Elevated and rising PSA, what should I do

I think I'd want to know. If you have a biopsy and it is cancer, you'll get a Gleason score. If it is a low Gleason like 3+3 then you'll know there is no hurry to have treatment if any. If it's a high Gleason then you'll know you need treatment sooner rather than later. My OH had a Gleason of 3+3 and was encouraged to go on active surveillance. But he decided to have brachytherapy. (Radio active seeds put into the prostate) Once the psa gets to 10 this treatment is no longer an option. My OH he a psa of 3.7 at diagnosis but 6 months later was 4.7

I know I wouldn't want to leave it as it could be cancer and could spread. Though admittedly prostate cancer is usually slow growing. 

All the best. 

Hi Girard,

Not sure where you are located or how sophisticated they are in your area but there are several other steps to take before rushing into a biopsy. 

1. You should request a 4K blood test. This is a more sophisticated test that measures 4 prostate specific markers. It predicts the likelihood of finding a "significant cancer" if the prostate were to be biopsied.

2. You should insist on getting a 3T parametric MRI to see if there are any lesions that can be identified. If there is a lesion it will be assigend a PIRAD score. Make sure it is read by a radiologist who is very experienced in reading prostate MRI's. Many are not. Do not settle for a 1.5T MRI since it is not strong enough to give clear images to evaluate thoroughly.

If there is an identifiable lesion then you have the advantage of being able to have a fusion guided targeted biospy rather than just a random biopsy. Often the random biopsy will be done along with the targeted biopsy to get a more representative sample.

3. After the doctor and you are able to evaluate the 4K test and the MRI then it can be decided if you need the biopsy. 

4. Make sure you have this done at a major teaching institution if possible.

5. If you urologist says this isn't necessary or is not familiar with the things I mention then please run the other way.

Hope this helps and good luck.

I had some similar experiences a few years ago and saw no reason to delay having a biopsy. At first it was inconclusive, but a year or so later, with PSA increasing but no enlargement felt during DRE, I agreed to a saturation biopsy and was then diagnosed as Gleason 3 + 3. Since then, no treatment, but continued surveillance. To me, July is far enough away to be sure that you would have recovered from any difficulties post-biopsy, so in your place I would agree to have it done now. However, the difference for you is that you have had BPH identified and I would imagine this is enough to explain your rising PSA scores.

gerard20400,

Your PSA number were just about the same as mine, when I was diagnosed with PCa. From the 4.4 to the 5.9 .only difference I never woke up with blood on my legs.

You do have time to consider your options, but the only way you will know if you have PCa is through a biopsy.

I elected to have one, and I was diagnosed with a Gleason score of 4+3 = 7 Intermediate cancer. I chose Active Surivillance because I had my biopsy remains sent for gentic testing, results came back non aggressive.

After a few months my PSA went to 6.86. I then decided to have treatment.

You do have time to think, and evaluate your condition. It's your decision to have biopsy or not get one,, but my advice is... get one.

Hope my story will give you some insight on your decision making. G' Luck going forward.

Roger

Hi, I was diagnosed at 63. Similar story to yours. PSA gradually rising from 4.5 to 6.2..ALL DRE's by GP's came back as enlarged prostate but no hard spots.Finally saw Urologist and his DRE was very different than GP's. Much more thorough.He felt the tumor when GP's didn't. Biopsy done. Gleason 4+3...Prostate and 13 lymph nodes removed. ..doing alright now.pat

gerard, Before you get on the biopsy train, get a mpMRI done. It will show you very quickly if you have any pca issues, it will be reported on by a radiologist. By your earlier comments, you have had a bladder/urethra issue which has upset the prostate, causing the increased PSA reading.

Anyway, so that you can get the June wedding sorted and be able to enjoy, get a mpMRI on a 3T machine asap. 

Thanks so much to everyone for the kind advice and thoughts.  Lots of useful information there.

I'd definitely be interested in the MRI option as a preliminary step to any biopsy.  I'll ask the doc about that for sure.  And I think I might make a July appointment now with a different doc for a second opinion in the event the first doc gives me a blank stare or pooh-poohs the notion of an MRI.  Although he seems to be very good and certainly has an outstanding reputation.  In fact, he's the chief of urology at a local hospital.

As for waiting until July, yeah, my wife is not real happy with that plan, but I've done a lot of reading on all this stuff recently, and I think a delay of just a few months should be pretty safe.  Granted, if I do have PCa, and if, God forbid, it's the super aggressive variety, well, waiting will certainly not have helped matters.  But given the range of circumstances here and the overall odds, I'm comfortable with it.

Thanks again, and if anyone has more thoughts to add, I'd be interested!

 

Well the bleeding would really concern me when I was in college I caught a knee in the kidney playing football and I was peeing blood for several days. so if I were you I would talk to an internist and rule out any causes of bleeding. As far as the prostate goes I've had BPH for over 10 years and in the last year my PSA has gone from 6 to 5 to 3 to 9 to 6... and my testosterone was below 300 six months ago when I finally had them check at so I'm getting bi-weekly testosterone injections. I'm getting my PSA checked every 3 months and if it ever goes above 10 I'll definitely have to cross the biopsy line. If your insurance Ohio I would get a 3T MRI done of the prostate to establish API Reds score which goes from 1 to 5 5 being the most serious I believe. My results were API Reds score of 3 with possible lesions in the intermediate Zone. Having the 3T MRI done gives them the option of doing a fusion biopsy where they overlay the MRI results with the ultrasound as they are doing the biopsy and they can better Target suspicious areas. In spite of my MRI results my local urologist doesn't want to do a Fusion biopsy and instead just the normal random biopsy. The urologist I saw at the Cleveland Clinic in Ohio wanted to do the fusion biopsy but since my MRI was six months ago he said I have to get a new MRI to proceed with a fusion biopsy. I probably should have had the fusion biopsy 6 months ago but at that time I was having a lot of pelvic pain with unknown causes so I didn't want to take a chance on an infection or sepsis which is not uncommon with a prostate biopsy. There is a new test with my primary care doctor suggested which evaluates the possibility that you may have prostate cancer from a simple blood test. I don't remember the name of the test but it's a three letter acronym for something. It's not the pca3 but something newer. Hope this helps

Your situation is very similar to mine.  My PSA was over 4 (Apr 2014) so my doctor suspected a UTI.  I tried some anti-biotocs and went on a cruise , forgetting about it all.  In Sep 2014 my BPH made it difficult to urinete so I went back to the doctor to get some flomax.  PSA was 13, doctor saying I needed a biopsy 'NOW'.   I finally got the biopsy in December, result was a gleason of 4+3., PSA now 17.  I made an appointment for screening and testing at MD Anderson, Houston, TX.  for Feb 2015.  My PSA was 32 by the time I was diagnosed by their team of professionals.  Result was I had PCA and it had spread to my pelviv area lymph nodes.  A long story short, I waited too long to receive treatments that could have cured my cancer.  Poster Scotth42 has great advice, follow it.  Or, if not possible, get a biopsy - it is basically painless, no side effects (in my case).  You must get ahead of this disease,  misery comes to those who wait.  Bless you and good luck.