Your asking this question to a bunch of men who have terminal stage 4 cancer that they are trying to manage for as long as possible before we likely in the end lose the fight. A biopsy? that’s nothing to worry about compared to chemical castration, chemo, radiation, surgery, bone mets slowly breaking down your bones causing crushing pain.
There you will find men who are closer to the problem you are currently facing.
Many men here had psa’s in the hundreds or even thousands when they first found out…..and honestly would love to turn back time and be in a position to catch it early.
No no no. Random biopsy’s are insane. I learned the hard way. 0/14 on random and 3-3 on MRI guided biopsy. If they see nothing in your MRIs, I’d wait and keep doing your PSA Every other month and if it continues to rise I’d do another MRI. Or if your PSA breaks 10, and another MRI is negative, maybe you do a random. Another option is to have your MRIs read by a top Radioligist at a top center like ucla etc Ff or. Second opinion.
DREs are very imprecise. A normal DRE means nothing. I had normal DREs when diagnosed with stage 4 mPCa with cancer in 11 of 12 zones targeted in my prostate biopsy. Gleason 8
My PCP felt the lump in prostate and she said to go to urologist. STUPID ME didn't follow her advice since I was training for my 2nd IRONMAN TRIATHLON and at age 64 I needed all the training I could get. FINALLY went to URO. some 8 months later and the result was 5+5. REALLY STUPID ME for procrastinating.
Just saying that knowing where I am NOW and was 6+ years ago, if I was in your position NOW I would 1st avail myself of one or more of the *non-invasive tests* that could shed some light on condition and then proceed always realizing that nothing is as accurate/informative as a proper biopsy.
Great article discussing the subject that underscores the accuracy of MRIs vs biopsies.
“Compared with biopsy alone, MRI with or without targeted biopsy was associated with a 57 percent improvement. in the detection of clinically significant prostate cancer and a 77 percent reduction in the number of cores taken per procedure.”
Most guidelines for biopsy after a positive MRI include a standard 12 core biopsy....though small in number, an additionaal number of significant cancers are found. I'm a good example, 6 total cores from my PIRADS 5 found nothing but benign tissue........ one of my standard nontargeted cores contained 4+5 cancer!!!!! Another core was 3+3. Good luck with your decision ! Did you ask your Doc for reason to advise standard biopsy also?
I would say no. For a start, your urologist should be doing trans perineal biopsy, if they are stillDoing trans rectal, get another urologist !
PSA is pretty high, but is it increasing? What’s the psa density (psa compared to Volume of prostate). What makes the urologist think they will find cancer with a biopsy ?
Your gland is twice normal size. Theoretically you can double your PSA value to 8 and therefore most likely PSA is coming from large gland. No guarantees of course.
If a trial of 5 alpha reductase inhibitors significantly drop PSA that would be supportive evidence for the BPH being responsible for the elevation. Again no guarantees.
If second read confirms first you are in no hurray to do anything other than what has been done. You are on top of this.
Biopsies are invasive and not without complications. What was your percent free PSA, if done.
I would accept your report as cancer unlikely, BPH likely. "... benign prostate hyperplasia (BPH) in elders may show PSA level of 7 or 9 as well in early stage." See: bloodtestsresults.com/norma....
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