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On the fence, no longer?

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Posted 9/17/2015 3:27 PM (GMT 0)
My last PSA, taken exactly one year after a PSA of 0.9 (on Finasteride), showed an increase to 1.2, not a good sign. I know my next step should be a biopsy, but I resist. I've suspected that I've had PCa for some years now, oh well. I have a URO appointment next month so I'll see what he has to say.

P.S. I've revised my signature to contain only the PSA tests done with the same assay method in order to compare apples to apples.
Posted 9/17/2015 4:19 PM (GMT 0)
One thing to consider is that normal variation in pre-treatment PSA is about ±20%, so it may not be a real increase. Your PSA is very low, and most biochemical tests, including % free PSA and PHI are not validated for PSA values that low. The nice thing about finasteride is it makes PSA and PSA changes a much better indicator. One option is to re-test in about 3 months to see if the small increase was real. You can also get a PHI test, which is inexpensive and Medicare will cover. You have to call the number in the following link to find a nearby urologist who offers it (it's not available from every urologist).

Prostate Health Index (PHI)
Posted 9/17/2015 5:36 PM (GMT 0)
Thanks Allen,

I just called Innovate Diagnostics and it so happens that my Urologist is listed as able to give the PHI test, so I'll ask him when I see him next month. One thing they did say though is that because Finasteride reduces the PSA level it will also reduce the results from the test. So I don't know how accurate that test will be.
Posted 9/17/2015 7:41 PM (GMT 0)
Though you did have a slight uptick just recently- but not even a doubling in 1 years time- you have had a steady decrease from much higher levels in 09, is that right?

Now true your Finasteride accounts for some of that drop, but looks like there had been a steady drop for some years before the drug was started. I'm not quite seeing a reason for concern. Is your DRE bad or a problem with some other test? Even if you doubled your PSA to account for the drug, that(2.4) still wouldn't be much for a 70 year old, and still about the same as you had back in 12, and a good bit less than you had in 09.
Posted 9/17/2015 10:17 PM (GMT 0)
onthefence,

That's a good point. PHI hasn't been validated for use after finasteride or with low PSAs like yours. The formula is:

PHI = -2proPSA/freePSA x √PSA

So, PSA has a diminished effect on PHI - only its square root affects it, and for low PSAs like yours, the √PSA is pretty close to one and has no real effect. The bigger part is how much of the free PSA is -2proPSA (an aberrant form of free PSA that is largely attributable to prostate cancer). While it may be difficult to draw conclusions from a single test, I think it might be useful to track it over time. Its billed cost isn't much more than a normal PSA test, and it includes a measurement of both PSA and free PSA in the report. I'll be curious to hear what your urologist thinks.

- Allen
Posted 9/17/2015 11:07 PM (GMT 0)
BillyBob and Allen,

The last time I had a DRE was two years ago and he said there was some asymmetry. I'll keep you guys posted as to what my Urologist says at my next appointment on Oct 12.
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