I've been heading down this path for about a year now and after visiting this site as a guest many times, I finally decided this is the best place for good information and guidance.
The short story is that over the past seven years my PSA levels have increased from less than 2 to a 4.9 in late March 2019. about six months ago when I was hovering around 4.0, my primary physician ordered a PSA free with the regular test. That came back at 14%, but my overall PSA dropped to 3.7. Three months later my PSA is 4.9 and my free PSA is 12%. Referral to Urolologist followed. During this progressive rise in PSA, I have never had any symptoms. I'm 64 yo now, 72" tall and weigh 170 lbs. I never get up during the night to urinate. Any DRE I've ever had has been negative. I exercise 5-7 days per week. I eat a gluten free diet by choice. I eat lots of greens and seldom eat any red meat. I do however have a weakness for chocolate.
Before I go further I need to provide a little history. In August of 1999, at age 44, I had my employer-mandated annual physical and my PSA came back in the mid-teens. I don't have any specific numbers in my current medical history files but my big picture memory is intact. I was told to take these results to my primary physician, who saw me the next day. We repeated the PSA right away, with a PSA free component, and I only recall the primary telling me that the regular PSA dropped in half. From there I had some sort of ultrasound exam that came back inconclusive. Referral to urologist resulted in biopsy #1, which came back inconclusive. We repeated the biopsy (#2) and it came back clean. My PSA was now less than 1.0. For the next five years I had a PSA test every four months. All were less than 1.0. All DRE's were negative. After five years, at my last visit with the urologist, he told me that during my second biopsy (done using fluoroscopy) there was a tiny dot on the screen that he was able to excise and he could only speculate might have been a source of my problem. Anecdotally, I was riding mountain bikes for cardio exercise when this all started and remember being numb after long rides. I stopped this immediately with the elevated PSA scare. I can only take a wild guess that I may have had some prostatitis that resolved itself when I stopped riding.
Fast forward to this past Thursday, 4/25/19. The referral to a local urologist here is Asheville, NC resulted in an MRI. The technique is listed as "unenhanced and enhanced high resolution multiplanar, multi sequence MRI of pelvis. The machine was a GE with a 3T magnet. (I was able to remember to ask about this from readings on this site.)
Short version of Findings: Prostate volume 34 ml. Diffuse prostatitis on peripheral zone. Lesion 1: volume 0.42ml within the left peripheral zone at the mid gland and apex. PIRADS 4.
They went on to state that: "(targeting biopsy particularly to the superior most two slices of the ROI in Dynaclad is advised.)
Central gland (transition and central zones): No index lesions identified.
Prostatic Capsule: No significant abnormality.
Urinary Bladder/distal ureters: Trabeculated.
All other notations were either none or no significant abnormality.
So while I was hoping for active surveillance at worst, the PIRADS score tells me they will probably want to go to a MRI fusion biopsy. I looked up the credentials of the Radiologist online. Nothing real specific noted except for a "specialty" in abdominal imaging. I'm in western NC, and I've not found a specialist or facility with a PC focus yet. I believe there is a MRI specialist in Chattanooga, TN that I could consider for a second opinion on the MRI imaging.
Well, that's all I got for now. Any thoughts are greatly appreciated.
I am a little late on this but in case others in the future find this thread, you want to go to Duke in Durham for optimal care..
One of the 5 top PC centers in teh country.
I am in NYC and set to retire. I'll be retiring within a few miles of this medical center so I have NYC grade doctors available.