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Fluctuating PSA

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Posted 12/5/2016 7:56 PM (GMT 0)
Hello to all you very smart men! I popped in here May 2013 when my husband's PSA had increased to 5.4 from 2.4 a year prior. We were very happy when his biopsy results came back normal. Life went on as usual with annual PSA checks. My husband is 66 years old and has BPH... for which he does not take medication. And if I remember correctly, his prostate was around 60cc.

At his recent checkup, his PSA was 7.2 and the % free PSA was 13.1%.

Here is a quick rundown of his numbers since 2013:
5/13 PSA 5.4 (6/13 Biopsy negative)
10/13 PSA 3.5 Free PSA 19.7%
9/14 PSA 4.9 Free PSA 15.5%
3/15 PSA 8.2 Free PSA 9%
4/15 PSA 4.7 Free PSA 23.6%
12/15 PSA 4.0 Free PSA 20.8%
11/16 PSA 7.2 Free PSA 13.1%

I understand a fluctuating PSA could indicate prostatitis as well as other benign conditions including BPH, but I thought that men with BPH have an elevated Free PSA percentage, usually above 25%. So I am concerned about the 13.1% and I wonder if anyone can address that. We are awaiting pre-certification from our insurance company for an MRI with and without contrast. If something shows up, he will have another biopsy. Looking forward to your insight! ~ Cathi
Posted 12/5/2016 8:59 PM (GMT 0)
You might consider a PHI blood test and a PCA3 urine test. Both are better than % free PSA. Insurance covers both after a previous biopsy.
Posted 12/5/2016 10:11 PM (GMT 0)
Catti, A couple of years ago, my fpsa fell from 20 to 14 due to trauma months after a biopsy. It's now up to 26. So, trauma, infections, swelling, and probably other prostatic issues could also cause that downward spike.

As TA suggested, a PHI test would be a reasonable next step.
Posted 12/6/2016 10:48 PM (GMT 0)
Allen and ASAdvocate,
Thank you so much for your guidance! I wish I had asked you guys my question prior to the doctor's appointment. My husband could have requested the PHI blood test and a PCA3 urine test then, when he found out his PSA and %fPSA were a bit askew. Knowing my husband's urologist, I doubt he would order those tests now. He really wants the MRI, which is scheduled for Monday. I will update you when we get the report. And if all is good, but the issue comes up again in the future, we will know what tests to ask for. :) ~ Cathi
Posted 12/6/2016 10:57 PM (GMT 0)
So what if he really wants the MRI?? who's working for who here...Urologists like that o are a dime a rhyme...
Posted 12/7/2016 6:22 PM (GMT 0)
They tell you different things. If it is a multiparametric MRI, it may or may not identify areas within the prostate that are suspicious for cancer and may be worth taking some extra cores from. It is affected by prostatitis and a lot of other tissue effects, so it can't diagnose cancer. PHI is a better version of PSA and % free PSA (it includes both) that somewhat eliminates the skewing effect of prostatitis and BPH. PCA3 checks for evidence of a genetic aberration that is sometimes characteristic of PC. None test for cancer per se, but after a negative biopsy where suspicion remains, they can, taken together, help avoid unnecessary biopsies.
Posted 12/7/2016 6:47 PM (GMT 0)
Yes Allen, it is described as a "high-field strength multi-parametric MRI." It is a Siemens Skyra 3T MRI. It claims to produce remarkably detailed images of the prostate. And, it eliminates the need for an endo-rectal coil, which makes my husband very happy! ~ Cathi
Posted 12/7/2016 6:57 PM (GMT 0)
Sounds good! And I hope that facility has an experienced radiologist, capable of reading it well. Do they have equipment to perform a ultrasound fusion-guided biopsy, if warranted?
Posted 12/7/2016 8:32 PM (GMT 0)
They claim their radiologists are highly skilled so hopefully they really are and it will be worth it. And yes, the urologist uses MRI/Ultrasound Fusion Biopsy if warranted. Can't wait to get some clarity!
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