PI-RAD 3

If you search the medical literature at pubmed or google scholar, I think you'll find that the majority of studies conclude that PIRADS 3 lesions, which are in the intermediate, or gray, area, should be investigated by biopsy. As you know, mpMRIs are not diagnostic of PCa, and even PIRADS 4 and 5 lesions, which are at higher risk of being malignant, sometimes turn out to be benign on biopsy. However, your PSAD is not suggestive of PCa.

I well know the problem of trying to rule PCa cancer in or out in the presence of BPH, which is likely to cause a continuously rising PSA. I can see the logic in waiting another 6 months. Yes, there are several blood and urine tests of different kinds whose results can point to a higher risk of clinically significant PCa and you can speak to your uro about them. However, if you are concerned about the risk of missing serious cancer, I think the best measure would be to biopsy.

Are you on a 5-alpha reductace inhibitor, like Proscar? If you have been, your PSA needs to be doubled (to about 7.3) to know what it would be were you not on this type of medication (I'm not sure how this class of drugs affects PSA density findings. I assume you use just use the shrunken prostate volume and the reduced PSA.)

Let's see what other Forum Brothers think. It may turn out that you do currently have low-grade/low-risk (Gleason 6) prostate cancer that could be monitored with active surveillance anyway -- i.e., not require treatment at present. In my lay opinion, I don't think a 6-month wait is a risk, but I think biopsy is likely in your near future.

All the best,

Djin

Agree, not a rush. PSA going from 2.5 to 3.66, in 16 months, especially with BPH which may contribute to PSA, doesn’t sound like biopsy urgency to me. But be sure to follow up. If you are nervous about it, or even if not, maybe retest in 3 months rather than 6

Welcome to the forum by the way.

I did a little more research...found study that recommend biopsy if density >0.15. Mine is 0.07
It also recommends biopsy if volume of tumor is >0.5 ml. Mine is almost 1.

Some quick observations:

Your 3.66 PSA is high for a 54 year old man, 4.0 criteria is for older men.
Your PSA had a significant jump with no other cause noted like infection, etc.
Your prostate density may be lower because your prostate is larger.

This would lead me to think that a biopsy would be recommended, the timing of which is up to you. The only way you will know anything is to get the biopsy information and plan from there. Whether you do it now or after the next PSA depends on your mental state after reading all the documents and forum posts you can find. Good luck.

A PiRADS 3 usually triggers a biopsy. But, there are some blood or urine tests that could add more data to that decision. These are the PHI and 4K Score blood tests, and the PUR urine test. Low risk results from one or more of those could favor not proceeding to biopsy at this time.

Merry Christmas everyone!
Prayers for health and healing.