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It says poorly defined lession PIRAD 3 which means could be or not could be cancer. Report says alternatively, it could be a long chronic prostatitis that mimics a neoplasm.

Ive believed for years that I have chronic prostatitis. I have irritable bowel syndrome where some papers shows there is a link with prostatitis.

Urologist says is my decision if i want to get biopsy then he won’t deny it to me, that cancer is low chance for a 39 year but not impossible

He thinks it may be better to wait and see but is my decision and he was asking me how concerned am i

Im concerned and devastated i thought it was going to be nothing. I have high pain tolerance the only thing that concerns me about biopsy is I read it could cause ED in some patients tho tends to temporary

But ive been thinking im already using injections for erections anyways so it wouldn’t matter

I think if i dont do the biopsy im gon drive myself crazy wondering and thinking the worst what if is cancer and is getting worse

Im also on trt which means if it is cancer it could make it grow faster tho the literature doesnt show that TRt cause cancer it could potentially fuel it

If a biopsy scares you (It is a simple procedure, I had a rectal biopsy in about an hour, local anesthetic.) look at "liquid biopsy". It analyses urine for tell-tale signs of cancer. It is not as reliable as sample biopsy, but much less invasive.

Perineal biopsy would have required general anesthetic, but is more accurate that rectal and has less chance of infection, but since I have an implant, my urologist did not want to chance damaging it by going through the perineum.

The pain of the biopsy's multiple (I lost count) needle samples was about equivalent to a bee sting and short-lived.

How is your history of PSA levels? Concerning? Rising quickly after a long history of being steady?

If i were to get it done it would have be rectal as perineum has the highest chance of ED

The first time I checked my psa out of curiosity was in 2021 and it was 2.8

This was before TRT

In 2022 i did more tests before TRT and it was 3.2

I got on trt compounded cream. At first, I was applying to the testicles. After 3 months, I got labs

My testosterone doubled but my estrogen was high at 71 and my psa went up to 4.5

I changed application to inner forearm

After 3 months my labs showed lower estradiol at 43

And my testosterone improved

My psa went down to 3.4

Rufian wrote:If i were to get it done it would have be rectal as perineum has the highest chance of ED
(edited for focus)

Rectal is less accurate and has higher chance of infection. Perineal, especially if image-guided (sonogram, I think) in the hands of a good surgeon is pretty darned safe for ED. Confirm with your surgeon.

PSSDorAmINormal wrote:

Rufian wrote:
The first time I checked my psa out of curiosity was in 2021 and it was 2.8

I'm not sure it is a good idea to just randomly check it at your age. I'm 40 and no doctor has ever asked me about my PSA numbers or suggested I get it. There are many things that can affect the psa score. I didn't know this and doctor never mentioned it. I had to find it on the internet but it does seem to make sense.

Ejaculation prior to the psa blood test will affect the score. Also rough activity such as anal sex, or even bouncing around like atv ride or horseback can affect the score. As a younger person maybe you did something?

Do you notice prostate problems or symptoms of enlargement? I thought I understood that DHT creams can enlarge the prostate, but I didn't know if the same applied to testosterone therapy.

that doesn't matter, the MRI shows a lesion PIRAD 3 which it could or could not be cancer

I have an actual lesion, so unless i get the biopsy i will never know if is cancer or benign