To me this rise is somewhat worrisome. If this is a "benign rise" it should come down closer to your original 2.25 range. Its very possible that is from some type of inflammatory process, resolving prostatitis, etc.
One option is to consider using a 5 alpha-reductase inhibitor (proscar or avodart) to see how much the PSA decreases. Ideally should be at least 50% although in your case if your PSA rise is from a benign cause I would bet it would come down even more.
I would definitely re-check the PSA once or twice over the next few month and if it still elevated you may also want to consider an MRI at an institution that does a high volume of prostate MRIs.View Thread
With a PSA of 18 and sudden decrease to 12, its likely prostatitis. I would wait until PSA comes down to more normal level before pursuing a biopsy. If it comes back down to 2, you can avoid biopsy. If it comes down to 3 or 4, reasonable to still do a biopsy, but you'll decrease likelihood of getting an infection after the biospy.
Losing weight is not rocket science. If calories consumed is greater than calories burned you gain weight and vice versa.
One app that has helped a lot of my patients is "Fitness Pal." Basically you record everything you eat and every exercise you do and it gives you a calorie "score" for each day. Stay under and you lose weight. Pretty simple. I've never seen it not work if you use it.View Thread
This is a difficult dilemma faced by urologists and patients every day.
There are some algorithms you can find online now where you enter your information and it tells you likelihood of a positive biopsy.
Bottom line is this:
1. If you have made up your mind that you would not treat prostate cancer even if you had it, then don't do a biopsy and stop checking your PSA
2. You are exactly right in saying that not all cancer needs to be treated at the time of diagnosis and in many cases not at all. The key is having the information -- which the biopsy gives you.
3. If you are strongly opposed to a biopsy, have BPH, and still are concerned about missing a significant cancer, ask your urologist about the possibility of starting a 5-ARI (Avodart of Proscar). It will treat the BPH and cut your PSA by 50% -- typically within 6-12 months. If your PSA is rising on one of these medications, that's a red flag.
I'm assuming you had Radiation therapy of some kind? I would speak to the treating doctor to explain further, but in many cases there is something called "PSA bounce" which he can discuss with you. Only time will tell if this rise is real or just artifact.View Thread
The first step is to rule out distant/metastatic disease. While most men with low risk prostate cancer don't require routine bone scans or MRI/CT scans, I almost always do some sort of staging studies in high risk disease. (anyone with Gleason 8 disease or higher)
In general, if the disease is truly localized than most experts would suggest multi-modal therapy. (ie, radiation with hormone therapy or radical prostatectomy and lymph node dissection followed possibly by adjuvant radiation).
There is however, good data from several large institutions showing durable cancer control with surgery alone.View Thread