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Posted 8/23/2014 7:06 AM (GMT 0)
I am a 50 year old Asian man. I have had 3 PSA tests within a month since 07/2014. They were ranged from 4.6 to 4.3. At the same time, I had 2 free PSA tests: one is 18% and another is 5%. I had a biopsy but the result was negative. The PSA density is .36. My urologist asked me to wait for 6 months to do another set of PSA tests. But I am very concerned with my very low free PSA and high PSA density test. I feel waiting for 6 months is too long, but at the same time I don't know what the options for the next step. Does anyone have any suggestions? Thanks a lot,
Posted 8/23/2014 11:58 AM (GMT 0)
If you are that worried, I'm sure that your urologist would agree to you having a PSA test in 3 months. But PSA tends not to vary by great amounts in short periods of time, so you would probably be wasting your time.

Your free PSA is a little low but your overall PSA is not that high. In Canada, 4% is usually the level where they request a biopsy. Your biopsy came out negative which is a major plus. You may just have a prostate infection. However, I've seen studies that say about 50% of men in their 50s have a little bit of Gleason 6 cancer - most die of something else and never know it. Asian men have statistically lower rates of prostate cancer but the rates creep up toward the general population when they adopt a North American lifestyle.

I fully realize that this stuff is unsettling but my advice would be to try to relax and take this as as an incentive to examine your lifestyle. If necessary, try to improve your diet, exercise and stress level. You may be very fortunate to have this warning sign early as I believe that is when lifestyle modifications can have the maximum benefit.

Take care
Posted 8/23/2014 4:28 PM (GMT 0)
Your next step should be an MP-MRI. Bostwick Labs also has tests like Polaris and PHI to determine if you should get another biopsy.
Posted 8/23/2014 5:00 PM (GMT 0)
I think waiting 6 months is very reasonable - PC is generally a very slow growing disease, and with your negative biopsy you have reasonable assurance that if you have it, it is not very extensive. This is especially true because of your small prostate - biopsies are more likely to find cancers in small prostates.

There are two biochemical tests you can ask for next time. In the US, they are covered by insurance.

(1) Prostate Health Index (PHI) is a combination of PSA, % free PSA, and -2ProPSA.
(2) PCA3 is a urine test after a prostate massage. It is approved for use after a negative biopsy when suspicion remains.

BTW- are you sure that your PSA density calculation is correct? That would mean your prostate is only 12 cc, which is very small.
Posted 8/23/2014 7:25 PM (GMT 0)
Hello Asian Man and welcome. JohnT and Tall Allen are two of our most experienced and most knowledgeable members. I cannot add to their excellent advice.

Jim
Posted 8/23/2014 10:25 PM (GMT 0)
Asianman,

You mentioned you PSA density, but you didn't mention your prostate size. Given the information you gave (psa=4.6, psad=.36), your prostate size is 12.7ml which is very small. PSA density should be below .15. So your prostate is putting out more than twice the amount of PSA then it should be.

With those number you would want to further investigate the elevated PSA. I would believe a multiparametric MRI (mpMRI) is warranted in you case.
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