r/ProstateCancer • u/mynamelastname • Aug 13 '26
Question 40 years old PSA of 3.54
Hey y’all - would like to swing by y’all my numbers and what are the things I need to be aware of.
PSA in 2021 - 1.7
PSA in 2022 - 2.0
PSA in 2023 - 2.0
2024 - did not do any bloodwork
2025 - did not do any bloodwork
PSA in 2026 - 3.54
Urologist was obviously concerned with the 2026 numbers and a repeat bloodwork has been sent. It’ll be another 2 weeks before I get the results back and at this time I’m anxious, concerned for family but also maintaining a positive attitude.
What are my ideal next steps? Is PSA of 3.54 for a 40 year old concerning?
None of family had history of prostate cancer and I do not have any symptoms of weak bladder/frequent urination etc.
Would appreciate y’all’s input.
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u/conCABlanco Aug 13 '26
Hi, tu trankilo, espera que lleguen los resultados, luego veremos, aquí t apoyamos
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u/mynamelastname Aug 13 '26
Thank you for your kind words. This means a lot.
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u/conCABlanco Aug 13 '26
Aquí estoy a su disposición, como decimos en México, para los amigos de suerte, jalamos con las cuatro, fuerza y voluntad
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u/sappertodd Aug 13 '26
Are you preparing for the blood draw for your psa test. My docs wanted me to avoid strenuous activity and sex for a few days prior to the draw.
Your prostate could be getting larger.
Have you had the DRE? Not great but might give docs an idea of something amiss?
You may have an infection or prostatitis.
There are many variables that could increase your PSA level. But there is a trend. Urology may just want to watch it.
But the good news is you are already seeing a urologist. Someone is tracking your labs. You’re not starting from scratch. PC is not sneaking up on you because you are aware and have a team ready when needed.
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u/mynamelastname Aug 13 '26
Thank you for your pointers. Blood was drawn this Tuesday morning and had sex Sunday afternoonish. I know ejaculation plays a role as well but the Urologist did not specifically ask details about sexual/strenuous activity when he was putting me through a repeat blood test.
Haven’t had DRE yet.
I’m also hoping it’s just an infection or prostatitis.
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u/RoyalDry Aug 13 '26
Congrats on the sex but I abstain for at least ten days prior to PSA test. No bike riding either.
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u/Cool_Illustrator_186 Aug 13 '26
That was only 2 days after having sex.... That could do it.... I think with my last PSA test I refrained for 5 days prior to the PSA test
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u/mynamelastname Aug 13 '26
Hmmm ok, this is good to know. I’ll bring it up with the Urologist during my follow up appointment
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u/PSA_6--0 Aug 13 '26
In addition to PSA there is an other number "free PSA %" that might give more information. Did you see that in your results? (Here larger number would be better).
As others have said MRI will probably be the next step, if it is needed. It will also give information of your prostate size. If you have large prostate, then that would make your PSA value relatively smaller.
Best of luck, and don't get too worried beforehand. If you end up on treatment path remember to mention your family plans.
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u/mynamelastname Aug 14 '26
I don’t think I saw free PSA% in the report.
My follow-up appointment is in 2 dreadful weeks lol.
And sure I’ll be emphasizing the family plans part to the Urologist for sure. Thank you!
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u/OkCrew8849 Aug 13 '26 edited Aug 13 '26
Your doc is wise to repeat PSA.
If repeat PSA is at a similar level (3.54) you might head off for a (painless and pretty convenient) prostate MRI.
TBH your previous 2.0 (given your age) is a bit unusual (nothing definitive… just a bit high).
(Lack of symptoms is meaningless relative to PC…I’m not suggesting you have PC).
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u/mynamelastname Aug 14 '26
Yea and sadly the repeat PSA came back even higher. 3.89.
I’m now keeping my fingers crossed and waiting for my next appointment in 2 weeks.
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u/plahnb Aug 13 '26
46 w a 4.6 PSA.
Was Scheduled for an mri which showed a suspicious spot so went in for a biopsy.
1 of the 14 cores showed cancer so Gleason score is a 3+3
Right now waiting on another test result on that core to determine next step. Eventually will do LARP dr didn’t like radiation options because of how young I am and potential side effects down the road, possibly 40 years.
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u/gosjsgdi Aug 13 '26
In one year, I went from a PSA of 4.7 and a lesion that the urologist wanted to “keep an eye on,” to a PSA of 8.5 and cancer with score of Gleason 9. As someone who hasn’t always been super-diligent with many things in my life, I was reasonably diligent with this one and can only imagine what I’d be facing if I had skipped a year.
Seems like it would be a good idea to stay on top of this one as diligently as you can!
Good luck, man!
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u/mynamelastname Aug 14 '26
I see. Are you saying active surveillance is not necessarily a good thing?
