Rising PSA - next step options

I also was 70 with a bad family history of prostate/breast cancer when I had an 3T MRI with contrast due to a rising PSA that went from 2.8 to 4.25 over about 2 years as part of my periodic physicals. My urologist asked for another PSA test and ordered an MRI with contrast. The MRI was a piece of cake, but I'm not claustrophobic. The MRI tech gave me an IV, and then I lay in the MRI for about 20 minutes with a set of headphones playing music. The hardest part was just trying to lay still. The MRI showed a lesion and the radiologist report (which I got at the portal of the lab which did my MRI) said it was PI-RADS 4 (high risk of cancer). Interestingly the follow up PSA had come down to 3.24. I got a 2nd reading of the MRI results I and the 2nd radiologist also gave me a PI-RADS 4 so I went ahead and got a fusion biopsy (which gives high confidence they biopsy the lesion). The biopsy found plenty of cancer, so the drop in the psa was a false signal. I'd suggest moving forward with the MRI because catching prostate cancer early gives you many more options than if they catch it late. I'd also suggest continuing with watching your PSA going forward if the MRI doesn't show anything. Best Wishes.

MRI wouldn't hurt given your family history so long as your insurance covers it and you're not claustrophobic. When you say "spiked", how much of a spike are you seeing?

Have an MRI !!! Absolutely ! If there is anything seen do a biopsy again.
Wishing you "zero" findings in both : )

Welcome to the forum! 🙂 I would make that appointment for an MRI in a heartbeat.

10/2021 1.0
10/2022 1.76
1/2023 1.56
3/2024 1.52
3/2025 3.06
7/2025 3.54

Glad you found this forum--you are welcome, and so is your question. The trend in the PSA scores you posted is in the wrong direction. Doctors look at the trend and not at the absolute numbers. Please take your urologist up on his offer of a biopsy, and ask for follow ups if the biopsy results point in that direction. Good luck and let us know how it goes.

Just to clarify.....he offered an MRI as an option at this stage. And then a biopsy if the MRI shows anything.

Yep, I'd jump on that MRI. Tell them to play some upbeat music. Last MRI I had, she pulled me out halfway through because I didn't respond when she asked if I was OK. I told her to play classical music, and I was sound asleep. 😁

Best wishes for nothing found!

Oh sorry--I misread your original post. I should have said "please take your urologist up on his offer of an MRI and then a biopsy if the MRI results points in that direction." Again, good luck, and please keep us posted.

You should proceed with the MRI, that will show whether you need another biopsy. Instead of or along with the MRI you could get a PSE test, which would give you a 93% chance of knowing whether or not you had cancer and needed a biopsy for sure.. The MRI may not be definitive, the PSE test could help you decide what to do.

My father also died of prostate cancer at 88. My brother and I both have it. Your father’s having prostate cancer gives you 50% higher chance of having it.

If you come off negative this time you should Continue active surveillance, It is probably a matter of time and you want to be on top of it if it happens. Ask your doctor about this. If they find something and it is a Gleason 3+3 Or even a 3+4 With very little tumor, You could still go on active surveillance, Get six month PSA tests at least.

I’ve got a couple of really good videos from doctors about whether or not active surveillance works for you so after you find out what’s going on, you could ask about them.