PSA rose 0.4 in 7 months, but Free PSA ratio stayed the same?

Hi guys,

7 months ago I got a Transrectal Color Dopplar from the renowned Dr. Bahn, and he said he found a lesion in the left side of my prostate that is most likely prostatatis since my PSA was low at 1.0 and free PSA was 46%, and believed it was not cancerous and told me to get a PSA test every 6 months. The reason why I went to get this test was because on DRE my urologist felt my left prostate was "harder" than my right side although there were no nodules.
Since then, my PSA rose from 1.0 to 1.4 in 7 months, but free PSA ratio is the same at 46%. Is this a cause for alarm?
I know a rising PSA level is not a good thing, especially in such a short time frame (and I have no infection), but the free PSA ratio remains high at 46%.
I am not exactly sure what to make of this data, I am waiting another 4 weeks to get another PSA test since I want to eliminate the possibility this is just a random spike.
But the lesion that showed up on the Color Dopplar does worry me as well as the fact my urologist said the left prostate felt "harder" than the right one. It is just a weird situation with conflicting data that confuses me, so I'd really appreciate it if some of you could shed light on what to make out of all this.

Thanks!

I am not aware that free psa has been validated as being of any relevance where total psa is below 2.0. 

PCA3 might be an option, or an MRI.

Best wishes, Medved

Hi,

I am 32 now and I only learned about all this because I had a severe case of bacterial prostatitis 2 years ago which was cured by Cipro, and I did a 23andme gene test which showed that I have EVERY bad gene for prostate cancer putting my total risk at 280% more than a regular person.

My prostate size is 30cc and from all that I have read, here is my belief:
1) prostate cancer cells are formed not in people's 50's or 60's, but rather, they are formed in people's 30's (and biopsy of young people who died in traffic accidents confirms that a lot of people have micro-tumors in their prostate).
2) the bacterial prostatitis made my prostate in a state of inflammation - and since it wasn't cured immediately in my case, I might have a chronic inflammatory resposne.
3) I had a super unhealthy diet with a lot of charred meat + I was chronically low on vitamin D for the last 3 years or so and lacked rest as my job is very demanding in time.
4) I have a very severe left side varicocele (which was proved by Dr. Yigal Gat in Israel to be linked directly to prostate cancer risk as it creates elevated testosterone levels in the prostate.

So I have nearly all factors working against me in terms of odds. So what I am going to do is to learn as much as I can and keep on eye on this, continue eating my anti-inflammatory vegeterian diet, and make sure if there are any cellular change, whether pre cancerous or not, that I am equipped with the knowledge to deal with it properly.

So my plan is as follows:
1) in 4 weeks I'll get another PSA test to make sure this is not a "spike"
2) then I'll get a PCA3 test
if PCA3 result is < 20, then I'll just forget about it and keep eating a healthy diet for a year
If PCA 3 result is > 20, then i'll go get a MRI.

Last summer, Dr. Bahn did told me to get a PSA test every 3 months even though he dismissed any possibility of me having cancer then (I always wondered why he wanted me to get a test every 3 months).

thunder2004 said...
Hi guys,

7 months ago I got a Transrectal Color Dopplar from the renowned Dr. Bahn, and he said he found a lesion in the left side of my prostate that is most likely prostatatis since my PSA was low at 1.0 and free PSA was 46%, and believed it was not cancerous and told me to get a PSA test every 6 months. The reason why I went to get this test was because on DRE my urologist felt my left prostate was "harder" than my right side although there were no nodules.
Since then, my PSA rose from 1.0 to 1.4 in 7 months, but free PSA ratio is the same at 46%. Is this a cause for alarm?
I know a rising PSA level is not a good thing, especially in such a short time frame (and I have no infection), but the free PSA ratio remains high at 46%.
I am not exactly sure what to make of this data, I am waiting another 4 weeks to get another PSA test since I want to eliminate the possibility this is just a random spike.
But the lesion that showed up on the Color Dopplar does worry me as well as the fact my urologist said the left prostate felt "harder" than the right one. It is just a weird situation with conflicting data that confuses me, so I'd really appreciate it if some of you could shed light on what to make out of all this.

Thanks!

Howdy,

At the age of 32, it is highly unlikely that you would have PC. Not impossible, of course, but not very likely.

As for free PSA, the doctors get suspicious when it goes below 10%. Generally, anything above 25% is considered excellent, so you are just fine there. Also keep in mind that fPSA is not a diagnosis one way or the other, but is usually just another clue that can sometimes be useful.

Other things can cause a slight rise in PSA, including infection even if you don't think you had one at that particular time.

Before your next PSA test, do not have any sex, do not perform any vigorous exercise, do not ride a bike or have any DRE performed in the 72 hours before the blood draw. Anything that stresses the prostate can put a temporary spike into the PSA reading.

Best of luck to you!
Chuck :)

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Firm erections now briefly happening in early mornings, 2 years post-op

Stop worrying. Dr Bahn has done over 30,000 biopsies and if he says it's prostitis it is. All other conditions also support this. If it walks like a duck and quacks like a duck it's a duck.