Welcome to still another Jim.

Some subscribers to this newsgroup have been offered bone scans, but
with a PSA of 5.7 I was not given anything but a needle biopsy at Johns
Hopkins.

I assume the urologist will offer to do a biopsy within a couple of
months because of the sharp rise in the past year, and/or if he or she
can feel any abnormalities in the prostate gland.

The biopsy is not a big deal.  Many previous posts about it.

jimhoney
not a doctor

That is perfectly normal.  The odds are still that you don't have
prostate cancer.  It could easily be prostatitis.  If you do have
prostate cancer, it is most likely at an early stage and can be cured.

The urologist will review your case, do another DRE, and will almost
certainly recommend a biopsy.   As I noted, a large increase like that
could be do to prostatitis, and more likely than not, you don't have
prostate cancer.   But it still has to be ruled out, and a biopsy is the
only way to do that. It is unlikely the biopsy will be done at the first
appointment since you have to clear the lower part of your colon.   The
doctor will also likely prescribe antibiotics to avoid infection.  Some
doctors start you with the pills the day before but others wait until
the biopsy.  Most men find a biopsy annoying, but tolerable.  Mine was
like a typical dental procedure.  They go more easily if the doctor
first gives you a local anesthetic.   If for some reason, your biopsy is
likely to be difficult, it can be done  under sedation.   You should get
all this straight at your appointment if the doctor decides on a biopsy.

Ultrasound imaging is part of the biopsy procedure, used mainly to guide
the probes.  Rarely does prostate cancer show up in the ultrasound
image.  If you do have prostate cancer,  your doctor may also order
further imaging tests.  This might include an MRI of the prostate area
or a bone scan to look for metastases.  But such tests are hard to
interpret and it is not clear they add much in most cases to what the
biopsy shows, so many urologists won't bother with them in a typical
case.  It really depends on the details of the case and the urologist.

Saw Palmetto can be a mixed blessing.  If I remember correctly it can
mask an increase in PSA.  Also, it doesn't really do anything that can't
be done by prescription drugs.

Fortunately, Jim, you do qualify as a member of our fine group here.  And,
while your concern is warranted, there are at least three prostate problems
that may cause your sudden rise in PSA.

I believe your uro will merely give you the finger wave and interview you.
He will then set you up for a biopsy.  BTW, you need not get a second
opinion.  You will want a biopsy with as many needles as they are willing to
throw into the prostate.  If you have cancer, you want to know now while you
can still cure it.

Once you have the biopsy, if it's clean, your uro will probably set you up
with antibiotics to see if they work on your prostate problem.  Of course,
you'll get antibiotics for the biopsy too.

If the biopsy shows cancer, they may send you to a bone scan and CAT scan,
but those are almost unnecessary at your PSA level (depending on the stage
and Gleason).

At that point, you will go into research overdrive trying to find the best
treatment for Jim Turner.  We will all help, of course, but the decision
will be yours.

And, I'm getting ahead of myself.  It is our sincerest hope that you never
join our club, but if you do, you will be welcome with open arms.

Should Jim also be given a FreePSA test also?

I want to thank everyone for their kind and thoughtful replies.    I
went to the Urologist a few days ago.   I know as little today as I did
when I posted this.

He took my history and did a DRE.   He said he wanted me to take another
PSA in two months.  That was it.   I figured he might tell me something
about the results of the DE,  but I was wrong.  I was in and out pretty
fast.

A couple weeks before the appointment,  I was pretty worried so I went
to a local lab and had another PSA.  I suppose I had hoped that there
had been a mistake on the first test. This time it showed a reading of
2.4.  Which shows there was no mistake,  but it was lower than the first
(5.6).   The first and second were from different labs and I realize
they vary.   Surely the doctor wasn't offended by my having done this ?

Whatever,  I'm suppose to see him again in July.