Need advice based on psa tests

My husband is 42. He began having his PSA test done at 40. His doctor ordered it as part of a routine screening. Shortly later his father was diagnosed with aggressive prostate cancer at the age of 66. His grandfather also had non-aggressive prostate cancer at the age of 75. His PSA test results look like this:

12/14 - 2.47
12/15 - 3.23
3/16 - 3.0
9/16 - 2.94
3/17 - 3.16

His free psa is 15% and his PSAV is .3

Prostate volume was around 35cc

We went to a urologist in March and September of last year. He was not overly concerned and suggested we wait to biopsy based on the information he had. He said if it went to 3.5 or over we would biopsy. I just want to get some opinions from others who have gone through this. We like the doctor and trust him to some extent but want to be proactive if possible. Any insight would be greatly appreciated as our emotions may be overriding logic at this point.

I would agree with the doctor. Maybe also have a PHI and/or a PCA3 test to have more results to consider. Biopsies are not always without pain or infection, I know that personally. So, you want to have a sound basis for doing them. Prostate cancer usually has a steady climb, while his has moved both up and down. Still with a free psa of 15, you need to keep closely monitoring it.

sounds to me like a very reasonable plan. Waiting and the unknown are killers, but you want to avoid the biopsy for as long as is reasonable - until there is evidence that it's truly needed.

Not sure the urethra sizes makes any difference to PSA, but it could cause other symptoms.

Andrew

That's a very stable PSA. Ask for a PHI test next time.

Thanks for all the replies so far. It's been very helpful at calming her nerves a little bit. I really appreciate the time you've taken to help. I guess my next question is in your opinion when do we pull the trigger on a biopsy? What would be reasonable for serious concern? I researched all this online but there's so much information that it becomes overwhelming and one website tells you one thing and another says something different. Thanks again as I said I really appreciate it

Here's some things to keep in mind...generally doctors should resort to biopsy only after eliminating other possible contributing factors. Know that the positive predictive value following an elevated PSA is low, typically reported to be less than 30%. For those who do advance to prostate biopsy, approximately 30% experience some type of mild to severe symptom from the biopsy process, including pain, fever, bleeding, infection or problems urinating, and about 4% of cases require hospitalization within 30 days.

Here's a bottom-line rule-of-thumb: the harder one looks for PC, the more likely one is to find it.


I'm lukewarm on the PHI test. This test is supposed to detect aggressive prostate cancer with a better specificity than total PSA and percent free PSA in a biopsy-naïve population, and should therefore be a useful tool to decrease unnecessary invasive prostate biopsies. BUT, PHI fails to accurately identify nearly 60% of all patients who (arguably) may not need a biopsy, and on the flipside fails to accurately identify all patients with potentially aggressive disease (i.e., Gleason 4 + 3 = 7 or higher). Arguably, still better than PSA...

Post Edited (JackH) : 3/7/2017 12:49:08 PM (GMT-7)

As the others have said, your situation appears to be stable with typical fluctuations up and down. As others have said, PSA is a measure of prostate activity, not a cancer test per se. Prostate cancer is usually characterized by a slow, steady rise over a period of months or years. For example, my history is similar to yours: Father died of aggressive PC, his father and grandfather had "prostate issues"--who knows if it was cancer or not?

I started having PSA's in my 40's. I was non-detectable until I was 53, then each year it took a rise from the previous year. When it increased exponentially (doubled every year) for 3 years in a row, THEN I went to the urologist.

Your PSA is hanging right around 3, give or take. It's a little higher than is considered normal at the age of 42....but it's not really doing anything either. Your doctor sounds like he's doing the right things.