I’m thinking about asking for an MRI. There are a lot of factors: age, the BPH, stress, exercise, sexual activity…. It’s all about how much of the PSA leaks out of your prostate into your blood.
Allegedly for me at 74 a PSA of 4 is considered normal simply because the prostate gets increasingly leaky with age. So the occasional spike to 7 isn’t necessarily bad if it comes down again.
Nevertheless more data is a good thing.
i’ve had bph for a long time. my prostate size was over 150 but then I had a minimumally invasive PAE surgery. That might have brought it down to under 100. I don’t know. the last check of my psa was about 12. but I might have been off my finasteride at the time. that’s what keeps my psa in mormal range. otherwise it would be way high.
In the first years I had a high psa numbers, I checked thoroughly for cancer but found nothing. concluded it was just bph.
cancer does not run in my family anywhere. so I’m not worried about it.
I’ve learned that the fda has approved some more minimmally invasive procedures as of 12/2025. one is a stent. they may not be approved for medicare but whenever they are approved, I’ll use those too.
I am age 77 have two small tumors of slow growing prostate cancer. My Prostate volume is about 100 CC and normal is more like 40 cc. So in addition I have BPH.
PSA is a function of many variables, including prostate size, level of general inflammation, sexual activity, and tumors inside the prostate.
From my perspective the two “gold standards” are first a PET Scan, then subsequent MRI’s, based on my urologist recommendations. The PET will tell you if you have metastasized prostate cancer, and if so where. It will also give you lots of information about your prostate. The MRI can show if the tumor is growing and if so is it moving toward the outside edge of the prostate. As long as the cancer has not metastasized, the MRI shows tumor size and condition over time.
My two cents would be to if in doubt get the PET first, then in a couple years follow up with an MRI as long as not very large jump in your PSA, which probably should be every 6 months once you know you have prostate cancer. Good luck.