High PSA, biopsies, cancer

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I have been combing the forums regarding PSA test, TRT, biopsy, non-invasive diagnostics and related.

I am 70yo, and take 40mg Test Cyp twice weekly. I have ben on TRT for almost 2 years. I do have ED issues but that predates TRT use by several years and was not the reason for starting TRT in the first place.
I recently got a psa score of 14 and my Uro wants biopsy on the test results only. I have NO family history, am Caucasian, I don't get up during the night. I havent had a DRE in a year and there has been no mention of other less invasive diagnostics (4-score, urine, possible prostatitis, MRI guided or other?) I am being handed off to a doctor who does the biopsies.

Also I live 2 hrs from my Uro ( I kept him after I moved away because it was easy only going there every few months.) I can imagine this will result in many 2-hr drives.

I feel better than I've felt in memory. I understand that biopsy can cause permanent or long term harm and I want to investigate other procedures.

I live in the Cleveland area. Would love it If anyone can recommend a Urologist up to date on these issues.
Defy Medical TRT clinic doctor


14 is indeed high. If you are having no prostate or lower urinary tract symptoms, I am a bit more worried. If you had symptoms, it could just be from BPH. If you had any urinary tract infection symptoms, could be infection. I would not put off diagnosis, but I also would not rush anything. Some urologists are very good at provoking undue urgency. If it is prostate cancer a week or two to do research and make a decision isn't going to make any appreciable difference. I would not however put it off for months.

I personally believe in more value from MRI before biopsy. Waiting for the order to come through for my third in 4 years...

The standard exploratory TRUS biopsy misses a tremendous amount of the gland, and there is no specific targeting of suspected trouble spots. It is just an evenly spaced spread in a grid pattern and all the territory between the grid points can contain lesions.

An MRI will show potential lesions which can then be targeted for biopsy either with MRI fusion overlay, which overlays the MRI image with the ultrasound used during the biopsy targeting, or better yet, targeted biopsy "in bore" of the MRI machine, where the practitioner does an MRI scan for every sample taken to ensure proper targeting. The "in bore" MRI biopsy is harder to come by. I traveled out of state to have that done once. (Tangent: My own case has been an odd one, the prostate problems are from a combo of BPH, and infiltration of the gland with leukemia cells, not prostate cancer. My PSA has been as high as 11.2)

To my knowledge, whereas complications from prostate surgery and removal are all too common, serious biopsy complications are not so much. Discomfort and anxiety, yes, of course! It is not pleasant.

I did have trouble, due to a very suspicious MRI, had 26 cores taken in bore MRI, which is a lot. I had to go to the ER 24-48 hours later because I could not urinate, and get a catheter for about 5 days, which was quite the misery. Ejaculate will turn black from bleeding for a few weeks, which is normal, but disturbing.
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