No semen and high PSA

Retrograde ejaculation is possible you can Google it and find it is not a problem in itself, but one has to wonder what the cause is.

What kind of biopsy was it? Trans rectal ultra sound TRUS is not very good at finding cancer, transperineal biopsy is more likely to spot cancer. Did he have an MRI scan? 

There is a possibility the high August psa is a result of the healing process from the biopsy. What has his urologist got to say about the rise in psa? 

I think I would be happy to have another psa test in October and see if psa has came down, if it has I would blame the rise on the biopsy. 

Ignoring the August test, his PSA is still rising at 30% per year. I presume he is on Active Surveillance, and this will have to continue until his PSA stabilises or they find cancer. 

OK USA may be different. In the UK we have the NHS and they tend to follow national guidelines. About half of NHS hospitals have bought the new transperineal equipment and the other half are still using the old TRUS equipment which will almost certainly be abandoned within a few years. 

Now-a-days an MRI is usually done before biopsy which can hi-light suspicious areas. The biopsy needles can then be directed at the area of concern. TRUS usually use about 12 samples, and with no MRI to help guide things, the chances of hitting a small tumour are not very high, but if it is a large tumour it may be found.

With the transperineal biopsy about 40 samples are taken so nearly four times as much chance of hitting the tumour. Doing an MRI just now would not be much use the prostate needs to heal from the first biopsy, give it a few months, and then consider the options Bollinge suggests.

Of course cost may be a factor, in this country we pay for the NHS out of high taxes, but at least it is there when we need it, and we have already paid for it.