Free PSA % never changes regardless of total PSA

Hi guys,

I have the following PSA history and I scheduled a 3T MRI guided biopsy in March.
My PSA history is as follows:
2010 0.9
2011 0.8
2012 1.1
April 2013 1.65
May 2013 1.0 (46% free)
Feb 2014 1.4 (46% free)
Nov 2014 1.1 (45% free)
Feb 2015 1.5 (47% free)

In the last 3 weeks, I have had old blood (brown colored strands) in my semen. A 1.5T MRI last November showed "intermediate suspicion of prostate carcinoma", and my prostate is 31cc.

The only other tests I have had is the new Opko 4k test which said I have only a 1% chance of having aggressive prostate cancer and my urologist trust this test so much he does not recommend a biopsy.

In the last year, I have had 3 different cultures done on my prostatic fluid or semen to culture for infections, and none were found. I also have no indication of inflammation from my prostatic fluid.

Since 2010, my PSA is clearly trending up even as it bounces, but it is the CONSTANT %free PSA that really bothers me. I did a lot of research which all indicate that with prostatis, the %free PSA actually goes down during prostatatis.

I just cannot believe that using 3 different labs and on 4 occassions, the % free PSA is so similar - I imagine there is some kind of tissue that is leaking constant free% into the blood stream, and this is not the way a normal prostate behaves.

I scheduled the biopsy because I think I now need to find out what's going on, since there doesn't seem to be any other way to ease my mind. I am stuck between:
The good: PSA still somewhat low, although not for my age(33), high %freePSA, excellent 4k score
The bad: MRI says very suspicious, PSA slowly trending up during the years
The weird: constant free PSA regardless of total PSA.

I have been trying to figure out how free PSA works to kind of get a mental image of how it could always be constant regardless of total PSA, but am still puzzled. But maybe it's all pointless to try to understand it since I scheduled the biopsy already.

And to add - "Free PSA" is a part of the total PSA. So it could remain the same for high or low total PSA measures.

Your PSA is low, your % free PSA is high, excellent 4Kscore - fantastic! Your numbers look great! I can't understand why you are so set to have holes drilled into you when there is no indication. I think your Uro is giving you great advice. This is the first I've ever heard of trying to use % free PSA kinetics as an indicator -- it doesn't work like that. MRIs show suspicion - just that - and a 1.5T is not likely to be all that accurate.Maybe it's a cyst that has ruptured.

Blood in semen happens a lot. It will probably resolve on its own. Or it may be kidney or bladder stones, or some prostatitis - lots of things. I can assure you of a lot more blood in semen if you have a biopsy.

- Allen