Whats my next step!

I will be on AS for five years at the end of the month. Had one core positive, Gleason 6 on my first biopsy in 2012. From my signature you can see the results of my next three biopsies that were all negative and MRI's were clean. What is concerning is my PSA velocity is increasing. Over the five years PSA went from 4 to 9 and I expect it will be 10 on my next visit next week. My Dr. at Memorial Sloan Kettering feels I have a very low form of non-aggressive cancer, has encourages me to stay on AS. Says they are now accepting men on AS with PSA over 10 depending on the circumstance. From my last biopsy and MRI, they cannot identify any infection. Are there any other tests or questions I should talk to my Dr. about next week?

TA to answer you questions,
How big is your prostate? 30 cc
Any evidence of chronic or acute inflammation mentioned in your biopsy reports?No
Any evidence of urinary retention? No

I look into the PHI test

"So in 2012 you had one core of 23% Gleason 6 and three subsequent biopsies were all negative? That sounds really odd to me."

I would like to understand that one also.

MRIs and trans rectal biopsies are poor at detecting cancer in the anterior or transition zone. A 30cc prostate should throw off a max psa of 1.8 to 3, which means that you have 6 points of unexplained psa, which is more than likely due to an undiscovered tumor. A consistent rise in psa is usually associated with a growing tumor as psa rises as tumor volume grows.
Advanced MRI fusion scans or multi parametric MRIs may be better at seeing the anterior. doctors such as Dr Bahn in Ventura and Dr Scholz in LA specialize in discovering hard to find prostate cancers use expected psa for prostate and tumor volume and search the transition zone for a tumor equaling the size of the excess psa. Your psa has doubled in the last 5 years which indicates a slow growing cancer and your doctor may be correct in continuing AS, a doubling time of less than 3 years would be a concern.
Dr Strum a well know oncologist said he has never seen a patient with a doubling time under 10 years not be eventually DXed with PC.

As TA noted, it is not unusual for men with low risk PCa to have negative follow-up biopsies. I am one of them. My doctors at the JH AS program have told me that negative biopsies and indeterminate MRI results are common results, even though these men all had at least one positive biopsy to enter the program.

it is not unusual to have negative follow-up biopsies.

Yes i get that, its hard to find. But he has had 3 mri guided biopsy's(or maybe just 2) with a doubling psa, not that large of prostate, no inflammation, and no infection. He has a "non-aggressive cancer"?
I ask because I haven't been diagnosed, I have only one negative biopsy. Even though I'm extremely claustrophobic i have been leaning towards the mri since I dont like some of the things i hear about the 60 core biopsy. Maybe i need to rethink that.

Post Edited (tommyc) : 2/19/2017 12:24:35 PM (GMT-7)