u/HelpfulCustomer487

Hi everyone,
I wanted to share my recent journey and get some perspectives. I’m 71 years old with a significantly enlarged prostate (85g BPH).
Here is the timeline of my PSA levels:
• Dec 2024: 6.1
• Aug 2025: 5.4 (I was relieved, thinking it was just the BPH or inflammation).
• May 2026: 11.0 (A significant jump in velocity).
The Diagnosis so far:
I had a multiparametric MRI (with contrast) that detected a tiny 3mm lesion.
• The Radiologist's view: She was very conservative, suggesting it was likely a "dormant" lesion (potentially Gleason 3+3 or low 3+4) and that given my age and low PSA density (0.07 at the time), we should leave it alone to avoid overtreatment.
• The Urologist's view: He pushed for a biopsy from the start, wanting certainty.
My dilemma:
At 71, my absolute priority is maintaining my quality of life. I am very concerned about the risks of impotence associated with radical treatments. With a PSA now at 11, the "velocity" is worrying me. My PSA density has now shifted to around 0.13.
I’m curious if anyone else with a large prostate has seen such a jump. Could it be a silent prostatitis flare-up, or is it time to stop "watching" and start "acting"? I’m considering focal therapy to target the lesion while sparing the nerves, but I’m wondering if a biopsy is now unavoidable.
Thanks for your insights!