After a jump back up to 6.42 two years ago, my PSA level dropped to 6.17 this year, 16% free.  Both results are more or less consistent with the trajectory of almost 10% average increases per year over the last 15+ years.  This trajectory seems to be more important than single results that can be affected by various factors, like sex or riding a bike. My urologist suggested to continue annual monitoring for now, as there were no other indications for additional testing.

Unfortunately, he is taking a position elsewhere, so I will be searching for a new urologist again. After my poor experience with the Duly Health Care Urology office, I hope to find a practice where you can actually consult with the physician, rather than being told by an assistant that you have cancer and being urgently sent to have a random, unguided biopsy to confirm it before treatment, all based on an MRI result that didn’t substantially change in 3 years.

For reference, in 2019, I had a PSA of 4.59, prostate volume of 41cc, PSA density 0.112 and a lesion size of 6mm.  In 2022, I had a PSA of 6.45, prostate volume of 55cc, density 0.117 and lesion size of 5mm.

Some new information on PIRADS scores and risk correlation: Men Overestimate PI-RADS Risks for Clinically Significant Prostate Cancer – Renal and Urology News

Also, lesion size and PSA density risk correlation: Does Size Matter? A Retrospective Study Analysing the Size of PI-RADS 4 Lesions and Its Associated Prostate Cancer Positivity with Transperineal Prostate Biopsy – PMC

My non-medical, quick takeaway: If you have a PIRADS 4 result on your MRI, your risk of cancer increases with a lesion above 8.5mm and a PSA density above 0.15.

Good news here- My results from 2019 and 2022 both indicated a lesion size of 5-6 mm and a PSA density under 0.12.  Given that, and the risks in the first article, I would guess my risk may be less than 50-50, what I had previously assumed based on older studies. I’m hoping I simply have BPH, like many men my age. Now to find a urology office that isn’t in a rush to so a random, untargeted biopsy on someone in my situation.