A biopsy can’t rule out prostate cancer.  Some men have 2, 3 or even more biopsies before they finally detect cancer.  Sometimes, they just miss it, because the major flaw inherent in using a biopsy to search for cancer is that it only samples a very small percentage of the prostate tissue.  It’s also possible that there was no cancer originally and it developed after the first biopsy.  In fact, some studies indicate that prostatitis, BPH or atypia may increase your risk of future cancer, so being diagnosed with these means you need to keep a close check.  There are also apparently some areas of the prostate that are difficult to sample during a typical transrectal ultrasound (TRUS) biopsy. 

Fortunately, there are newer techniques for prostate biopsies other than the random 6 or 12 sample method done in in a typical urologist’s office.  Like the targeted MRI/TRUS fusion biopsy I had, there are also saturation and ”mapping” biopsies that use more samples or some type of specialized imaging to improve the coverage and reduce the chance of a false negative.  Some of these are transperineal, meaning they are done through the skin, rather than through the rectum.  A biopsy like these might be considered by higher risk patients who have had a negative biopsy in the past. 

Because I had two other negative tests, I hope that I am in a lower risk situation than most men with a negative biopsy and relatively high PSA level.  My PCA3 test score was negative and also quite low overall.  I had an advanced “3 Tesla” MRI with 4 different types of scans and that showed nothing of significant clinical interest, either.  All together, it’s unlikely that I have an undetected cancer.  On the other hand, something is clearly abnormal, because my PSA is high for my age.  Most men in their early 40s have a PSA below 1.0, whereas mine has been between 2.4 and 2.7 for at least a year and a half, over 4 different PSA tests.  Also, my prostate is slightly enlarged, about 30cc.  Finally, my MRI indicated a pattern consistent with prostatitis and my biopsy did show a couple areas of atypia; both of these might be a precursor to cancer.

So, I do intend to keep a pretty close check on it.  I’ll probably have my PSA checked every 6 months with or so along with a DRE and perhaps get a PCA3 test each year.  I also plan to keep my appointment with Dr. Catalona.  I had scheduled this a while back, just in case my biopsy pathology showed cancer.  He’s pretty much THE expert on prostate issues in the Chicago area.  I want to get his input on what I should do in terms of checkups, health, diet and possibly even future studies that might be relevant to me.  My appointment isn’t for a couple weeks, but I’ll report on it at the end of this month.