Premature worrying?

Hello: I have always had health anxiety issues, and my doctor thinks I am worrying prematurely, but I need some broader perspective.

I am 56 years old, and generally in excellent health. I have been a vegetarian since I was 13, and I exercise every day. In my most recent annual physical, my PSA came back at 3.8. It was 2.3 in my previous exam (which was actually 13 months ago, not 12). Over the previous few years, it had bobbled up and down, ranging from 2.1 to 2.8. My DRE is normal. There is no known history of PC in my family. Although my doctor did not comment on prostate size, I remember during an ER visit for a kidney stone a couple of years ago the ER doctor saying that my prostate looked "really big" on the CT scan, but I have never had any significant symptoms of BPH.

Knowing that I am a worry-wart, my doctor ordered an immediate redo of the PSA, and it came back as 3.3--good news, seemingly, since that was a .5 drop in just one week. However, he also did a free PSA test, which came back at 15.5%. This was a new thing to me, so I started doing substantial research, and have ended up more confused and alarmed than before. There are many sites that indicate the risk of cancer at 20% or less for a free PSA percentage between 15 and 20. I know that means there is an 80% chance or more that it's NOT cancer at that level, but being me, I am focused on the 1-in-5 chance that it is cancer. Meanwhile, I have found many seemingly reputable sites that suggest a biopsy be performed if the %-free PSA is below 20, or even below 25.

Here's my question: Does anybody have a sense of whether these figures (PSA 3.3, down from 3.8 a week ago, plus free PSA at 15.5%) would warrant a biopsy?

Candidly, I have always enjoyed a vigorous sex life, and I am quite active. I must admit I am less scared of cancer than of the possible side effects of its treatment.

Thanks.

First all worry is premature ;-) I had PSA over 3 for many years, when it went over 4 then we acted. however, it depends on other symptoms. And my doc did an MRI first, which showed a lesion, then the biopsy. Finally, not all treatments have debilitating side effects. Denis

I could see getting a biopsy in your situation, or putting it off and just testing your PSA again in six months or so. (What does your doctor have to say on this? His opinion is better informed than mine.) Keep in mind that with your history the chances are that even if you had a biopsy and some cancer was found, there's a high probably that it would be a low-grade cancer that wouldn't warrant immediate treatment, especially for someone who is more concerned about side effects than cancer. (One of the first things I've said to both urologists that I have worked with is that I'm much more worried about overtreatment than undertreatment.)

Hi MMINDC,

I just got my negative results after my first biopsy. All my details are below in my signature line. Also, see this thread.

https://www.healingwell.com/community/default.aspx?f=35&m=3952179

Your PSA would be considered elevated, your free PSA is in the "caution" area. Anything below 14% is very concerning and anything over 25% is good, anything in between is in purgatory, that is, could be good, could be concerning. My PSA Free was 18% in July; 3 months later it was 29%. I would ask for another PSA in 3 months as your PSA score could be something but could be nothing. See where it is in 3 months. If it levels off.....I would not get overly worried. If it continues to rise, a Bx is in order. Also, you need to find out if your prostate is enlarged or not. If it is, that may be causing the higher PSA score. Keep asking questions, thats how I learned.