47 - PSA 3.0+, Negative MRI, LUTS, biopsy?

Sorry this is long.About 2 years ago I started having a noticeable increase in LUTS. Getting up a 2-3 times a night, weak stream, particularly after drinking a few drinks, and after holding my urine for a while. I had a phone screen with a urologist who, who suggested a PSA and Floxmax.I did the PSA in April of 2020 and started flomax. The PSA came back at 3.03. I didn't like the flowmax because of the RE so I stopped.

The urologist was of couse concerned about the 3.0+ PSA and ordered a retest a couple weeks later that came back at 3.09. He then suggest a course of antibiotics and a retest about 3 months later. He also wanted to do a biopsy which I did not want to do. The retest came in at 3.22 about 4 months from the first test. I switched to a different urologist who was closer to me and he also wanted to do a biopsy(both with Kaisar NW). I did get into the office and he did a DRE and a cystography. He said my prostate was large but didn't feel anything unusual. The cystography showed my prostate pushing into my bladder and I was clearly peeing through a small slit. He did also see some tribiculation in my bladder. I still refused the biopsy and pushed for an MRI. He begrudgingly ordered the MRI which came back negative. This is now September 2020

The MRI said the following. Curious on other's opinion's here.

*TECHNIQUE: Multiplanar multisequence images of the pelvis were performed. 7.2 cc of Gadavist IV contrast was administered.

FINDINGS:

Prostate gland dimensions: 4.0 x 5.5 x 4.9 cm

Prostate volume:56.1 mL

PSA density: 0.06

Transitional zone:

BPH nodules noted. No suspicious lesion.

Peripheral zone:

No suspicious prostatic lesions. Regions of decreased T2 signal within the peripheral zones are favored to relate to prostatitis.

Extra-prostatic extension:

None

Seminal Vesicles:

Unremarkable

Lymph nodes:

No pelvic lymphadenopathy

Urinary bladder:

Unremarkable.

Bones:

No aggressive osseous lesions

IMPRESSION:

1. No suspicious prostatic lesions.
2. No pelvic lymphadenopathy.*

Based on this it seemed that aggressive cancer was unlikely.The urologist agreed that I was probably ok and we agreed to keep checking my PSA every 6 months.

6 months later, now March 2021 I check my PSA and it is 3.09. I had also been taking Quarcetin which is supposed to help with BPH but is also an anti-inflammatory, so that could be the reason my PSA dropped.Happy that it dropped, I didn't think much about it again until I did my next retake. I went a little longer than 6 months and had it taken Nov 1. This time PSA was 3.54 and I had not been taking any supplements. I also made sure to take it easy a couple days before and hadn't ejaculated in about 5 days before. Now I am concerned it went up and by an amount that may be concerning by some accounts.

My doctor's office called and he wants to talk to me about my PSA.

I know my PSA is high for someone my age. I have LUTS and BPH and a 56 mL prostate. PSA density is OK based on my research and my doctor's opinion.My PSA did go up a lot in a 7 month period, but is still only about 0.5 since my first reading about 18 months ago.

What would you guys do? Hold off on a biopsy and keeping watching the PSA? My LUTS is getting to be annoying so I will need to do some kind of procedure at some point to preserve my bladder.

I read there are some other blood tests that are more specific to PC. I could even pay out of pocket for some of these if I can't get Kaiser to order them. Is that an option for that? Should I do another MRI?

No cancer history in my family. I am healthy, non-smoker, exercise a lot.

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