Is it mandatory to get prostate biopsy for PSA 5.7 with negative MRI?

Question

Hello doctor,

I had a 4.4 PSA and had an MRI that was negative. Six months later my PSA is 5.7 and even though the MRI was negative it is suggested that I should have a prostate biopsy. I am a 73-year-old male. I am certainly not that excited to have a biopsy. Any thoughts?

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern about undergoing an invasive investigation without any symptoms. Let me explain you what does PSA suggest. Basically, PSA is secreted by the prostate as well as some other body tissues. It does not reach circulation and hence remains low in blood as long as the barrier between prostatic tissue and blood vessel is kept intact. Rising PSA is a sign that there is some tissue alteration which has resulted in breach of this barrier. Hence, do not be under the impression that rising PSA always means malignancy. But it is better to confirm the absence of malignancy by biopsy as, at a PSA level as low as 5.7, even in a unlikely event of report being malignancy, the chances of organ confined lesion is very high, which is easy to treat and chances if cure are high. Hence, it is better to undergo biopsy and get your fears allayed. As such, the biopsy is a very small procedure and safe in experienced hands. Wish you a safe biopsy and I hope the results will be benign.