Questions, Free Psa

Ken: Sometimes free PSA can be used to help see what is going on.  I had to push my urogist to do the free  PSA test and once I dropped into the low 20% (21%), I knew that I was in trouble. My DRE's were all fine.  My total PSA was 3.3 at 58 years old and I believe that the free PSA test really helped in pushing me and the doctor towards a biopsy. I turned out be be Gleason 3+4, (1 of 12 cores) but that was downgraded to 3+3 after surgery and everything was organ confined.  Nearly 2 years past surgery, my ultrasensitive PSA's are less than (<) 0.015 so I am very happy.  Not to make you upset in anyway, but my numbers floated around 2.2 to 2.5 for many years and my free PSAs were in the 30% range for all of that time.  But finally the free % dropped and that is what caused me to take action.  Please take solice in the fact that if they do find PCA, you surely caught it at a very early stage like myself.

Good luck.

Bill K. from NJ

Thanks guys. Yes, Allen, my error, he said he would like to see it above 15.
Bill, can't say your response isn't making me nervous, but i do appreciate the information. Now i am thinking if your guys wanted a biopsy at 21%, what does my 11% mean? Ugh.

I always thought Free PSA was a more useful (accurate?) predictor for those with psa of >4. Maybe i am wrong about that.

I guess the PCA3 and the MRI will tell the tale of whether i need another biopsy or not. But it sure is nervewracking.

Does anyone know if an 11 PSA is very low, or is it just a little low and free PSA of single digits is common in PCa?

I guess I'm sort of grasping at straws to stay under control until the MRI is done.

Pratoman,

As my local uro told me back in 2009 (I had a PSA around 4.0), I was TWICE as likely to get PC since my father had it. When I told him that one of his brothers also had it, the uro said my chances were then THREE times as likely.

This was his failed attempt to talk me into a biopsy. But I am a member of the Medical Coward's Union, which required me to chicken out.

In 2011, my PSA had jumped to about 6.41, and this time I violated my union "oath" and let him do a biopsy -- which detected my case of PC.

A specific PSA number does not always mean there is PC -- but the TRENDING can be quite telling. If the PSA is going upward (especially if it doubles within a year or two), it strongly hints at PC. Combining this with your family history & also the PIN, you should stay very much on top of this.

It would appear to me that, if you should have (or eventually develop) PC, your total PSA suggests it would be a lower aggressive type that could easily be curable.

The trick is to stay on top of it. I would really suggest that you consider another biopsy in the near future.

In any case, if anything should show up, you would have treatment options that would probably be curative.

See you over in the other PC forum,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1.
Semi-firm erections now happening 14 months post-op & slowly getting a bit stronger.

The test manufacturer, Beckman Coulter, validates % free PSA for PSA in the range between 4.0 and 10.0, although there was one study that found it's accuracy was about the same for PSA values less than 4. It's not a very good test. At a cut-off of <10% and PSA between 4-10, the risk of PC is 56%. Among men who have %fPSA>10%, the test will miss 55% (false negatives) of the men who really do have PC; while among men who have %fPSA<10%, the test will result in positive biopsies 95% of the time. Men with %fPSA above 25% have only an 8% risk of PC. If you set the cut-off at <25%, it will only miss 3% of the cancers, but 87% of men will be sent for an unnecessary biopsy.

Most men will have % Free PSA in the range of 10%-25% -- median is 15%. So with most men, including yourself, falling in that gray area, you can see why it's not a very good test.

% Free PSA is also related to prostate volume and BPH. There's an FDA-approved test called PHI that distinguishes PC from BPH, but I don't think it's available yet in the US. I think it will be out this year.

FWIW, here are my %fPSA numbers:

Date: PSA: %fPSA
------------------------------
2009-08-13: 1.7: 12.94%
2009-09-28: 4.5: 6.67%
2009-10-13: 4.7: 7.66%
2011-09-15: 2.7: 14.81%
2012-01-11: 2.2: N/A
2012-10-25: 2.5: N/A

Pratoman said...
Is PCa3 also something that can't be taken at face value (for lack of a better way to put it?)

It detects the RNA expressed by the PCA3 gene. The amount collected depends on how rigorous a massage is given. Many prostate cancers do not express the PCA3 gene, but if they do, it’s a good indicator. It has the advantage that it is independent of PSA, age, prostate volume and prostatitis. It is related to tumor volume and Gleason grade.

At a cut-off of 35, it has sensitivity of 64% (meaning it won't detect 36% of the cancers that are really there), and a specificity of 76% (meaning about a quarter of men will be sent to unnecessary biopsies). It's overall accuracy is 73%. Not great.

All of these biochemical tests are only useful hints that a biopsy may or may not be warranted.

Thanks ZODude. I appreciate it, and no worries that you worried me, it doesn't take much. And i very much appreciate you taking the time to respond in the first place. I'm here looking for truth, good or bad.
I guess the whole problem with this thing that we all come here to talk about is that its not like other cancers, where there is black and white, and a right way to diagnose and treat. Just a ton of moving parts. I DO wish i could learn to relax, i mean, God, i have not even been diagnosed. Imagine the ball i will shrivel up into if i do get diagnosed. You guys are tougher than me.
Anyway, i will wait until the end of next week, it think the MRI will be most important, for now.
BTW they are giving me contrast for the MRI, Does that mean its the multiparametric 3 Telsa thigamajig, or color dopplar are some other sophisticated not just another MRI?

Thank you Bill. I need to hear stuff like that now.
I've gone 62 years without ever being seriously ill. Maybe thats why I'm a wuss. But i know i'm blessed to be able to even say that.
Keeping my fingers crossed, i'll update when i know more.

@Allen - re mindfullness i will look into it thanks. Last time i went through this, i asked my doc for something for the anxiety. He prescribed Lexapro. After i read about it, thought about it, and took it for two days, i threw it in the trash. I would rather take a xanax as needed.