As you just learned, PSA is not a very good test for PC because it is affected by things like infections, inflammation and enlarged prostate. % free PSA is a bit more specific. PSA of 4.75 for a man of 75 may not be abnormal, especially if his prostate is enlarged, as is almost always the case. The doctor is probably just being cautious. However, let's suppose there is some PC found, as is often the case in men at 75. It is typically a very slow growing cancer and something else is likely to kill him before it does. All treatments carry significant side effects. For this reason, the American Urological Association guidelines do not recommend routine screening for men of 75. Your husband may want to consider this before going further with testing. It's his decision to make.
If he does want more testing, there is a new test that includes PSA, % free PSA, and another protein called -2ProPSA. It is called the Prostate Health Index or PHI.
There's more info about it at this link. My understanding is that insurance covers it, but you may have to visit one of their approved doctors to get it.
PCA3 is a nice complement, but it is not approved for use before a negative biopsy, so most insurance will not cover it.
- Allen