Ultrasensitive PSA test results: Should I be concerned?

Ginger38314, you might ask for Episwitch. https://pmc.ncbi.nlm.nih.gov/articles/PMC12249354/ Glad you are feeling great.

Most people with prostate cancer do not know they have it, It has no physical effect on them yet some have very serious cases.

A large prostate can result in a high PSA. If you are really concerned, because of the recent increase in PSA, you should ask the urologist to do an MRI. It can tell whether or not there are lesions in your prostate and how serious they are. You could also get a PSE test, which will tell whether or not you have cancer in your system and if you need a biopsy.

A DRE is only so accurate. You can have prostate cancer, even if the DRE and MRI show nothing. That’s why the PSE test is convenient to do, It is 94% accurate.

Wishing you the best! When you go in next time, please ask him if you can get MP-MRI (3T-MRI). The chief urologist, who first treated my husband, explained to us that PSA is like an engine light. Once it comes on, it means to get the engine checked. Similarly, once your PSA is above the recommended level, you should get a thorough check. It can be just infection, or worse: it can be cancer. The key is to get it tested further. The goal is to catch cancer as early as possible if there's one.

We live in Germany. My husband was 47 when his PSA was elevated to 5.2, finding it from PSA test during his physical check-up (Feb 2021). He had NO symptoms. Our GP referred him to the chief urologist at the certified prostate cancer near our house. We met him in March 2021. DRE was normal, but he ordered an MP-MRI anyway just to be on the safe side because it's uncommon for younger men, like him, to have this high PSA. Sure enough, MP-MRI showed one big and one small suspicious lesions on the side of prostate gland that DRE cannot access. DRE only get to the back wall (posterior surface). His lesions were assigned PIRAD 4, so he got MRI-guided fusion biopsy in April 2021. It confirmed prostate cancer (5 out of 17 cores- 4 with Gleason 7(4+3) and 1 with Gleason 8-only 5%). After exploring through all treatment options, he decided to get surgery.

Going through this uncertainty is definitely psychologically and emotionally challenging and exhausting. However, knowing all aspect of prostate diseases, including cancer, including treatments and side-effects is helpful. When we dealt with diagnosis, we were like deer hitting on by the headlight. It's very difficult. I've spent my almost 5-year post his treatment to research and gather information on everything. He's currently experiencing recurrence, but we have been doing much better psychologically and emotionally this time around because this time we know more and see how advance medical world is.

@ginger38314
Seems your PSA is going up and down. My PCP and urologist says the major issue of PSA is a steady rise in numbers over time.

Your present PSA is high. The normal level is below 4. But your urologist has examined you and diagnosed you with enlarged (very large) prostate glan. This could be BPH or from (the recent rise in PSA) the enlargement of prostate. But you are seeing a urologist so that is good and follow through on the recurring PSA tests.

Regarding feeling anything. Are you having any increase in urination? That would be a sign of BPH at least one of the signs. PC can or cannot cause pain. I had no pain at all. I also had a normal PSA with no symptoms at all including a normal size prostate. But had cancer.

A high PSA does not mean you have cancer nor does a normal PSA mean you don't (I am proof of that). Just keep monitoring your PSA. Not unusually to get jumps like this but your are going up and down not just up. Make sure you use the same lab for all your PSA test. Using different ones can cause very different numbers.

Not any severe abnormal symptoms, at night and day on average I go every 3
hours. No starting or stopping issues, thanks for responding to my post.

I'm just hoping like 3 years ago it went from 4.1 to 2.2 after 1 month,
will get retested in 3 weeks then I will know if I have to get an mri or
not. Even if it goes down I want to get one just for piece of mind.

Wishing you the best. Getting MP-MRI was highly recommended by my husband's urologist. We're skeptical at first until he told us that DRE could only see the back wall of the prostate. We're thankful looking back because had he not ordered MP-MRT, we wouldn't know that my husband had prostate cancer because he had no symptoms at all.

A recent long term study of 23 years found that regular PSAs will reduce disease specific mortality by 13%. So one test is not as valuable as ten showing a jump over an interval. I like the 'red check engine light' analogy. The multiparametric 3T MRI with dye is next. Then a targeted ultrasound (US) MRI fusion perineal biopsy (bx).
Then a PSMA PET CT scan to determine if there is any disease called outside the prostate.

Hopefully it is just bph like it was 3 years ago, thanks for responding.

Depending on lab and method PSA can vary by as much as 20%. Something to keep in mind if the tests were done by different labs (and Quest, LabCorp the two largest use different methods). PSA can also be elevated with recent sex or an infection. Did you get prescribed antibiotics to eliminate that possibility for the retest? That said, if you have prostate cancer it will continue to rise. At these levels the Ultrasensitive test is a waste of money (that is to get to .001 levels for post prostate removal when PSA should be close to zero). Should insist on a PSA Free test along with normal PSA (lab can use the same blood draw for both tests). If elevated PSA is due to cancer the free PSA will be much lower than if due to other causes. Not nearly as good as PSE / Episwitch (same test) but cost is about the same as PSA. The PSE costs about $1K and insurance is not likely to cover without a longer and higher history of elevated PSA unless you are on classic Medicare. An mpMRI or PSE is a next step if free PSA indicates cancer is likely. If PSE indicates cancer than the mpMRI is still required to locate lesions so you may go direct to that step.
As mentioned, if prostate cancer has any symptoms before it metastasizes, they are the same as a non-cancerous enlarged prostate.