Wayne...Color doppler ultrasound by Bahn or Lee or MRI by Shinohara.
These imaging techniques allow the docs to see more of the gland and in
much higher resolution.  These docs are also the best at what they do.
They can then perform "targeted biopsies" if they see something.  You
can google these terms with "proste cancer" to learn more about
them...Ron

Duke K. Bahn MD
Medical Director, Department of Radiology
Prostate Institute of America
Community Memorial Hospital of San Buenaventura
168 N. Brent Street, Suite 402
Ventura, CA 93003
888-234-0004
805-585-3082
Fax: 805-641-3965
dkbahn@cmhhospital.org

Fred Lee, MD
Crittenton Hospital
1135 W University Dr, #420
Rochester, MI 48307
(248)650-4699

Katsuto Shinohara MD
1600 Divisadero Street, 3rd floor
UCSF
San Francisco, CA 94115
Tel:415-476-1611
Fax:415-476-8849
kshinohara@urol.ucsf.edu
Assistant, Mary, at 415 353 9877

Did you get a "free PSA"?  What is that score?  Did you do a test-run
of antibiotics to see if undiagnosed prostatitis is involved?  Is your
urinary system otherwise normal?  No bladder stones, or anything?

A color doppler ultrasound will help them identify the areas to biopsy.
Few places have color doppler ultrasounds, most use black and white
ultrasound.  Color doppler is less of a stab in the dark. Personally I
think that an MRI with spectroscopy would be helpful, it there has been
no biopsy within 8 weeks, but I don't know if they do it before a
diagnosis.

Chances of cancer with a PSA of 6 is about 25%. In fact, a PSA of 4 has
a 25% chance of cancer.  The 'free PSA' will give you information about
increasing or decreasing that 25% estimate.  It needs to be higher
rather than lower.  The websites below will have information on that.
If you have BPH, that will raise PSA also.  So if your prostate is not
enlarged, that increases your chance of cancer above the 25%.

Doubling time is significant.  I think this jump means a doubling time
of about 12 months.  That is very high.  I definitely would not wait
for 4 months for further testing.  Doing a PSA every few months may be
a "close watch" but it is not taking action.  Check your doubling time
here. http://www.mskcc.org/mskcc/html/10088.cfm  Have as many PSA
results as you can get, going back years, to put in the chart.  But 2
is enough to do it, if that's all you have.  Run those Partin tables as
if you have T1c cancer, and see what you get.  Put in your current PSA.
Then run it again with a PSA of 9 (just guessing for 4 months down the
road) and see how the numbers change. If you get over 10 you put
yourself into a whole other category, high risk, with worse outcomes.

Good luck, don't give up without a diagnosis.  If it is cancer, you
want treatment while the PSA is still low for the best chance of a
cure.

Resources:
http://prostate-cancer.org/index.html
http://www.ustoo.com/Default.asp
http://www.phoenix5.org/

Glossary of terms and abbreviations:
http://www.phoenix5.org/glossary/glossary.html

Couple more suggestions/comments in addition to the good ones already
posted.  Did you get your own copy of the biopsy report?  How many cores?
Was there any high grade PIN?  If so, how many cores?  (12 seems to be
fairly standard now.)  Was there any inflammation?  If there were cores with
high grade PIN, or with "focus of atypical small acinar proliferation," you
may want to get the slides read again by one of the "experts."  Or if your
next biopsy will be soon, consider these comments with respect to it.  It's
a good idea to study the path report yourself.  In my experience, at least,
it contains extra detail that the uro may not notice or may not discuss with
you.

Keep reading and asking questions.  You should feel more empowered as you
gain knowledge and the benefit of others' experience.  Good luck,  RonL

Hi, Wayne.

You don't give your age or the results of the digital rectal exam (DRE).
I'm assuming 55-70 and negative DRE and negative biopsy.

How many needles were used in the biopsy.  Six was the old standard.  I've
heard as many as 20.  Obviously, 20 shots in the dark, especially when
patterned, is better than six.

And, did he give you a regimen of strong antibiotics to see if that knocked
down the other possibility, infection?

Just to answer some of the questions and thank you for your comments

I am 66

I had a biopsy 6 months ago with 10 samples I believe. I was told the
results were negative. No qualifications were given.

I have had bph for some time now and am taking 10 mg Xatral.

my psa history is as follows

Aug 98     3.3
Mar 99     3.96
Mar 00     4.73
Sep 00     4.9 ultrasound and biopsy ok
Feb 01     4.3
Nov 01     4.9
May 02     5.3 antibiotics
Nov 02     3.9
May 03     3.66 urinalysis ok
May 04     3 39
May 05     6.09
Aug 05        biopsy  ok
Feb 06     6.5
June 08   next PSA and if up again a biopsy will be scheduled

Wayne
Ottawa

Wayne, here is a paste from something online.  I'm thinking that free
PSA (also called PSA-2) would be helpful to you, as you unravel what
your information means.  There is a LOT of information on the Internet
about free PSA and what #s mean what.  If your free PSA is high, then
that would be one more thing in your favor to indicate it is not PCa.
laruel

Investigators at the Brady Urological Institute and the Baltimore
Longitudinal Study of Aging discovered that free PSA is predictive of
the aggressiveness of prostate cancers. Using frozen serum samples to
measure PSA and free PSA long before the diagnosis of cancer was made,
it was found that the percentage of free PSA (PSA in the blood not
bound to proteins) distinguished between aggressive (high grade) cancer
and non-aggressive cancer 10 years before the cancers were diagnosed.
The percentage of free PSA in the blood fell as the tumors progressed
toward the date of diagnosis. A percent free PSA of 15 or lower was
predictive of the diagnosis of aggressive prostate cancer 10 years
later.

Dr. Epstein demonstrated in another study that a percent free PSA
higher than 15 was predictive of the presence of small volume disease
in men with PSA detected prostate cancer. And in a study from
Washington University in St. Louis, investigators found that a percent
free PSA lower than 15 was predictive of more extensive, higher grade
disease at the time of radical prostatectomy. So, three separate
studies with very different designs have concluded that percent free
PSA is predictive of the biology of the tumor. Based on these data, we
are less enthusiastic about expectant management in men who have a
percentage of free PSA that is consistently less than 10-15.
http://urology.jhu.edu/prostate/advice1.php