Upfront I want to say that I'm a bit biased against PSA testing but understand why the PSA for routine screening is so tempting. I believe anyone reading this forum is likely to be interested in how the PSA can impact TRT and male hormone therapy. I strongly recommend reading "The Great Prostate Hoax" by Richard J. Ablin, PHD who is credited with the discovery of PSA.
If it is possible to avoid an elevated PSA then it should be avoided!
Now here is my experience with an out of normal range PSA:
Back in June my regular 6 month labs came back with a PSA of 4.1. It had been steady at around 1.5 before this. I had some symptoms of prostatitis a few weeks prior to the test, a burning sensation when I pee'd, mild fever, low back pain, that cleared in a couple of days .The clinic administering my TRT had me stop injections until I could be cleared by a urologist.. I chose a urologist near my home that my insurance company recommended. This doctor insisted on doing a prostate biopsy, no other options were offered. I wanted to clear myself and get back on TRT and agreed with an understanding that a biopsy wasn't that bad. Now, with a few months perspective, I will say that the biopsy is more unpleasant than it was portrayed. The doctor told me there would be a little discomfort. It is like having a bb gun stuck in your butt and shot 12 times, maybe that's "a little discomfort." He said "there could be blood in your urine and semen for a short time after the biopsy. "Fountain of blood" better describes ejaculation after the biopsy. I was still passing clotted blood more than 2 months after the biopsy, with condoms other wise unnecessary but just to keep from freaking out my wife. I endured two very unpleasant weeks of waiting for the results from the biopsy (is it cancer? what happens if it is? prostatectomy? incontinence?, impotence? penile atrophy?) and was reading a lot. Enough that I understood that maybe the biopsy wasn't called for, that I was pressured into it more because it makes money for the urologist than because it could save me from a horrible unnatural death.
The results were negative. The urologist simply said no cancer was found. I asked if there was any indication of inflammation or something that explains the high PSA, he had no answer. It seemed he was disappointed he wasn't going to get to remove my prostate, and he was surprised that I wasn't satisfied with "no cancer" as the happy results from this painful, degrading procedure. When I asked where to go from here he said we would test PSA again in 4 months and if still high may need to biopsy again. I decided I didn't like his doctor and asked if I could get a copy of my results. He left the room for a copy and when he returned, surprise, there were in fact indications of inflammation. I checked later and this urologist charged my insurance more than 400 dollars to cover me on the results from the biopsy that he would not have even read if I hadn't asked for a copy.
4 months after the biopsy I had another PSA, this time it was way elevated, 7.1!
In the interim I had looked around for a progressive, compassionate urologist , instead of what I had searched for before , one that was near home and in network. My TRT clinic did not stop injections with this 7.1 PSA because I had a recent negative biopsy and would provide evidence that I was under a urologist's care. I found a urologist at a Dallas teaching and research hospital. He authored and co-authored many papers on PSA, Prostate issues and TRT. It took a couple of attempts but I got an appointment. He reviewed my history and agreed that TRT likely had no impact on my PSA issue. He ordered a 3 Tesla MRI with Endorectal coil and contrast, imaging to see if there were some suspect area that might be appropriate to biopsy. The MRI was clean, no cancer, but BPH at 48.9 ML, and indications of inflamation, asymptomatic prostatitis, The procedure was uncomfortable, but way better than the biopsy, and I was better prepared for it.
So all told, I have BPH and some prostatitis that doesn't usually present symptoms. This incident prompted discussion with my brother and it turns out he has had prostate problems, BPH and inflammation, but never cancer since his 20's and so did my father, I had no idea.
I just had bloods done and PSA is 3.2. Which is not ideal but is headed in the right direction. I'm still on TRT, happy with everything it is doing for me.
I hope my experience can help others and want to point to key learnings. Take care in the selection of your care giver. Question the options. Research the impact and benefit of intrusive tests. And most important don't freak out about PSA.