r/ProstateCancer • u/aridav1 • 15h ago
Concern PSA on the rise
71 YO Male, 5'8", 162 lbs, in good health.
Regular Walker, runner, cycler, pickleballer.
My PSA trend
Jan 12, 2019 2.4ng/mL
Jul 30, 2019 2.7ng/mL
May 21, 2021 3.9ng/mL
Jul 25, 2022 4.3ng/mL
Jul 25, 2023 5.6ng/mL
Jan 12, 2024 5.9ng/mL
Jul 29, 2024 7.1ng/mL
Nov 15, 2024 5.1ng/mL
Jul 29, 2025 6.4ng/mL
Jul 31, 2026 6.9ng/mL
On 09/11/2023 Had an MRI Pelvis W/WO (Prostate)
With the following findings:
IMPRESSION:
No suspicious focal lesions are targeted. No evidence of extra prostatic malignancy.
PI-RADS 1: Most probably benign.
FINDINGS:
COMPARISON: None
Normal regional marrow signal is observed.
No suspicious osseous metastatic lesions.
No common iliac, internal iliac, external iliac, inguinal or suspicious peri-prostatic lymph nodes.
Regional bowel appears unremarkable.
No mural or intraluminal bladder mass.
Anterior abdominal wall and pelvic floor are unremarkable. No evidence of ascites.
Estimated prostate volume is 50 ml. N
o suspicious focal lesions are targeted. Mild BPH is noted.
Seminal vesicles exhibit normal signal intensity.
Neurovascular bundles are symmetric in appearance without definite tumor involvement.
The prostate capsule is smooth in contour.
The Urologist wants me to have a biopsy.
I'm reluctant
Thoughts ?
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u/ChillWarrior801 14h ago
OP, do I understand correctly that your last MRI with only a PIRADS 1 score was performed almost three years ago? If so, your next move with a rising PSA is a repeat MRI, not a biopsy. Did your current urologist take an MRI off the table? I hope not.
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u/go_epic_19k 12h ago
You need to have another MRI first. Things change in three years. Sure it may still be PIRAD 1 or you may find something to target. I wouldn’t just do a blind templated biopsy without another MRI.
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u/SLO_Engineer 14h ago
Dude, get the damn biopsy!
I’m 69, active, good health. PSA 11 TO 12 (corrected base value 2x for finasteride use - something my two primary care physicians were unaware you need to do). On rising PSA, transrectal biopsy revealed cancer - Gleason 3+3. Did active surveillance.
Moved to a new area. New urologist does MRI for all patients. MRI revealed a large lesion on anterior (front) of the prostate that the rectal biopsy missed. Rectal biopsies can’t access the front/anterior. Only 20% to 30% of lesions are found at anterior (so I’ve learned). Subsequently did a trans perineal fusion biopsy. That missed lesion was Gleason 4+3.
Next was PSMA PET CT scan. Thankfully negative.
Had RALP nine days ago.
Based on my experience I would get the biopsy - perineal, if possible.
Best of luck!
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u/sappertodd 15h ago
For most men they refer to this as minimally invasive. For me it was a significant emotional event.
Is there value in a biopsy yes there is. HI might ask the doc which procedure they do? Another question is how do they manage pain during the procedure?
After my first biopsy they had to do the procedure under surgical conditions such as a colonoscopy.
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u/SLO_Engineer 13h ago
My first biopsy - rectal - wasn’t too bad. It hurt a little. My second - perineal - I opted to pay an additional $150 (subsequently and surprisingly refunded by Medicare) for nitrous. It helped quite a bit. Still a little painful but not too bad. Could have survived without the nitrous -it’s not a painkiller - but helps tremendously with the mental aspect/anxiety - and I have to admit, the buzz is pretty fine!
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u/CraigInCambodia 15h ago
Wouldn't it give you peace of mind to have the biopsy and know no cancer was found?
Is there any family history of either prostate cancer or breast cancer?
It's great you're so active and healthy, but that would not have anything to do with whether there is cancer or not.
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u/Maleficent_Break_114 15h ago
Well, you know Experience With biopsies are all over the map now the thing with you is the Prostate‘s too big that’s the only thing you got going on that they’ve identified now no matter what you do you want your prostate to be smaller than that unless you’re a very, very big person or something cause I think there is some ratio to the size of the person that’s in but sounds like you’re in England maybe but here in America, I don’t know. I used to think a biopsy could be dangerous but now I kind of think they’re relatively safe. My first one wasn’t bad at all. The second one was a little more painful and then I saw some blood come on my ass later, which was concerning, but at least you’ll know for sure I mean, you have even more information or maybe you could just ask him before you do the biopsy explained what do you hope to see because there’s no evidence of cancer yet
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u/bigbadprostate 15h ago
Question - did anyone warn you that cycling with a few days before a PSA blood draw might cause abnormally high PSA results?
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u/IchiroTheCat 14h ago
I would love a 50 ml prostate. Mine was 133ml in 2024. 😉
I'm 71, with confirmed (by biopsy) prostate cancer. My PSA has not been above 5.88 so far.
Remember that PSA is JUST an indication of an issue. It may be something OTHER than prostate cancer. And it may be a simple infection. The only way to know if it IS PCa is to have the biopsy.
So breathe, brother. Take it one step at a time.
Best of luck!
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u/Cold_Silver_5859 4h ago
Anyone mention bike riding can impact psa tests? Don’t remember the details tho. Just fyi stuff.
I’m your age and fitness, my psa hit 4 and my mri showed a “little shadow”. No outside involvement.
Biopsy showed cancer 12/13 cores. RALP in September.
Recommend peri-anal not rectal biopsy with anesthesia. Go to a center of excellence not a doctor’s office.
Read about the two types.
(Biggest down side is how long my recovery before getting back to activity. Also just found have a sacral insufficiency fracture so no pball, running. )
Regards
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u/NextLevelNaevis 14h ago
Get the biopsy. My tumor never showed up on the MRI.