My New PSA Results & Recommendation

IADT3since2000

Hi Sw1218,

I have had no enrolled medical training, and your uro is, of course, a doctor, and has examined you and apparently followed your situation for some time, and he does not appear to be rushing you toward a biopsy and treatment. Therefore his recommendation of an MRI has a lot of credibility. My layman's understanding is that the ideal MRI for your situation is a multiparametric MRI (mpMRI) with a 3T magnetic field, and that is probably what your doctor has in mind. These days, especially when a patient has had a previous negative biopsy and with increased confidence in 3T (great image resolution) mpMRIs, a rising proportion of doctors are using MRIs instead of another biopsy as the next step.

Here are considerations on the other side of the scale, on the side of just continuing to observe with PSA tests.

- Your last three values, spread over 9 months, are virtually stable - a really long PSA doubling time (PSADT), though significantly higher than the 5.9 and 6.2 values, with the spike to 7.6 an anomaly. As prostate cancer involves cell division over a fairly constant period of time, the pattern of increase is an exponential rise. In other words, 1 million cells become 2 million, 2 million become 4 million, 4 million become 8 million, etc. That does not match the pattern of your PSA results, though the difference does not rule out cancer.

- Benign growth, known as BPH - which you have, results in a fairly steady growth of the prostate, and that is not associated with an exponential rise. It could account for the gradually increasing PSA results that you are seeing. Usually BPH is not significant until men are older than you are, but some men get the growth earlier, and the biopsy proved it. The rule of thumb is that you get about 1 unit of PSA for every 10 cc of healthy (meaning here non-cancerous) prostate tissue, so a prostate of 70 cc would probably account for your PSA. But you could have BPH accounting for some of the rise in PSA and infection/inflammation accounting for the rest, or perhaps a small amount of cancer also involved.

- Inflammatory prostatitis, which you had and maybe still have, often causes scary abrupt rises in PSA followed by reassuring declines. That looks suspiciously like the pattern you saw from the summer of 2015 through the spring of 2016.

So I'm thinking your doctor probably thinks it's very likely you do not have prostate cancer but wants the additional assurance of that MRI. That's reasonable and understandable to me.

Because of BPH and prostatitis, it is quite possible for a man to go through all of his life without having prostate cancer. I suspect that happens rather often.

The research on prostatits and prostate cancer mainly indicates they are not connected, but there is some uncertainty.

Good luck!