Want to avoid biopsy

Hi, WH. By "negative' was there a PIRADS score on the MRI? Any prostate enlargement?

In any case, for the vast majority of guys, a biopsy isn't that big of a deal. Of course there's the 'freak out' factor. Ya can't help that, but look what women go through at their GYN checkups!

Your PSA is on the high side for your age though. My understanding is that PCa is considered as more of a 'sporadic' disease than hereditary. My uncle (dad's brother) had it in '96 (still kicking at 74), but my father, at nearly 72, has never been diagnosed. From what I know, my great-grandfather had it but died of something else. My stepfather died from it after a 6 year battle, and had no family history at all.

So, I guess the question is about how comfortable you are about waiting and seeing.....

IMO, don't sweat the biopsy. It's over in a few minutes. You're going to have a bit of blood in your urine, and possibly in your stool. And definitely in your semen! But it will all eventually go away. There's a slight risk of infection from the procedure, but you'll be given antibiotics for before and after.

Where do you live?

There are worse things than a biopsy. Why do you want to avoid it?

The normal procedure is to rule out all other causes of a PSA rise before biopsy, enlarged prostate and infection are two of the top reasons. Assume the doc has also checked for enlargement, the doc has a reasonable notion to do it.

You have to balance the risks. It could be an unneeded procedure, but it could also uncover something serious. It's difficult for me to say you should or you shouldn't. Personally, I had a similar rising pattern and was happy I had the biopsy as it uncovered something I needed to have treatment for.

Your milage my vary,
Andrew

I don't think I'd have a biopsy today without first having a mp-MRI. I doubt the pelvic MRI can detect prostate cancer as well as a mp-MRI. I would also try to find a facility that does a fusion biopsy or a MRI guided biopsy in case the MRI shows you need a biopsy.

You might have trouble getting a mp-MRI depending on where you live and your insurance, but if you can, I think it would be a better option than doing the biopsy right now. The mp-MRI with state of the art equipment interpreted by an experienced radiologist can detect around 97% of prostate cancers worth finding. Small, Gleason 6 cancers, likely indolent, are probably not going to show up. This is what you want to avoid finding on a standard biopsy.

The trouble with negative findings is that they don't rule out cancer. They just mean none was found in the very small sampling that was taken.

What did the DRE find? Any abnormalities? Have you discussed any other tests that may be helpful?

Some 50-55% of biopsies are positive. Clearly many shouldn't be occurring. Try to find out what the percentage of your urologist is. If it is only in line with the national average it may indicate he isn't doing enough to rule out enlargement, infection or inflammation before going to the biopsy.

Get the biopsy, see what it says. Your PSA is increasing, antibiotics did nothing. Further investigation is warranted.

Get the biopsy, is my recommendation. The younger you are when PC is found, it usually should be treated to avoid getting to involved.

I can only give you personal experience. My PSA rise was about the same when I went in for a biopsy due to my GP referral to the Urologist. They found PC. I had a prostatectomy soon after. I wish it had been diagnosed earlier because after the surgery, I found that the apex and nerves were involved. This resulted in two issues; 1) This resulted in more tissue than I hoped for being removed, which impacted ED issues, 2) It ended up escaping the prostate, and evolved into a progressively more aggressive PC that I have been in battle with for over 10 years, and the treatments are getting more aggressive as well.

Therefore, I am a proponent of as early as possible diagnosis and treatment. The hope would to possibly "cure" it with the initial treatment vs not treating and possibly having a life long battle with treatments.

I am wishing you the best on your travel along this path, and hope that the biopsy is totally negative.

Ted

Keeping in mind that I'm just a random guy on the internet, I'd probably wait, but keep a close eye on your PSA. Yes, there are 45-year-old guys with PCa, including some here. But in general, that's very uncommon. Looks like you're getting PSA test every three months so at the very least, another one is right around the corner.

Also, as asked per above...I'm presuming you had a negative DRE.

For those who say why not get the biopsy,

well, let's see, sepsis, scaring of the prostate, expense and the procedure itself, probed and shot through the a**, if not clearly indicated it's necessary.

The tests aren't that accurate, your still 3 point something.

DRE normal?

Your PSA is high for a 45 year old guy.
Get the biopsy.