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history of elevated PSA's

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Posted 6/1/2009 6:25 PM (GMT 0)
I have a history of elevated PSA's. I'm 63-had first test at 50- result was 4.4. Had a biopsy then and it was negative. Three years later- PSA went from 3.3(my lowest ever) to 6.3.- another biopsy which was also negative. Over the past 9 years or so I have always been in the range of 4.8 to approx 5.4. Had a test last October and it was 4.9. Had one the end of this April and it shot up to 7.5. Am going to have a biopsy in two weeks. Obviously I am concerned and have been looking to get some re-assurance from the reading that I have been doing.-I have had the free PSA done on 4-5 occasions. Every time it comes back anywhere from 10- 13%. This past elevated PSA also back at 11% which is in the range of prior tests. From what I have read, with a spike in the overall PSA like I had, if it was from a malignancy, wouldn't the free percentage have dropped lower? I know that I read somewhere that if the increase is proportionate, then the odds favor a benign situation. Thanks for any help!
Posted 6/1/2009 7:57 PM (GMT 0)

Dear Sporto:

Sorry you have had to join us, but welcome.  Hopefully, your biopsy will be negative and your stay with us will be short!  If not, there are plenty of caring and helpful people here...

With regards to your question, the PSA free test is notoriously inconclusive in the mid ranges.  All you can really say is that (1) most men with prostate cancer have a PSA free of less than 15%, (2) a high PSA free, e.g. 25% is probably BPH and (3) a low PSA free, e.g. 7% or less is probably prostate cancer.  Other than that it's a crap shoot and at 11% you probably can't read too much into this one way or another.

Beyond that,  clearly your PSA is high for your age so something is going on.  Presumably you have been  tested and/or treated for prostatitis.  Beyond the "regular" biopsy, perhaps you should consider some additional testing.  The PCA3 test is being used more and more.  Also, maybe you should consider a more extensive biopsy such as color doppler.  At this point, I'm sure you want some answers...

Good luck,

Tudpock

Posted 6/1/2009 8:47 PM (GMT 0)
Sporto,
My free psa jumped all around from 10% to 15% for 10 years. The only pattern was a consistantly rising PSA. So free PSA really doesn't follow a pattern.
If you are getting a 2nd biopsy consider a color doppler ultrasound with a targeted biopsy. It's much more accurrate than the standard 12 core, and you can get a baseline and only have another biopsy if something changes. I had 13 biopsies before they found my tumor, A color doppler would have found it years earlier.
JT
Posted 6/1/2009 10:56 PM (GMT 0)
Thanks so much for posting a reply. I guess my pinning hope on the fact the my free % stayed in the same range in spite of the elevated PSA is wishful thinking.

I do however have one additional question that I'm hoping someone may have an answer for. Shortly after my last PSA (10/08) (4.9), I began taking a supplement called BioResponse DIM 150. I began taking it because a preventative medicine specialist I see had order a testosterone and a estradiol level earlier in the fall which showed that my estradiol was at the high end of normal(53).From my research I found that high levels of this hormone contribute to BPH as well as heart disease and several other maladies. It seemed more than coincidental that my PSA's over a period of the past 10 years have been in a fairly acceptable albeit elevated level and then all of a sudden it jumped to 7.5. My logical mind makes me think that this must have something to do with the rise in PSA. I have not found much info to support that conclusion but it seemed to make sense to me that with the estradiol going down and the testosterone level going up ( 390-510), theoretically, that could contribute to a growing prostate and an increase in the PSA. Any insights would be greatly appreciated.
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