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Best Labs After PSA and Free PSA

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Posted 7/14/2018 12:48 PM (GMT 0)
I have an enlarged prostate, BPH and prostatitis. My most recent PSA was 11.84. A year and half ago it was 30 and after antibiotics, it dropped to 5.6, the lowest it had been in many years.

I had the free psa done at the same time as recent PSA, but it says it's not valid for a psa over 10. My % free PSA was 35.39, which if valid would indicate a probability of cancer of 9%. Any thoughts on free PSA when PSA is over 10? My free PSA always comes back with low probability of cancer which is why I am not freaking out over the high PSA.

What should my next test be? PHI? I had the test done several years ago when my PSA was high and it came back with low probability of cancer. At that time, I also had an MRI which showed prostatitis and BPH, but not cancer.

My doctor mentioned 2 other tests:

  • CA-Profile from american metabolic laboratories which is not specific to prostate cancer, but provides early detection for cancer in the body
  • IvyGene Cancer Blood test from Ivy Gene Labs which measures the methylation status of cell-free DNA. Prostate cancer is not one of the 4 cancers listed, but I think that just means it would detect cancer but not be able to identify it as prostate cancer.

Any thoughts on these 2 tests or any others you would recommend? Also, it would be helpful to add whether you know if it is covered by Medicare or not.

Thanks
Posted 7/14/2018 1:16 PM (GMT 0)
You could do a genetic test to see if you have the BRCA1 or BRCA2 mutations.

Here's some info /gucasym.org/daily-news/current-brca12-genetic-testing-guidelines-prostate-cancer-and-implications-oncologists

www.color.com

A good friend in your position with BPH symptoms had a saturation biopsy. It was negative. I probably wouldn't have, but he's happy he did it.
Posted 7/14/2018 2:00 PM (GMT 0)
I've done several searches and looked at 23andme and promethease and haven't been able to identify the brca 1/2 snps for prostate cancer. I sure wish authors would include snps because just knowing the gene isn't helpful. Everyone has a brca1 and 2 gene.
Posted 7/14/2018 2:28 PM (GMT 0)
Have to looked through snpedia?

/www.snpedia.com/
Posted 7/14/2018 2:52 PM (GMT 0)
It seems there are quite a few studies out there which have looked at snps for PC. Here is one:

/www.ncbi.nlm.nih.gov/pmc/articles/PMC4383163/
Posted 7/14/2018 3:16 PM (GMT 0)
richh: here's a nomogram tool that can predict PCa at levels of Total PSA above 10ng:

https://www.prostaterisk.ca/prostate-risk-calculator/

Despite it looking like a hokey site, it was developed by a top prostate surgeon here in Toronto.
Posted 7/14/2018 3:25 PM (GMT 0)
Try the PHI.

Andrew
Posted 7/14/2018 3:48 PM (GMT 0)

Geekything said...
richh: here's a nomogram tool that can predict PCa at levels of Total PSA above 10ng:

https://www.prostaterisk.ca/prostate-risk-calculator/

Despite it looking like a hokey site, it was developed by a top prostate surgeon here in Toronto.


I don't know IPSS, but it doesn't seem to be a major factor. I just used the midpoint. Came out to about 50% chance of cancer with a 30% high grade cancer risk.

If my PSA hadn't been high for over 10 years I would be worried about high grade cancer risk, but my PSA hasn't doubled in the last 5 years so a fast growing cancer is unlikely. I seem to have chronic inflammation in my gut and in my prostate. I'm thinking the gut problem might be causing the prostate problem.
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