“Low % free PSA (~8%) with PSA fluctuating around 5 — MRI before biopsy?”
Hi Everyone, I'm a 63M with no prostate cancer diagnosis, trying to decide reasonable next steps after PSA rose into the low 5’s in 2025 but recently dropped back to 4.26 without treatment. PSA history: 2.9 (2019/2020), 3.2 (2021), around 4 in 2023–2024, then 5.35 in June 2025, 5.1 in July/Dec 2025, and 4.26 in May 2026 (I studied harder for this test). Free PSA has stayed around 0.41–0.43, with % free PSA repeatedly around 8%. I had prostatitis episodes in my 20s and 30s, so maybe some possible chronic inflammation? Can it affect PSA and % free PSA decades later? My current doctor seems inclined to go straight to a random needle biopsy rather than getting an MRI first, and I’m likely to push for MRI/PHI/4Kscore before biopsy. Interested in hearing from people with similar PSA swings, low % free PSA, prostatitis/BPH history, or MRI-before-biopsy experiences. Thanks!