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Posted 1/16/2016 3:48 AM (GMT 0)
Hello, everybody.

Please provide me with your thoughts. I took my free/total PSA blood test yesterday. Here are my results and comments my uro provided. I'm confused and scared, because I don't know what to do. Please read:

PSA still high, with concerning free-fraction, making risk of having prostate cancer around 56% (normal risk with high PSA is around 30%). But you had inflammation on last biopsy, so the slightly higher PSA could easily come from that inflammation.

There is another test performed on post-prostate massage urine sample that measures gene expression called PCA3 test. If the gene expression is low, the 75% negative predictive value that you do not have prostate cancer. If it is abnormal, then the 57% positive predictive value that you do have something. Thus, it is much better at reassuring us that there is nothing concerning there when negative, and sparing you from another biopsy. The PCA3 test is FDA approved, but insurance does not reimburse enough to cover the test, so patients are directly billed $175 for it. For most men, that price is worth it to avoid another biopsy. If you want to have that done, make an appointment for RV (return visit) and we can get that done quickly.

If the PCA3 test is positive, then I would recommend getting a multi-parametric MR of the prostate which can identify suspicious areas for biopsy. We then would fuse the MR images with a 3-dimensional prostate ultrasound to get targeted biopsies of those suspicious areas rather than the 12 "template" biopsies with standard prostate sampling.

You could skip the PCA3 test and go to the multi-parametric MR if you were concerned about the cost of the PCA3, but I think it is worth the price to avoid another biopsy if possible.


Results:
Date
Result Name
Value
Ref Range
1/14/2016 15:44
Prostate Specific Antigen
7.66 ng/mL
(0.00 - 4.00)
1/14/2016 15:44
Free Prostate Specific Antigen
0.67 ng/mL

1/14/2016 15:44
Prostate Specific Antigen Ratio
8.7 %
Posted 1/16/2016 5:15 AM (GMT 0)
I think your URO is offering a reasonable plan. If you can afford the test, do it.

but it's more than likely that you PSA is really just due to the prostatitis and BPH. Likely you nothing in the cancer line to worry much about.

Andrew
Posted 1/16/2016 5:58 AM (GMT 0)
Thank you, Andrew. What makes you feel this way?
Posted 1/16/2016 11:56 PM (GMT 0)
Folks,
Sammas would like to hear from some people other than just me.

Andrew
Posted 1/17/2016 1:58 AM (GMT 0)
Sammas, i responded to your issue in another forum. As i said, with the low %fPSA, I would get an MRI done. Then go from there.
I'm sure you saw the response, but figured i'd bump this thread up to the top for some more responses.
Posted 1/17/2016 5:28 AM (GMT 0)
Andrew, this same post is on another forum, and has received a number of comments there.
Posted 1/17/2016 8:16 AM (GMT 0)
ASA,
I'm just trying to receive different opinions. I hope that's not an issue.
Posted 1/17/2016 2:26 PM (GMT 0)

Sammas said...
ASA,
I'm just trying to receive different opinions. I hope that's not an issue.

That's perfectly fine. I've done it too. Andrew had expressed concern that nobody was replying to this post, so I wanted him to know that you had comments elsewhere.
Posted 1/17/2016 3:15 PM (GMT 0)

ASAdvocate said...
Andrew, this same post is on another forum, and has received a number of comments there.

With all due respect, I don't participate in that "other forum" so how was I to know that?

All I saw was this thread be ignored here, and decided to gently try and get the OP more comments here.

Andrew
Posted 1/17/2016 3:23 PM (GMT 0)
Andrew, you had no way of knowing. I don't think anyone meant anything derogatory. You do a terrific job of making sure every newbie who comes here has their issues and questions addressed. Keep it up
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