Free PSA + Biopsy ??'s

Sorry if this is a silly questions but I keep coming across posts with "free PSA" which I have never really heard of...only known about PSA...I just wanted to know what the difference was if there was any...

Also, has anyone encountered a false positive with their biopsy? I did research about my dad prostate cancer and remember reading about this but that was a while back and my brain is full of tons of things at this time...

I wanted to know if the biopsy confirms prostate cancer 100%....I am trying to see if we can request a second biopsy because my dad is still in denial and thinks the prostate biopsy came back positive for cancer because he had cancerous bladder tumor...Do you just flat out ask the doctor for a second biopsy?

Jojo, I am sorry that you and your dad are going through this. I can only imagine how "full" your brain is at this point, and how difficult it is dealing with your dad's denial.

Each type of cancer is different - prostate cancer cells look different than bladder cancer cells which look different than breast cancer cells, etc. A pathologist is trained to look at these cells and determine what type of cancer cells they are. It is very possible to have 2 different types of cancer and have them discovered at the same time, especially when they are in the same area within the body. If your dad's bladder cancer had spread to the prostate, the pathologist would have been able to determine that. When a cancer - for instance, breast cancer - spreads to another part of the body, it is still breast cancer even though it might be in the bones or the lungs. This is referred to as metastatic cancer.

I have never heard of a false positive for a biopsy as cancer cells, especially those that are aggressive, have a very scattered pattern. Normal cells are very well differentiated and cancer cells are less differentiated. The more aggressive the cancer, the less differentiated the cells.

Free PSA is the amount of PSA that circulates within the blood system. The lower the percent of PSA circulating the greater the likelihood of prostate cancer. Free PSA should be around 25% or higher - my husband's was 11%. This, along with the rise in his overall PSA led to a biopsy which led to the diagnosis.

I would strongly suggest sitting down with your dad and his doctor and having an honest discussion about your dad's diagnoses.

jojo
It would help if you could post your dad's biopsy results -- number of positive cores, % cancer, Gleason score. You might also tell us why his doctors decided to do a biopsy in the first place. You will probably have to call the doctor to get this info. Take a look at the sigs at the bottom of each of our posts to see the kinds of information that we include. Remember -- none of us knew what to ask or what to keep track of when we got here and we were helped by those who were here before us.

In general, a biopsy can give a false negative but only rarely a false positive. A false positive can mean that the biopsy needle got the entire tumor. As others have suggested, have your dads slides sent out for a second reading just in case of the very rare event of a misreading.

Remember that a biopsy is not without its own risk -- if you are thinking of a second biopsy have a very serious talk with your dad's uro about advantages and disadvantages.

Finally, cancer is frightening but PC has many good treatments. Depending on your dad's stats, he may be a candidate for watchful waiting -- monitoring PSA and perhaps doing a repeat biopsy in a year or two. Note that this is a medically supervised treatment -- not at all the same thing as denial.

In any case, we are here for you and your dad -- ask what ever you want.