Rising PSA, no cancer detected (yet) – seeking shared experiences

Dear community,

I'm a 52-year-old male (born 1973) with no family history of prostate cancer. Over the past two years, my PSA levels have been rising:

April 2023: PSA total 1.03 ng/mL

April 2024: PSA 1.36 ng/mL

May 2025: PSA 3.96 ng/mL, free PSA 0.538 ng/mL (ratio 13.6%)

June 2025: PSA 4.16 ng/mL (confirmed), free PSA 0.565 ng/mL

Parallel test (other lab): PSA 3.91 ng/mL, free PSA 0.92 ng/mL (ratio 24%) → methodologically inconsistent

I had an mpMRI (May 2025): PI-RADS 2, no suspicious lesion but signs of past prostatitis.
A PSMA PET/CT (June 2025) also came back negative: no suspicious uptake in prostate, lymph nodes, or skeleton.
Vitamin D was low but is now in normal range (47.3 ng/mL 25-OH and 47.3 ng/L 1,25-OH). CRP stable around 0.6 mg/L. Testosterone levels are normal. No urinary or erectile issues.

Relevant history: severe Stevens-Johnson syndrome mid-2024 (due to NSAIDs), COVID in Sep 2024, brief corticosteroid therapy Oct 2024.

Important note: My PSA increased by 2.8 ng/mL over 13 months – which translates to an average rise of ~0.22 ng/mL per 28 days. This exceeds the threshold sometimes cited for “biological activity” and might indicate an active process in the prostate.

I'm currently pursuing a conservative, supplement-based approach:

Sulforaphane (broccoli extract)

Omega-3 fatty acids (high EPA/DHA)

Astaxanthin

Quercetin

Vitamin D

Zinc

No antibiotics or alpha-blockers so far.

My urologist is cautious but not alarmed. Next PSA and free PSA check is planned for late August or early September 2025 – along with a follow-up mpMRI.

Has anyone here experienced a steadily rising PSA with negative imaging and no symptoms? How did you proceed? Did a biopsy eventually become necessary? I'm weighing the risk of overdiagnosis vs. delayed action.

Thank you for reading – any shared experience or advice is appreciated.