PSA of 4.1 when never previously higher than 1.0

I think that a retest of the PSA from the same lab would be prudent. If that does not give you an answer the get an MRI. If you still do not have an answer then perhaps a biopsy. You need to be proactive but do not panic. Prostate cancer is slow growing but if you have it you want to address it before it spreads to outside of the prostrate. Finally, get care at an excellent cancer center, not your family practitioner. Good luck

Stage 3 metastatic prostate cancer patient here weighing in.

Speaking for the rest of our group I’m glad you’re here asking such an important question. I hope you don’t have to join our community but if you do, we’ll be here for you.

A marker of prostate cancer is often a short period of time in which your PSA value doubles. As a matter fact it’s called doubling time. A doubling time less than 12 months is highly suspicious for aggressive prostate cancer. Based on the numbers you shared, your PSA has doubled twice in 12 months. It’s not necessarily cause for panic, however it is cause for further investigation in a timely manner. While it’s true that prostate cancer is typically slow moving, that’s not always the case.

In 2020 my PSA doubled in less than 12 months. At my request, my physician ordered a PSA 4K test. That test came back with an opinion of high likelihood of significant disease. I then had an MRI, which showed a PI-RADS 4 lesion. I then had a mapping biopsy that resulted in the diagnosis of prostate cancer. I was treated with low-dose Brachytherapy and thought I’d beat it. In 2023 my PSA started to rise again and doubled twice in the period of 11 months. An MRI revealed two large lesions and lymph node involvement. I then received a PSA-PSMA scan, which confirmed the very high likelihood of the return of prostate cancer. Since then I’ve had salvage radical prostatectomy and I’m currently undergoing 24 months of first and second generation ADT as well as eight weeks of IMRT radiation.

Based on my experience, if I were in your shoes, I would ask my physician to either give me a PSA–4K test or PSA–ISO test as soon as possible. If either of those tests reveal a high likelihood of significant disease, I would ask for a three Tesla MRI as the next step. If that comes back with a high PIRADS score I would request an MRI guided FUSION biopsy. I would not settle for anything less. The first time I was biopsied in 2020 I did not receive an MRI guided biopsy and the inferior biopsy I received missed significant high risk disease, which is why I’m in the mess that I am in.

The bottom line is you always have to be your own advocate. Good luck to you and please let us know how things work out.

I'm 59 and my PSA went from 3.5 to 5.5 in 6 months. I have a history of BPH and previously my PSA was in the 1.5 to 2 range. This spike sent me to the Urologist and I had a biopsy that ruled out Prostate cancer. I'm on 2 years of observation for Prostate cancer and am on some drugs to help me pee. The sudden rise could be the result of BPH. If your dad had BPH you could have the same condition. You could have prostatitis, but I had 4-5 urine test come back clean for anything, including STD's and STI's. After an exam my Urologist determined that my prostate was "somewhat inflamed". After my biopsy he explained that a PSA doesn't necessarily mean Prostate cancer and it also doesn't mean any underlying health concerns. My urologist is a little bit blunt but work with yours to help mitigate some of your anxiety. Please update this forum as to what happens. I'm less anxious about my prognosis after joining this group, hope you will be as well.

Thank you, hbp. I’m giving the urologist one day to respond and then I’m going into the office to ask his nurse or PA to show him my email. I’m very proactive. Pretty scared too, unfortunately.

Sorry to hear you’ve gone through all this and wish you the best outcome. Thanks for all this info. It’s very helpful. I hope it’s unnecessary, but I’m pretty worried. As I said above, if my urologist doesn’t respond in one day, I’ll go to his office and speak with his pa or nurse to ensure he sees my message and gets back to me quickly with a plan for further evaluation.

Good luck. My PSA in 2019 was .3, 2020 .6, 2021 .9. Then I had an MRI, then biopsy which diagnoses PC Gleason 9 , high risk. It would have been better if I caught the answer sooner.

Thank you so much, Jay. I’m glad to hear you’re doing well and hope my scenario winds up similarly. But I’ll move forward with urgency as all here have recommended until I have some type of answer, good or bad.

Hi all. My urologist did get back to me and wants me to redo the PSA test in 6 weeks. I saw on the Sloan Kettering site that this is consistent with their guidelines. I replied to him with a follow up question about including a “free PSA” test as part of the follow up. I’m guessing that my age of 64 has something to do with a less aggressive approach than some of you under-60 guys’ experiences.

I also read on the MSKCC site that “PSA velocity” is no longer considered a reason for immediate biopsy. See here: https://www.mskcc.org/news-releases/change-psa-level-does-not-predict-prostate?msk_tools_print=pdf#:~:text=Researchers%20at%20Memorial%20Sloan%20Kettering%20Cancer%20Center%20have,in%20the%20Journal%20of%20the%20National%20Cancer%20Institute.

I don’t know where I fit in here because I’m literally 0.1 over the cutoff of 4.0. Thoughts?

I really appreciate everyone’s opinions, insight and experiences. Just trying to make sense of it all before I start demanding more aggressive and possibly unnecessary procedures.

My psa went from 2 to just over 4 in 1 year. I fought with the first Dr who said it was normal for my age. Got to the 2n urologist and had a biopsy asap. Gleason score 10, highly aggressive state 3C. 45 radiation treatments 18 months of orgovyx and am now negative psa and feeling good. Keeping up my gym and exercise and diet. Stay on top of it, and good luck.

Yes, I’m anxious about the dramatic spike and pursuing a second opinion. Problem is getting a near-term appt with a new doc. I guess part of the doc’s decision is based on my long history of bph/prostatitis symptoms. But I’ve never had such an elevated reading, although the test is done only once per year, so who can know if these spikes havent happened to me periodically. I’m sorry to read that you went through all that, but glad to see that you’re doing well. May I ask how old you are and how long between your 1st and 2nd opinion on this?