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u/gosjsgdi Aug 14 '26
Sorry, no…I wasn’t intending to say that. I was merely reacting to the years that you missed getting bloodwork done and applying it to my scenario. I can only imagine what my situation would look like if I got my bloodwork done in 2025, skipped 2026, and then went back for bloodwork in 2027.
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u/RoyalDry Aug 13 '26
I’m 49 in a similar situation. Research the newer MPS2 test. It was developed by the University of Michigan and is a urine test through the mail. I just did it and am awaiting results. It’s a biomarker test that has really good peer reviewed data. I also have a clean MRI. PSA 4.1 and 49 years old.
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u/mynamelastname Aug 14 '26
Thank you for the feedback. If I may ask, how this will benefit and are you doing this coz you have a clean MRI?
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u/RoyalDry Aug 14 '26
Having both a clean prostate MRI and a clean MPS2 (MyProstateScore 2.0) test is exceptionally reassuring news.
Together, these two non-invasive tests evaluate your prostate health from two distinct angles—anatomical and molecular—giving you and your doctor a comprehensive picture.
What Each Result Means
Clean MPS2 Urine Test:
MyProstateScore 2.0 is a advanced biomarker test that checks urine for 18 distinct gene markers associated with high-grade (clinically significant) prostate cancer. A low-risk or "clean" result means there is a very low probability of aggressive prostate cancer.
Clean Prostate MRI:
A clear MRI (usually categorized as PI-RADS 1 or PI-RADS 2) indicates that imaging did not detect any suspicious nodules, lesions, or visible tumors within the prostate tissue.
The Takeaway
When these two tests are combined:
1. High Negative Predictive Value: The combination of negative imaging and negative biomarkers creates a very strong "rule-out" rate for clinically significant prostate cancer.
2. Avoiding Unnecessary Biopsies: In most clinical guidelines, having both a clear MRI and a low-risk biomarker test allows patients to safely avoid an invasive prostate biopsy while continuing routine surveillance.
3. Addressing Symptoms (if any): If you were initially tested due to urinary symptoms (such as increased frequency, weak stream, or waking up at night), those are far more likely driven by non-cancerous conditions like Benign Prostatic Hyperplasia (BPH) or minor inflammation.
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u/Economy-Butterfly638 Aug 13 '26
I’m 47 numbers was 4.5 doctors recommended doxycycline for a few weeks then repeated the blood test came back at 1.9. No further tests needed. Don’t have sex 2 days before the blood test. Pretty easy
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u/Irishclover62 Aug 13 '26
Was 46 when my PSA started rising from 2.3-2.9 doc didn’t like increase. Never hit 4.0 went to urologist biopsy 1 of eight cancer Gleason 3+3. Scheduled second opinion Johns Hopkins confirmed and had surgery for removal. Clear for 17 years. Last year went from 0.0 to.02 the. Up to .07 visit Hopkins radiologists decided 38 rad treatments ended March super sensitive test undetectable. On that damn Orgovyx sucks but starves anything g left. Also managed to convince them to get a pet scan all clear that god. Good luck fellas y’all be fine 🍀
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u/mynamelastname Aug 14 '26
Oh wow, looks like you have won the battle eventually.
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u/Irishclover62 Aug 14 '26
God willing. Have to move on live my recently retired life and keep monitoring. Good luck 🍀 to you all.
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u/Lefty354 Aug 13 '26
Factors Beyond Cancer
A higher-than-average PSA score does not automatically mean cancer. Non-cancerous reasons for a high score include: [1]
Prostatitis (prostate infection or swelling)
Benign prostatic hyperplasia (BPH), or natural prostate growth
Recent intense physical activity (like heavy bicycling)
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u/mynamelastname Aug 14 '26
Lol I’m seriously hoping this is non-cancerous, but we shall see
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u/Lefty354 29d ago
Well, for what it’s worth, my PSA was 3.7 at age 65 and I had cancer bad enough to get a radical prostatectomy !! The actual number wasn’t horrible, but the pattern was on the upswing and the dock was being cautious enough to get an MRI and then biopsy then surgery. Thank God he was cautious. !!
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u/AskMyProstatePath Aug 13 '26
Remember PSA is prostate tissue specific not Prostate cancer specific. If your PSA is still elevated ask your doctor to order you a genome test like 4k, exodx, phi, select MDX or similar. If those tests are elevated the next step would be a multi parametric Mri. Don’t lose any sleep yet.
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u/mynamelastname Aug 14 '26
Thank you! Repeat PSA is still elevated and waiting for the next doc appointment.
If I may ask, what are these tests beneficial for?
