Looking for some help and advice!!

Welcome, and I hope you end up just passing through here. At this point, there's nothing you can do but wait. That said, BPH can very well be the cause of the higher than normal PSA and your symptoms are more consistent with that than PCa, which is essentially SE-free for many years. You should also know that most biopsies are negative--particularly in your age group.

Let us know what your results are. Good luck to you!

According to this Harvard website, with your psa and free psa you have a 28% chance of having prostate cancer.

https://www.harvardprostateknowledge.org/what-is-the-difference-between-psa-and-free-psa

Remember that psa is NOT a measure of cancer. There are multiple explanations of an elevated psa and cancer is but one, and not the most important. As others have said, you will need to wait at this point until more evidence comes in. When the uro performed the dre, did he find nodules? Or just a large prostate?

Hang on until you get your biopsy results. Waiting is really difficult, we've all been there but no reason to panic.

Regarding your DRE, if the uro had found a nodule I'm sure he would have told you. Regarding PCa being SE-free, it just really doesn't have any symptoms--I had no issues peeing and everything "worked" fine. OTOH, there are plenty of prostate issues that have side effects, such as BPH that can affect your ability to urinate. Also, the fact that alfuzosin is working is another sign of BPH.

Hang in there!

JohnN said...
Thanks everyone. Very much appreciated!! Anyone understand free psa. Very worried as my Uro said 14 free psa is borderline.

I'm no doctor, but "total" PSA is the sum total of all PSA present (i.e., protein-bound + free or unbound), so something doesn't seem quite right with your numbers here (i.e., the lesser of the two numbers should be the "free" value, not the "total" value). Are you sure you don't have your numbers reversed?

Here's an explanation of "free" vs. "total" PSA that might help . . .

"Rather than subject everyone with an elevated PSA to a biopsy, some urologists measure free PSA in patients with a total PSA level between 4 ng/ml and 10 ng/ml. Studies have shown that men with a total PSA in this “gray area” and a free PSA greater than 25% are more likely to have a benign condition than to have cancer, making a biopsy unnecessary. Men with a total PSA in the same range and a free PSA below 10% need to have a biopsy. More likely than not, they have prostate cancer."

If your "free" value is 5.5 (rather than 14), and your "total" value is 14 (not 5.5), that would make more sense, and then, at least according to statistics, you are apparently more likely to have BPH than PCa. However, having a total value of 14 is above the 4-10 range cited here, so that may explain your urologist's concern.

Hello John and welcome. I'm hoping your biopsy results are negative. But, if not and you want some help and support, please post the results here in some detail. We have a lot of knowledgeable folks who can assist you thru this. Anyway, good luck and awaiting your results.

Jim

I don't how free PSA manages to increase, but mine went up and down over the years. If there's one thing I've seen here over the years, it's that PSA is not a super precise cancer measurement. It's like the check engine light on your car...it's a signal to get it checked out, which you're doing.

Hope you get some good news today.

Balladeer...that's because free is a percentage of PSA. So he has a PSA of 5.5, and 14% is free PSA. (Unless I'm misunderstanding John's post...)

John, PSA is not a cancer test. Repeat. PSA is not a cancer test. PSA is test of prostate activity--infection, bicycle riding, having sex, other things will all increase PSA. Cancer is usually suspected if the PSA gradually increases over a period of time, like annual readings from 1 to 2 to 4 to 10 over 4-5 years. Or if PSA is super high, like in the hundreds or thousands (yes, it can go that high).

The only way to know is to get the biopsy results. When you get them, please post them and we'll help you understand them.

Try to relax.

Hi Michael T

I got my results back today and the 12 core samples came back benign. My doctor is sending them to ConfirmMDx. He is also having me get an MRI and additional blood work.

Obviously I’m very worried. I thought it was a relief to hear all benign but the fact he is asking for an MRI, blood work and sending to ConfirmMDx has me thinking something came back suspicious or a false negative. Otherwise, why would he order the additional tests.

Michael T

I will try to get the report today. It was such an anxious and emotional week leading up to getting the results and relief when we got the news it was benign. Now, my nerves are starting to kick back in He must have seen something on the report that was questionable or bad enough to order the additional tests. I doubt it’s just his normal protocol. I read somewhere if it comes back suspicious than most of the time the second biopsy will show cancer. I just don’t know what to think anymore. What happens if it comes back as the aggressive type and could spread. It’s totally draining !!

John,

ADT is androgen deprivation therapy--or hormone treatment that kills your testosterone. It is rarely used in low risk PC, much more common in high risk or metastatic disease. Which you don't have.

I'd second the suggestion to have your second opinion done at Johns Hopkins, they are the world experts. And, even if you have PC, it's far from a death sentence. In fact, you may never have to treat it. Even if your second opinion comes back positive, it will almost certainly be low risk--which means active surveillance (a fancy term for keeping an eye on it until something does change), is real.