Who knows a lot about PSA test results?

I just copy the google definition of PSA for you:

What PSA level indicates cancer?
In the past, PSA levels of 4.0 ng/mL and lower were considered normal. However, some individuals with PSA levels below 4.0 ng/mL have prostate cancer and many with higher PSA levels between 4 and 10 ng/mL do not have prostate cancer (1). In addition, various factors can cause someone's PSA level to fluctuate.

ExoDx is from urine test. Below is from their website:
What is the ExoDx Prostate Test?
The ExoDx Prostate Test is a non-invasive, non-DRE, urine test used as a risk assessment tool to provide risk probabilities for aggressive prostate cancer. It relies on cancer-specific genomic biomarkers found in the urine. Patients below the cut-point of 15.6 are considered at low risk of having high-grade prostate cancer. Patients above the cut-point of 15.6 are considered to have higher risk of high-grade prostate cancer. The doctor and the patient should discuss the patients’ ExoDx Prostate score in a shared decision-making process including all relevant factors and make a decision as to whether or not to proceed with a prostate biopsy.

Once he gets his MRI result, his doctor will look at all 3 tests and decide if he needs a biopsy. If he does, make sure he asks for a transperineal biopsy not transrectal biopsy.

Good luck to him.

thank you and will tell him about the biopsy recommendation, wishing you well

As Frank said - be SURE it is transperineal biopsy!! Also be sure the uro has done plenty if them - if not go somewhere else. I know 2 people who were told it was going to be TP and then got standard painful rectal with complications. Also, the local anesthetic should be delivered by NERVE BLOCKS - 2 shots should do it.
Believe me, the idea of the biopsy was worse than the idea of having cancer, having heard so many horror stories. In fact it stopped me from seeking treatment sooner.
Best of luck to you and remember, this forum is where you go if you have any questions at all. The people here have done so much research and have been thru it all….

Thank you this is new good knowledge I will share with him.

Ok, the relationship stuff I would not venture to go there. If he has a PSA above 4 the literature says it’s considered cancer. However, don’t go freaking out over until the MRI results cause that will tell you if it’s big ol aggressive cancer or just the manageable kind. I experienced the Sam deal with the medical folks. It’s just a job to them. After my MRI it was not good. Btw PSA is only part of the equation. There’s the Gleason score and a whole lot of other stuff. You can drive yourself nuts. My non professional opinion is to take it one day at a time. There is no “silver bullet.”

tinamaria1: the higher exodx may have him thinking cancer is a possibility and of course, everybody processes the concept of cancer in different ways.

The PSA numbers do vary regarding its indication of cancer and treatment. My brother had a PSA of 6.5 with prostate cancer that metastasized outside of the prostate. I had a PSA of 10.5 but my prostate cancer was contained in the prostate.

Get as many different opinions from doctors from different centers of excellence as your budget will allow. There is a natural bias that can occur with doctors. It's important to compare opinions.

If the MRI shows something (an MRI fusion is a reasonable choice), come back to this web site and ask your next step questions. People on this site are very generous with their time and their opinions are based on real experiences. They will answer many questions and raise some new ones. The answers are not always black and white but research will help you and your bf make educated decisions based on his and your needs. There are a number of choices and directions but take one step at a time. You and your bf will have a lot of support.

thank you...funny how I focused on your sentence "the literature says it’s considered cancer," i don't know why because I am usually a very positive person..but last night he wanted to avoid his adult kids who were visiting his home so he made me a nice dinner and brought it to my house, for quiet and privacy...about a month ago before when he got his first high PSA results of 6, the doc told him to lose 40 pounds, which i thought was excessive...and she also referred him to a dietician which I thought was good...for A1C and hypertension issues..he was weighed then, then he worked hard for about 2/3 weeks, changed diet and walked a lot when he could..and in about 2/3 weeks, he lost about 20 pounds..I was amazed how easily it fell off. Then he stepped on a scale last Saturday (feb 24th) when we were outa town and he was 180 lbs..which was about right since he lost the 20 or so lbs. But last night before dinner, we decided to weigh him again because to me, he looked even skinnier in just 7 days..and this time the scale said 172 lbs..so it said he lost another 8 lbs in just about 7 days..so then he said he was concerned, for the first time. I countered and said, even though he stripped to underwear for all the weighing, probably the outa town scale was imbalanced, and he really probably only lost about 2/3 lbs..but i know it made him depressed..

So yeah we will wait for the MRI..i pushed him to tell his adult kids..He did not want to tell all of them since he/they lost their mom a few years ago to an aggressive colon cancer and she was pretty young too..and they all seem to still be grieving a bit..my bf was married to his wife Antoinette for 34 years..and he was her caretaker until the end.

so now I want to figure out how to plan a care situation for him..so he knows he will be cared for during his treatment, IF, he has cancer...i know I am venting. He scheduled his MRI (don't know what kind), next friday.

My heart goes out to all of you who are suffering from this cancer or other things, but I am focusing on hope, and enjoying each day.

thank you, this numbers info is good to know so we don't hyperfocus on the numbers as meaning one extreme or another..will suggest encourage him to get a 2nd opinion after the MRI..he is going to Hopkins, so likely he won't but I will suggest so..thank you and take care

I got my second opinion from Johns Hopkins on the prostate biopsy. I was glad I did because they found some things that Mayo Clinic did not.

After your boyfriend has a biopsy, he will better know his risk level, called a Gleason score. Mine was “favorable intermediate,” so I had the entire range of treatments to choose from. That is good, but can also tend to be overwhelming.

My wife and I spent several weeks reading articles, watching videos, reading books, clinical studies, etc. After my biopsy and diagnosis. It’s a very complicated subject! I was glad that I investigated both surgery and radiation, and interviewed 2 urology oncologists (surgeons) and 2 Radiation Oncologists. I’m lucky to live just an hour away from the mayo clinic in Minnesota.

An important thing is to give yourself some time, research, and look into both surgery and radiation. Whatever modality you choose it’s good to find a doctor who is very experienced in that modality.

Not sure where you live, but there are many “centers of excellence” across the US that deal with a lot of prostate cancer. Regardless, find the very best hospital that you are able to access.

I’d also say to stay on Mayo Connect. The phenomenally good surgeon that we wound up choosing was as a result of my wife putting a question out there on Mayo Connect and getting great responses.

Many or most prostate cancers are very slow growing, so that’s a positive. And there have been lots of improvements and treatments, high tech solutions, etc. in the last decade or so.

All the Best to you and your boyfriend in this journey. Feel free to give me a private message through this portal at any time if you would like to.

All the best,
Jim G

I was diagnosed with an enlarged prostate and PSA of 4.3 in 2016. I had a biopsy and MRI, both negative. For the next 6 years my PSA went up and down like a roller coaster. My only constant symptom was frequent urination when sleeping. I got a second opinion and was told that my PSA could be higher due to my enlarged prostate; that a larger prostate has more volume, thus can carry more PSA. In late 2022 I got a second MRI, again negative. Later in the year I got a second biopsy which showed 2 cores of cancer, one at 3+4=7. I decided on removal, and had successful surgery last November. However, my pathology report changed my Gleason score to 4+5=9 and close to the capsule. My first blood test in January showed my PSA at < 0.01. I’m hoping it stays that way. My point is, do anything and everything you can to make sure you have accurate information before making any treatment decision. As far as prostate treatment has come, there can still be discrepancies. BTW, I am 71 and very healthy for my age. I continue to work out everyday. Best wishes and health and happiness.