PSA rising exponentially..

I have been plotting my PSA using spreadsheet for years.
I normally ride between the 1.0 to 2.0 zone.

PSA
1.7 10/2019 (last normal number)
2.2 10/2020
2.9 03/2021 (MRI ordered. Neg)
3.3 09/2021 (ExosomeDx ordered. Neg) (2 Weeks antibiotics)
3.5 10/2021 (after antibiotic check.. still upwards)

PSA velocity 1.21 /year (JHU web calculator)
PSA doubling 1.6 years

If you plot this out, it will trace out what seems to be a textbook exponential track. I know my numbers in an absolute sense are still lower, but the instant skyward move is horrifying.

But I have the Negative MRI and the Negative Exosomedx.

MRI was a 3T machine and the reader was a prostate pro.

Anybody have any comments on how this can happen?

The PSA curve looks like Death.

The Urologist is now giving me the choice of standard or saturation biopsy.
Think its TRUS style.

Agree with halbert. Biopsy. Maybe will be a bit uncomfortable. Not a big deal. Gotta know.

So i got an email on details of the biopsy..

They said an ultra sound probe up the rear.

Then a transparenial template. For saturation biopsy.

It seems he mentions 8 cores?
I thought saturation was like 30?

I've been thrashing around on Excel (can post a pic if you like but need to change PC) and it is probably exponential but of course still low and you can't rule out a data artefact. But my prior would be it is exponential. Doubling time just over 2y (you can pretty well see that in the first and last points). That's too quick for comfort so you are right to be monitoring closely (monthly test will just pick up noise, though, so cool it a bit!) ADD But a free PSA test might be good. /ADD

It's a tough one: I think most of the guys on here would be suspicious but an 8-needle fishing expedition would have to be really lucky. But your uro sounds reasonable (not always a bad thing despite my signature). PERSONALLY (YMMV) I waited for an MRI target before going for biopsy. Transperineal (for me, ALWAYS: there I was unreasonable) and saturation (I would REALLY want that contradiction cleared up between 8 needles and "saturation").

@halpert my 2019 saturation transperineal template biopsy (STPTB) involved TRUS as they steered the needle to the MRI target (and missed: hah!). By that time they were doing them under local here. Now that needle REALLY gets the attention.

Great question on age.

I don't recall a post saying "I wish I'd waited longer to schedule a biopsy." Just sayin'. I encourage you to get on it. There's a wide spread in outcomes after initial intervention (if warranted...)

Good luck
Wilderness

@Alephnull you need to distinguish between pre- (our OP) and post-treatment PSADT. Pre treatment it is not widely accepted as an indicator (with many regarding it as irrelevant compared to level). But those who do use it suggest you need PSADT to be on a timescale of years. (Again, IMO and YMMV.)

groundhogy - A standard TRUS biopsy is typically 12 cores (4x3 pattern) guided by ultrasound while a MRI guided biopsy may include extra targeted cores based on the MRI imaging. The TRUS biopsy can be done in the doctor's office (special room setup) whereas transperineal biopsy is typically done in a facility where light anesthesia can be administered (like colonoscopies are typically done nowadays).

When your urologist is suggesting a standard vs. saturation biopsy, is he/she suggesting both being done with the TRUS method (saturation being 20+ cores)? Transperineal method is preferred for saturation biopsies. You might want to investigate further and also find out if the process will be done in the office setup with a nerve block or at a facility where anesthesia is used. I can not imagine doing a true transperineal saturation biopsy without anesthesia.

May also want to check out what insurance covers in your case with a negative MRI. Sometimes you have to have the right parameters for insurance coverage of more extensive testing methods.

Isn’t there always?

Apart from the math debate, what about gradual enlargement from BPH as a source of the PSA progression?

Perhaps a course of Avodart over some months to somewhat shrink the prostate and reduce the PSA. Then, if the PSA continues the upward progression, it would be much more indicative of PCa and may warrant a biopsy.

Groundhogy, what is the estimate of the prostate size? Any symptoms or changes in urinary habits like urgency, flow and or voiding differences, or nocturia? What are the DRE findings? Have you had DRE with each PSA test? Have there been differences felt?

With relatively low PSA and no reported DRE abnormalities, a biopsy, to me seems possibly premature. A benign 35cc prostate would be expected to express a PSA of about 2.31 on average. Your PSA is a bit higher than that. By the same calculation your current expression would indicate a volume of more like 50cc more indicative of BPH. However, let’s assume a 35cc prostate with some G6 expressing that additional 1.0 of PSA would indicate tumor volume of about 0.2 to 0.3cc. That is very small to find with a biopsy or MRI. Now if you reported that your prostate was only 20cc (small), then the calculations would be much more indicative of PCa as the source and better indicate the biopsy. At your PSA, assuming a normal or small prostate, an abnormal DRE with a felt nodule, should prompt a biopsy. As would changes in the DRE over the past few years.

I would do a bit more investigating before a biopsy. Also understand that most third party payors won’t spring for a more expensive saturation biopsy until you have had one or more negative TRUS biopsies. So check on that.

Keep searching…..the truth is out there……

Compiler:
Nice math skills. Lol
My plot is linear, so i am eyeballing it as exponential. I was thinking of plotting semi-log as exponential should show up as a line.
Or it could be early exponential?

Shaws also good on the exel/math.

-Prostate is 41cc.
-But up until a short time ago, i was popping out PSAs at like 1.7... with likely an only slightly smaller prostate?
My PSA quickly running northward has been strong and quick.
Wouldn’t simple growth related PSA increase go up more gradually over years?

Fourty One WHAT?!

The biopsy has been scheduled for beginning Dec. With recovery, that will make the next possible move around Feb-March.

Looking at my PSA graph, i estimate my PSA to be at 5 by then.