High PSA, uptake of PSMA marker and two negative biopsys

Hi There

My prostate has been playing up since 2017. It started of with issues going to the bathroom – stinging and weak flow. My GP did a blood test and I think the PSA count back then was around 5 or 6. I was referred to a specialist and an MRI was carried out, along with a physical examination. The prostate was large but smooth and pliable. Since then I’ve several specialists, as a few just couldn’t answer my questions. One was asking me what I thought we should do! The count is currently 10. I personally make sure I get 6 monthly blood tests. The count has kind of gone something like this pattern since it was discovered: 5, 6, 8, 6, 7, 5, 8, 8, 9, 7, 8, 9, 10. I did change pathology lab half way through to the one where the test gives a higher count. That said, the trend is up. Not a massive hockey stick uptick, but a gradual increase over time. I had a PSMA test in 2022. This showed an uptake of marker locally in two spots within the prostate. Following this I had my first biopsy, which came back negative. I had my second biopsy three months ago and another MRI. This latest biopsy also came back negative. The MRI showed the prostate is almost double in size, which can in and of itself also lead to a higher PSA count. The most recent physical examination confirmed that one half of the prostate feels firmer, but both sides are still smooth – no lumps. What should I do? Is there anything I should be asking my specialist? Despite two negative biopsies, I’m well aware that the needle only needs to pass 1 or 2mm to the side of something nasty and it will show up as a negative tissue sample i.e. in the clear. If there was something in there, is there usually a noticeable uptick in PSA if it is on the way to metastasising? I did ask if we could just remove the gland but was told this isn’t possible without a positive tissue sample i.e. imagine if something happened and there was nothing dodgy found other than e**********. I don’t lose sleep over this, but just want to know if you feel there is anything else I should be doing or looking at. Any thoughts gratefully accepted.