the new guy - a candidate

I understand your concern about doing a physical biopsy BUT it's the only method that will give you a practical assessment (at a reasonable cost) of the likelihood that you have prostate cancer.  It possible to get a false negative but that is actually quite rare.

Neither an ultrasound (even w/color doppler) nor a standard MRI will tell you much, if anything, and, even if they are suggestive for PCa, you will still have to get a biopsy anyway to verfiy the diagnosis. 

The only screening method that will tell you for sure if you have PCa or not (without a biopsy) is an MRI/MRSI spectroscopic scan using a Tesla 3T coil inserted in your rectum to detect choline which is a marker for cancer.  This is a very expensive procedure which is seldom (if ever) approved by insurance carriers for initial PCa screening. 

So, if you are self-funding your screening and treatment, you should consider asking how much this would cost and, if the cost is not prohibitive, choose it as the method of screening.  You will get no more dispositive assessment than with an MRI/MRSI.  However, if you are limited to what an insurance will approve, only a biopsy will yield a practical assessment of the probability that you have prostate cancer.

PS: I had a biopsy for initial screening in 2010 (which was positive) and an MRI/MRSI after a worrisome bounce (3 increases in PSA) around 3 years after treatment w/Cyberknife (an advanced form of radiation treatment) which was negative.

I would add to your doctor's suggestion that you take prostate cancer (PCa) as much as serious.

From your post I can figure that you have been researching about cancer screening. That is a good approach when someone is found with an high PSA. But when "looking" for cancer one should try methods that assure the result, not just probabilities. I absolutely aggree with above survivors for you to choose biopsy over an image study this time, if in fact you seriously want to know if you have PCa.

The methodologies you describe above, to avoid the inconvenience of a biopsy, are practical in particular cases where the "patient" would get benefits from those probabilities; For instance, when one cannot do a biopsy due to religious restrictions or due to other impossibilities, AS patients that may also benefit from these techniques when judging progression or increased aggressivity, etc. Max sets it rightful:  An academic review of every PSA test. 

You have not shared details of the problematic BPH. I wonder your age and the symptoms/investigations done that lead to BPH diagnosis. Hyperplasia increases the PSA and so does any massage of the gland before drawing blood for the test (riding a bike tractor, horse, stressful physicals of the abdomen, masturbation, sex, etc). A graphical plotting the PSA histology can guess the cause of the increase. BPH presents a sort of seesaw graph with fast increases and fast decreases. PCa is like a slow slope of constant increases.

Surely you can have an MRI before a biopsy. It will be helpful in future comparison with the findings of another image study, when looking for probabilities of metastatic cancer. This is the sequential exam done after a positive biopsy. Choline based contrast agents in MRI/PET (commented by Swing) are better. However they do not substitute fully the microscopic analysis of a sample of tissue from the gland done by a pathologist.

Your PSA > 8 is three times above normal high significative of cancer if this is the solo element producing the serum. The following markers are also practical for guessing a positive result when one is doubtful of the PSA, but these serve the purposes when compared to previous results:

PSAf (free PSA)
PCa3 (genetic analysis of cells in the urine)
PAP (prostatic acid phosphatase)
CEA (Carcinoembryonic Antigen)
NSE (Neuron Specific Enolase)
CGA (Chromogranin A)

So far you are not considered a member of this exclusive club. I hope you do not.

Best wishes,

VGama

It seems you misunderstood what was written to you... You need a simple 'test,' not 'processing,' whatever that is.

But we submit insight, not instructions.

max

Hi,

I did the MRI 1st which help the Urologist pinpoint where to take the biopsy samples.  Even still the biopsy can still be a little hit or mis depending on how good the Urologist is at taking the samples.  I would find the best hospital & doctors that you can afford to get the basic info on what's going on inside of your prostate. 

If you have a general MD that you are seeing they might be able to help you finding good doctors.  Good luck..............

you may wish to explore this.

I wonder what your age is and where do you live? There are differences in care in various parts of the the USA, of which some of us are familiar can direct you to a place of excellence if you wish.

The only test will indicate if you have prostate cancer or not is a biopsy. There are various types of biopsies. The one that vasco recommended is the most common. It is a stratified random test, taking 12 cores.

There are also more sophisticated tests; an MRI guided biopsy, that is a T3 MRI that locates suspicious lesions, then targets these lesions with a 3 dimensional biopsy machine that can lock into these lesions and sample them

You mentioned other tests that perk your interest...however with a PSA of 8, you need to have a biopsy now....the results of these tests will not change your need for a biopsy (do you have any historical PSA readings?)