Prostate cancer and PSA


I was diagnosed a year ago with stage 1. PSA was 9. I had a MRI and biopsy. Of 42 cores, two were Gleason 3+3, and two were 3+4. Prostatitis was also found. I was prescribed Tamsulosin. I opted for Active Surveillance.

In Feb this year, PSA was 15.3. Urology suggested I take a month of antibiotics as it might be the prostatitis causing the rise. I did, then had another PSA test in May which came back at 16.1

I had another MRI a fortnight ago which showed no obvious change. I saw my consultant last week. He said I couldn't continue with Active Surveillance and had to opt for treatment. I could choose from external beam radiotherapy, brachytherapy or prostatectomy. 

I will admit to being worried about the effects of treatment. Maybe foolishly, or hopefully, I think I could be someone who will die with prostate cancer, not of it. (I'm 64.)

My question is, if my recent MRI shows no change from a year ago, does a rising PSA suggest the cancer is about to spread, or could there be another reason for that? 

Thanks everyone.

  • Hello and thanks for you post,

    I would get the opinion of the the urologist who is involved with your care.

    I can't say what the latest PSA result means but it does rather imply that the cancer may be become more active. It is good to hear that the MRI scan was the same as last year.

    As your PSA has now doubled in size the doctors have taken the precaution to start active treatment. 

    From what I have read the doctors are following the guidelines about what should be offered when a PSA starts to rise. You may be interested in reading about active surveillance on our website and Prostate Cancer UK have some more information on this subject

    You may have  a urology nurse so do talk this through with them so you have an understanding about why they suggest you start treatment.

    We do have some information on our website about decisions about treatment which you might find helpful to read before your next appointment.

    I do hope some of these links maybe helpful. If you would like to talk any of this through with one of the nurses on the helpline then you are very welcome to give us a ring.  The number to call is Freephone 0808 800 4040 and the lines are open from 9am till 5pm Monday to Friday.

    All the best,


  • Hello Catherine 

    Thank you for your reply, and for the links to resources on the website. I will have a look.

    Your suggestion to talk to a urology nurse is a good one. That is something my hospital offers, so I will do so.

    I think my concern is that my consultant is following protocol, but it may not be necessary in my case, especially as it appears true that PSA levels are not a definitive or accurate measure, and changes may have other causes than simply cancer. The MRI seems to me to me to be a far more reliable indicator. But what do I know? I'm just the patient.

    Thanks again for taking the time to reply in detail.

    All best wishes