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Tony, thanks for the additional information. It seems the quandary exists because your PSA was not checked for 7 years (2012-2019). Now you have a high PSA, especially for a small prostate. I am not a medical doctor, but I suspect that sometime during that period you developed prostate cancer. It's probably a slow growing Gleason 6. The only way you are going to know is a biopsy (preferably a 12-core). That said however, I've had 4 and have sworn I would never have another. My advice is to monitor your PSA every 3 months and see the direction (up or down) and its "velocity" (rate of change). Personally, if it was me, I would wait until your PSA was >10 and then get a biopsy. If you do actually have PCa, a biopsy will tell you how "aggressive" it is. With a few cores of Gleason 6, you might consider Active Surveillance for a few years to maintain your current Quality of Life. With a Gleason 8-10, some treatment might be in order. As to what to ask you urologist next week, I would ask him what would your PSA level need to reach before he recommended a biopsy.
Regardless, at 64 you still have many more years ahead to enjoy life.
There you have my thoughts, perhaps others on this site would like to give theirs.
The only other thing I can recommend is to be cognizant of your activities the day prior to your PSA test as many activities (riding a bike, having sex) can artificially raise your PSA scores and create an unfounded concern.
Thanks Willian and Joe for your suggestions. 6 months later and PSA still bopping up and down within my range 9.6 to 7.1 to 9.1 so I consulted with 2 different cancer centers since and they both say the only way to really know what is going on is with a biopsy so I agree and will have a 12 core done in 2 weeks. I am now OK with the biopsy idea as my older brother had one and his experience was comparable to a colonoscopy. There are more options available now to treat Pca than say 12 years ago and I rather know now in the early stages. Problem is, even a 12 core biopsy may miss cancer cells and give false results.
Finally got my Biopsy done. Honestly, the after effect of the antibiotic needle hurt more than the biopsy itself. The pathology report says I have a Gleason score (3+3) 6. 12 Cores biopsy. Number of cores positive = 3. There was high grade PIN in 3 cores. Will be meeting with Urologist to discuss but I would truly appreciate comments from the fine folks here at YANA.