Five Years Active Surveillance

I can post results of MRIs and biopsies if requested

Well you certainly have quite history - I would want to know a lot more given a spike of 21 in my PSA.
To your question ...Stress is never good and the hormones can fuel cancer I am told. That said I have never read or heard of anything that suggests such a drastic rise in PSA due to stress.
The ongoing issue with Active Surveillance nationally is no formula exists that clarifies when a patient/MD should be concerned and seek treatment.
Do you know your Gleason score? Did you ever have a testing to see how likely it was for your cancer to spread?
No one can tell you (especially on an internet site) what decision is the best. Personally I would be meeting with another Urologist at a regional cancer center sooner than later. Dennis(ProstateCancer.net TEAM)

Much thanks for the informative reply.
I found the following Gleason score and I'll keep looking
". . . Prior biopsy: Small focus of prostatic adenocarcinoma in the left anterior, Gleason score 3+3=6 (Grade Group 1), involving less than 5% of one (1) core on 9/27/2019. Small focus of prostatic adenocarcinoma, Gleason 3 + 3 = 6, in the right apex on biopsy 1/22/2016. Follow-up biopsy 7/27/2016 demonstrated only benign prostatic tissue. . . '
I'm posting the results of my most recent MRI w-W/O contrast
MRI PROSTATE W/WO CONTRAST - DetailsPrinter friendly page--New window will open
Details
Study Result
Impression
IMPRESSION:
No suspicious abnormality on MR imaging.
Overall PI-RADS = 2/5
Overall Follow-Up Score (PRECISE) = Stable MRI appearance: no new focal/diffuse lesions. 3/5
Overall Assessment Categories (PI-RADS V2.1):
Likelihood that a clinically significant cancer is present based on MRI parameters
1. Very low (clinically significant cancer is highly unlikely to be present)
2. Low (clinically significant cancer is unlikely to be present)
3. Intermediate (the presence of clinically significant cancer is equivocal)
4. High (clinically significant cancer is likely to be present)
5. Very high (clinically significant cancer is highly likely to be present)

Overall Assessment Categories (PRECISE):
1. Resolution of previous features suspicious on MRI - Previously enhancing area no longer enhances.
2. Reduction in volume and/or conspicuity of previous features suspicious on MRI - Reduction in size of previously seen lesion that remains suspicious for clinically significant disease.
3. Stable MRI appearance: no new focal/diffuse lesions. - Either no suspicious features or all lesions stable in size and appearance.
4. Significant increase in size and/or conspicuity of features suspicious for prostate cancer. - Lesion becomes visible on diffusion-weighted imaging; significant increase in size of previously seen lesion.
5. Definitive radiologic stage progression. - Appearance of extracapsular extension, seminal vesicle involvement, lymph node involvement, or bone metastasis.
Eur Urol. 2017;71(4):648-55.

Images and interpretation personally reviewed by: xxxx xxxx, MD

Images and interpretation personally reviewed by: xxxx xxxx, MD

Narrative
EXAM: MRI PROSTATE W/WO CONTRAST

INDICATION: Prostate cancer, surveillance.
PSA 18.8 dated 2/19/2021
Prior biopsy: Small focus of prostatic adenocarcinoma in the left anterior, Gleason score 3+3=6 (Grade Group 1), involving less than 5% of one (1) core on 9/27/2019. Small focus of prostatic adenocarcinoma, Gleason 3 + 3 = 6, in the right apex on biopsy
1/22/2016. Follow-up biopsy 7/27/2016 demonstrated only benign prostatic tissue.

COMPARISON: Prior studies including prostate MRI dated 6/22/2019.

TECHNIQUE:
Imaging at 1.5 Tesla performed at Johns Hopkins.
Coil: Body Matrix coil
Sequences: Large field of view images of the pelvis were obtained: 3D T2 weighted and axial T1 weighted with fat suppression after contrast administration. Small field of view imaging of the prostate was performed with axial and coronal T2 weighted
imaging. Diffusion weighted imaging (DWI) was performed with apparent diffusion coefficient (ADC) mapping. Axial T1 weighted imaging pre-contrast and dynamic contrast enhanced (DCE) imaging was performed following injection of 0.1 mmol/kg gadolinium IV.
Offline post-processing of DCE data was performed on a dedicated Invivo DynaCAD workstation to generate pharmacokinetic maps.

Post-processing: Additional post-processing of MRI data was performed on a separate DynaCAD workstation, to include volumetric segmentation of the prostate (DCAD Prostate Boundary).

FINDINGS:

IMAGE QUALITY: Diagnostic.

HEMORRHAGE:
No areas of high T1 signal suggesting hemorrhage.

PROSTATE VOLUME:
Prostate measures: 5.7 cm TV x 4.7 cm AP x 5.8 cm CC, volume 80 cc.

Prostate volume calculated in DynaCAD Prostate Boundary segmentation: 86 cc

PERIPHERAL ZONE:
Linear T2 hypointensity without restricted diffusion or asymmetric perfusion, which can be seen with prostatitis.
No areas of restricted diffusion or abnormal enhancement.

TRANSITION ZONE:
Severe hypertrophy with heterogeneous T2-signal.
No focal areas with suspicious morphology.

SEMINAL VESICLES: Normal.

NEUROVASCULAR BUNDLES: Normal, symmetric.

BLADDER NECK: Normal.

MEMBRANOUS URETHRA: Normal

LYMPH NODES: None enlarged.

BONE MARROW: Normal signal intensity.

Other: Limited evaluation of bladder secondary to underdistention; however, there is median lobe hypertrophy with mild bladder wall thickening and trabeculation suggestive of mild chronic bladder outlet obstruction.