Is a small hike in PSA level anything to worry about??

[Chuck67]

HI, I am now almost 53. One year ago , almost to the day, i had a biopsy. These are the results: Gleason 6 (3+3). 35 cores taken, good lengths in all, 1 core with 1mm cancer found. Was put in Active Surveillance and have just had a year where I could almost forget about PC. PSA levels taken three times throughout the year - 4.1 - Jan 2019, 4.2 - June 2019 and 5.1- Oct 2019. My Doctor says another MRI is required and possibly/probably another biopsy. Please let me know your thoughts. Your opinion is greatly appreciated by me (and by a lot of other people on his forum). It is my go to place for advice and hate the thought of a needless biopsy!!

[Darryl Partner]

If you feel comfortable having an mri the go for it. Then let the mri and most recent psa results guide your biopsy decision

[Hope4Happiness]

I think the best bet is to go with the MRI first. This procedure will give you an effective overall view of your prostate and will reveal any specific focal lesions. If lesions do appear, they can be given a specific PIRADS score and that can guide the next biopsy, if need be.

Your biopsy from a year ago revealed so very little cancer, so just going for another biopsy without any MRI first would be just be "firing in the dark."

[Apfadt]

Hi Chuck

You have gotten some good advice.

Here is some more.

PSA test results, particularly when the prostate is still intact, have a large amount of intrinsic variability- between 15 and 20%. This means that a test result of 4 ng/ ml could range between 3 and 5 purely by chance.

Furthermore, if you had sex before the test or ride an exercise bike, or if your prostate was temporarily irritated for any other reason, the differences could be even larger.

Therefore, comparing any single test result with the previous one is essentially meaningless.

However, if you are having 3 tests per year, you can examine the pattern of variation in your own test results to determine if your latest value of 5.1 is a “ signal” that something changed or if it is just more “ noise” due to random variation.

So don’t do anything until you have one more test.

If you post your test results on line or send them to me at

[e-mail]

I will graph them for you and provide guidelines for interpreting the next test result.

Or you can read an article I recently published in Oncogen ( oncogen.org) that provides guidelines for graphing your own data.

Active surveillance is not for the faint of heart- it takes courage to live with uncertainty.

I hope you have a real world support group as well as this online community to help you deal with the challenges of living with this uncertainty.

Have you had a 2nd opinion regarding your Gleason score from your original biopsy.

If not, I would recommend that before getting a second biopsy.

Good luck on your journey and keep us informed.

[Chuck67]

Thank you for all the comments....as always, this forum is a fountain of knowledge. I met my consultant today who explained another MRI is the next step. He is not worried and neither am I - a good place to be!!