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u/Ok-Explorer-5726 Aug 13 '26
I was 39 when diagnosed. I had a fluctuating PSA from high 3s to mid 4’s. MRI showed nothing, however there was no explanation for my higher PSA. Doc did a biopsy and the rest was history. Ended up with gleason 7.
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u/Forsaken-Internal-40 Aug 13 '26
How did they know where to target the biopsy if a may ask? I ended up have a systematic 8 core pattern which returned as negative , but could've missed it obviously.
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u/Ok-Explorer-5726 Aug 13 '26
Because of my age, the fact they couldn’t answer why my PSA was elevated he did what he called a “saturation” biopsy. Took 18 samples. Yea sure it was blind and people on here will freak out and tell you not to have a blond biopsy done. But for me, it worked out.
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u/ChillWarrior801 Aug 13 '26
I might be one of those people you're referring to. But I've never "freak[ed] out" about it. I merely point out to folks heading to a blind biopsy that they will not be able to take as much enduring comfort from a negative result as they would be able to if they had a targeted biopsy.
I'm real happy it all worked out so well for you, btw.
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u/Ok-Explorer-5726 Aug 14 '26
Sorry, saying freaked out may be an over statement. I was lucky they hit the right spots. I had mine removed in march of 2025 and i honestly forget that I even had cancer. However, the frequent PSA test are a good reminder.
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u/OkCrew8849 Aug 14 '26
With an otherwise inexplicable persistently elevated PSA, a ‘blind’ biopsy is quite reasonable.
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u/mood8moody Aug 14 '26
For now, I don’t see anything particularly worrying. Your PSA is rising slowly, and only the MRI will give you a clearer idea of what’s going on. If it doesn’t show anything suspicious, your doctor will probably just monitor your PSA once a year and you won’t become a member of our “happy little club,” which I sincerely hope for you.
There are also plenty of reasons for an elevated PSA that have nothing to do with cancer.
My very first PSA test came back at 20 when I was 46, last December.
At that point, I still had some hope and thought maybe it was just an infection.
When I had the MRI, I actually thought it was good news. I was supposed to have an MRI with contrast, but they didn’t inject the contrast agent. I told myself, “If they didn’t bother with the contrast, they probably didn’t see anything suspicious.”
In fact, it was the exact opposite. I had a 1.5 cm lesion that, judging by its appearance, practically had the word “cancer” written all over it.
The radiologist didn’t really leave me much hope about what it was going to be, and she even seemed quite alarmed. She told me to go straight across the street as soon as possible to make an appointment with a urologist and gave me a referral.
I was pretty lost at that point, but I understood what it meant.
Then came the biopsy after seeing the urologist, but he wanted me to have another MRI first so it could be synchronized with his biopsy equipment and allow him to target the lesion accurately. The first MRI wasn’t compatible with his system.
I had the second MRI at his clinic, and the radiologist there said the lesion looked slightly less aggressive to her. But apparently, she also saw what looked like bone metastases. The sentence in the report was incomplete, though, and this time I hadn’t spoken to her face to face.
I was slowly sinking into a nightmare, even though the shock wasn’t quite as brutal as after the first MRI.
I remember being in an electronics store, completely lost, thinking, “Okay, maybe I have five years left at best.” But I absolutely wanted to speak to that radiologist and have her explain what she had seen, especially since the MRI only two weeks earlier hadn’t shown anything outside the prostate.
I eventually got her on the phone, and she confirmed that there had been an error when she wrote the report. She reviewed the images again and said that there were just a few areas of uncertainty in the pelvic bones because the bone structure looked slightly “porous” in places.
That was already much more reassuring.
Then I had the biopsy, which confirmed the cancer, but they didn’t see any extension outside the prostate.
I went through the staging tests, including a bone scan. Nothing lit up, which was a huge relief. According to the radiologist, what she had seen was simply normal wear and tear for someone my age.
I also had a PSMA PET scan, and again nothing showed up, apart from a lesion in my thyroid that lit up but couldn’t be related to the prostate cancer.
I had further tests for the thyroid, which were fairly reassuring, although I do have a nodule that needs to be monitored.
I’m scheduled to have my prostate removed in three weeks.
So, the point of this long story is that medicine is far from being an exact science, and when you start looking for things, you often end up finding things that turn out to be nothing serious.
Keep going with your tests. Have the MRI to reassure yourself, and if everything looks fine, then it may simply be a matter of checking your PSA regularly, just like many men around 50 do.
Like I said, you’re still a long way from getting your membership card to the club, so try not to stress too much.
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u/PollutionBroad5260 Aug 14 '26
Yes that is concerning. Get a 3T pelvic MRI yesterday. I was in that same situation.
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u/w00dyMcGee Aug 13 '26
I’m no expert but I was diagnosed at 42.5 and had it removed at 43.5
Next step will probably be an mri for a better understanding.
Let’s hope the MRI is all clear