Re: Rapid rise in PSA
There are forms of chronic prostatitis that will not respond to antibiotics, but you can't assume that is the case with you. I assume they found no sign of hyperplasia on the biopsy, so you can rule out BPH. Inflammation may also occur as a result of cancerous lesions. As you are well aware, your PSA is high and rising quickly, so it's important to ascertain the cause.
There are a couple of blood/urine tests they can run: % free PSA and PCA3. Taken together, these biomarkers have sometimes been able to detect cancers, even when biopsies have been negative.
Biopsies are random and can easily miss the cancer, depending on where they happen to poke. Standard biopsies don't sample all over the prostate, but only in areas where prostate cancer is most likely to occur.
There have been some techniques developed for looking for suspicious lesions before they go poking at the prostate.One imaging biopsy option is a multiparametric MRI -guided biopsy. It is also not available everywhere, but these MRIs can sometimes detect lesions that are otherwise invisible. There are a couple of doctors who will do a color doppler ultrasound guided biopsy, or an ultrasound elastography guided biopsy that have also been able to find otherwise undetectable lesions. I have a friend who had two biopsies and a multiparametric MRI-guided biopsy which were all negative. Finally, they found it with a 30 core saturation biopsy. His PSA was a lot lower than yours, however. The higher the PSA, the more likely that one of those imaging options may find a suspicious lesion that may be biopsied.