High PSA AND High Free PSA

I just received a call from my general doctor stating that my free PSA was indicative of 3% to 5% cancer however my overall PSA was 12.76 in late January and then 16 in mid-February (different labs). Question one: Is he on Crack? Is this possible? In my second PSA test they drew blood AFTER I received a DRE – I’ve read that’s not optimal - but at my levels not really germane. My general doctor did not state the fPSA value – he was out of the office when he called and couldn’t remember the exact number – just that’s correlated to of 3% to 5% chance cancer – I asume that means high free PSA. He thought it good news and wanted to tell me.  I will get the actual number Friday. As it just so happens today I had my first appointment with my urologist who did not have the fPSA data available to during my visit. DRE result was enlarged and hard. I have a biopsy scheduled this Friday - then everything elese will be a moot point. I’ve read that when PSA is over the “magic number of 10” fPSA is not very meaningful. But I haven’t had ANY good news lately – it’s hard not to look at this as scrap of maybe good news. Question: Do folks with high fPSA and cancer tend to have lower g-scores? Or is it like everything else with PSA in all its various flavors, you need an ouija board and a crystal ball? K2

High PSA (usually below 10 ng/mL) and high free/total PSA ratio is a typical indicator for BPH.

Be aware that it is possible for a man to have a prostate infection, and BPH, and prostate cancer at the same time...you can have any combination of two of these, or even have all three at the same time.

Benign prostate tissue contains more free PSA than prostate cancer tissue. Patients with prostate cancer tend to have lower free/total ratios, whereas men with benign disease have higher free/total ratios, except in the case of prostatitis. Free/total ratio is usually used only up to 10 ng/mL, but you aren't far above that, and may be having the contribution of an infection which might bring your baseline back below 10 (a significant percent of men with elevated PSA respond favorably to antibiotics). Furthermore, if the free/total ratio is valid at 10, this doesn't mean it is totally invalid at 11, or 12, but it would be decreasingly sensitive (not a "1" or a "0" on validity).

PSA blood draw after DRE is definate no-no...the impact of this mistake would be variable, but would likely be at least several ng's/mL.

Hardness in DRE is troubling.