI initially 16 months ago, but I insisted. Probably he believes that the MRI's have missed cancer that does not present as a lesion or tumor. He may be right. I don't know. I've not seen any other clinical reports from him and I've actually only met with him twice. I'll learn more over the next few months as I pursue another PSA, MRI and hopefully the MPS2 or PSE test. As I mentioned earlier , I'm not opposed to a biopsy but I would prefer to go into one after the research and diagnostic biomarkers say "you are no longer in the grey zone. Its time to do more than surveillance".

The MRI did not show my prostate cancer, but show a lesion that they said need more testing, meaning they did biopsy. They did biopsy's of the lesion and many more in all segments of prostate. Found cancer in many of the other segments of prostate, but the lesion found by the MRI was really nothing.

Hopefully, you can get a PSE test, I wasn't given that option, but in the end didn't matter for me.

@diverjer so was the lesion they found benign? What sort of biopsy did you have? transrectal or transperineal?