This is precisely why the U.S. Preventive Services Task Force recommended against PSA screening. The pressure from most urologists to treat aggressively every case of prostate cancer, in the process overtreating a large fraction of them, is so difficult to withstand by a patient, especially one who just received perhaps the most devastating news of his life . After all, who are we to question a professional?
In my case, I got resistance from the surgeon I consulted, when my PSA dropped from 9.6 to 1.0 after a TURP. I felt that if there was any cancer in the remaining prostate, it would manifest itself by raising the PSA number the next time I tested it. All I wanted to do, at first, is wait 3 months to see if the PSA would go up. The surgeon did not believe I should wait. When I checked with another urologist for a second opinion, he agreed with the first surgeon. I decided to wait anyway, and 3 months later, my PSA dropped to 0.9.
In the meantime I sent my slides to Epstein at JHU for a second opinion on the biopsy slides. I talked to Dr. Epstein personally; he not only gave me his opinion on the biopsy (it was G6, with "small focus" cancer) but also gave his opinion as to how to deal with the cancer: "just watch it".
As for the usefulness of mp-MRI, study after study in recent years have demonstrated its success. It is probably the most significant advance in recent years in the support of prostate cancer. See:http://www.cancernetwork.com/prostate-cancer/state-prostate-mri-2013. Unfortunately this advance has not reached the local urologist.
10/1997(age 50): psa 1.0;10/98: psa 3.4; 6/2000; psa 4.2
7/2000: negative biopsy
From 2000 to 2011, psa gradually rose to a high of 9.6
2006 and 2009: negative biopsies
4/12: TURP performed;7 out of 245 chips cancerous;Gleason 7(3+4)
5/12: psa 1.0
6/12: mp-mri negative
8/12: second opinion on biopsy by Epstein at JHU: gleason 6
PSA fluctuated around 1.0 since.
6/2013: negative mri