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Posted 1/2/2016 12:42 AM (GMT 0)
I am 57 years old. I had a PSA test that came back at 2.1 I waited 2 months and tested again, it was 1.7. However my %of Free PSA was 12
( normal is over 25). I am going to wait and check again in 4 months. I would love some input.

Thank you

Post Edited (Pumpkin1313) : 1/1/2016 5:45:24 PM (GMT-7)

Posted 1/2/2016 2:06 AM (GMT 0)
Someone please speak up.
Posted 1/2/2016 2:19 AM (GMT 0)
A low free PSA result increases the chance of prostate cancer so it indicates the need for a biopsy. Your urologist is aware of this.
Bob
Posted 1/2/2016 2:51 AM (GMT 0)
My first free PSA was, as I recall, in the teens, I think 16. Biopsy was negative
My second was 12amd the biopsy was positive. My total PSA however, unlike yours, was 4.3, and rising.
Your total is pretty low, and the drop to 1.7 is favorable.
Still, the question of a need for biopsy is a valid one and should be discussed with your Dr. Consider an MRI before deciding to move forward, or in conjunction with any biopsy
Posted 1/2/2016 3:32 AM (GMT 0)
% free PSA is only validated for PSAs from 4.0-10.0. That means that at your current PSA level, % free PSA is meaningless and doesn't provide you with any useful information. A pattern of fluctuating PSAs is associated with prostatitis rather than PC. Congratulations on your low PSA - if it were me, I'd wait a year. Biopsies or advanced imaging at this point is premature.
- Allen
Posted 1/2/2016 5:13 AM (GMT 0)
Welcome to HW.

What TA said, retest in a year.

Retest in 4 months isn't likely show anything interesting.

Andrew
Posted 1/3/2016 11:02 PM (GMT 0)
Have you been tested for prostatitis? An infection or inflammation of the prostate can lower you %free psa.
Posted 5/19/2016 10:11 PM (GMT 0)
Tall Allen. Just read that you stated a fPSA % is useless with a PSA of under 4.0. Mine was 3.5 with a fPSA% 7.6. I've read that some believe the cut off for PSA is 2.5 now. There seems to be a lot of disagreement on these #'s. Makes it hard for one to know what to do. I also had questionable abnormal DRE. I think the Dr words were "feels kinda funny to me". Then the uro said "oh ya , I feel what the Dr's talking about". Wasn't real convincing to me actually but it was the fPSA% 7.6 that convinced me to get a biopsy. Scheduled for 6/1/ 2016. I keep going back and forth about the correct thing to do. Drives me crazy sometimes. Time to get out of my own head I guess :-)
Posted 5/19/2016 10:24 PM (GMT 0)
Artist Mark-

The reason there's no agreement about what PSA to use as a cut-off is because it's such a lousy test at detection when there's an untreated prostate. NCCN is currently recommending 3.0. Some use 2.5 for younger guys, and 4.0 for older guys. Another approach is if the PSA density (PSA/prostate size) is over 0.15. I like PHI better than PSA or % free PSA (it includes both), but it still ain't great. PSA becomes a better test for men taking 5-ARis (Proscar or Avodart). Then there are a bunch or expensive or uncovered-by-insurance tests.

With your suspicious DRE, and low %freePSA, and assuming you don't have an oversized prostate or a history of fluctuating PSAs, it's not unreasonable to have a biopsy. There are seldom "automatic" answers when it comes to PC.

- Allen
Posted 5/20/2016 11:46 AM (GMT 0)
During my Urologist visit yesterday I brought up that my old Urologist should have pulled the trigger on a biopsy 3 years ago when my free psa percentage was 6%. He replied that he does not use the free psa and it is not reliable?

Not sure he is correct?
Posted 5/20/2016 12:09 PM (GMT 0)
Bobby Mac, our urologist said that the free PSA test is the only number he relies on. He said the PSA test was the unreliable one.

It would certainly help if they could come to a consensus over the numbers.
Posted 5/20/2016 12:29 PM (GMT 0)
Annie -

I agree! I know other urologists rely on free PSA and don't know if he said that to me to protect the other doctor?

Bobby Mac
Posted 5/20/2016 10:24 PM (GMT 0)
13 years ago, age 45, my free PSA was 7-ish, with a PSA of 5, wandering up and down a bit.

3 biopsies later, over about the following 18 months, never found PCa, only some inflammation. I was totally panicked at first, and tried to figure out what the follow up plan would be. PSA dropped to 3, 2, and settled around there over the next few years. I quit checking it, figuring whatever happened cleared itself up. But at that low PSA, no urologist would do anything. So, at age 50+ I gave up and decided to check my PSA again at age 55.

So, I did. My PSA at age 55 was in fact elevated again, to 4.1. Six months later, it was 5.2. So biopsy, and then my life changed. Gleason 9, stage 3, all sorts of fun. When did that light off? No idea. Some butt-kicking about not checking every year, but it's water under the bridge.

Did the free PSA at age 45 predict my later situation? I'll never know. But it seems there wasn't anything there at the time anyway.
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