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False Positive?

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Posted 4/23/2015 8:54 PM (GMT 0)
Hello All, I am grateful for any advice you can give me! My husband had a biopsy in June/2013 because of an elevated PSA of 5.4. (Prior to that his PSA history was 1.9 and 2.4) His biopsy results were normal. (He is 65 years old and does have BPH. He is not on any medication for it.) Since then, he has had the following PSA levels:
October 2013 PSA=3.5 Free PSA=19.7%
September 2014 PSA=4.9 Free PSA=15.5%
April 2015 PSA=8.2 Free PSA=9%
I was floored by the recent numbers. His Urologist wants him to repeat the test in two months, thinking it might be a fluke, citing his recent surgery. My husband had a successful hip replacement in February… 6 weeks prior to the PSA test.
My question is "What are the odds that both the PSA and the Free PSA could be false positive? Would love to hear your thoughts! Thank you ~ Cathi
Posted 4/23/2015 9:04 PM (GMT 0)
The odds are very high of false positives, especially when BPH is known. Try PHI instead (link below). The false positives are still high, but not as high.

Prostate Health Index (PHI)

He can also get a urine test called PCA3, which is FDA-approved after a negative biopsy when suspicion remains.

PHI and PCA3 together may give a more accurate assessment about whether another biopsy, perhaps mpMRI-targeted, is warranted.

If he were on Proscar or Avodart for his BPH, the blood test would be giving him a more accurate reading.

- Allen
Posted 4/23/2015 10:18 PM (GMT 0)
Catti,

Have they ruled out any prostate infection or inflammation? That alone can increase your PSA and lower the Free PSA. Usually a 4 week treatment of oral antibiotics is indicated (Fluoroquinolones have demonstrated the best tissue concentration and are recommended as first-line agents.)
Posted 4/23/2015 10:37 PM (GMT 0)
Thank you both for your informative replies! The doctor didn't mention the possibility of infection or inflammation. I think he wanted to first be sure the results were accurate… or rather inaccurate. We won't wait the full two months for a re-do though. That would be difficult. Instead, my husband will repeat the test in 2 weeks. Hopefully, the PSA will be lower. I think I am especially worried about the 9% Free PSA. But it is helpful to know that both test results could be skewed by something as benign as an infection. And we will definitely ask about the PCA3 urine test if need be. :)
Posted 4/23/2015 11:31 PM (GMT 0)
Oh, catti, there are a few other things that can elevate the PSA...riding a bicycle or having sex up to 48 hours before the blood draw.
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