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Urology (Expert Forum)
High PSA, Low Free Psa
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
High PSA, Low Free Psa
by gstreamcapt, Apr 01, 2003 12:00AM
Male,age 68, excellent health.I have worked out regularly ever since I was a young USAF pilot. I have had BPH since age 58.I am taking Hytrin, 5mg. No problems until last year when PSA went to 10. Five weeks of Cipro but PSA still high. 12 needle biopsy, negative. Three months later,PSA down. Six months later PSA 11.Free PSA 2.9(28% chance of cancer). 12 needle biopsy again negative. I am scheduled for another PSA in three months for further evaluation.
Question: Is this too soon? I have no symptoms at all and only have to get up once or twice during the evening. I did have slight amount of blood in my urine about 18 months ago. Also some blood in my semen until last year.I feel that I may have an infection. I am now taking saw palmetto(Prostate 5Lx) twice daily and feel that the antibiotic Vibra Tab might help. I don't want to continually have to take a biopsy. Kindly request your thoughts?
Thanks.Gstreamcapt
Question: Is this too soon? I have no symptoms at all and only have to get up once or twice during the evening. I did have slight amount of blood in my urine about 18 months ago. Also some blood in my semen until last year.I feel that I may have an infection. I am now taking saw palmetto(Prostate 5Lx) twice daily and feel that the antibiotic Vibra Tab might help. I don't want to continually have to take a biopsy. Kindly request your thoughts?
Thanks.Gstreamcapt
Doctor's Answer
by Kevin Pho, MD, Apr 01, 2003 12:00AM
, Apr 01, 2003 12:00AM
Hello - thanks for asking your question.
The lower the free PSA, the higher the risk of prostate cancer. Studies show using a cutoff of <10 percent free PSA, the probability of cancer is 56 percent. You have a percent free PSA percentage of 26% - studies show that the probability of cancer in that range is 8 percent.
The sample from a prostate biopsy is relatively small and may miss any cancer. A repeat biopsy may be done via ultrasound guidance to enhance yield. You may suggest this to your urologist. Studies show that 3rd and 4th biopsy attempts yield cancer in 4 to 5 percent of cases.
I would agree with the recommendation of the 3 month PSA test. If there is blood in your urine, you may also consider bladder cancer and further evaluation with a cystoscopy.
To answer your question, I would say that 3 months is not too soon.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
The lower the free PSA, the higher the risk of prostate cancer. Studies show using a cutoff of <10 percent free PSA, the probability of cancer is 56 percent. You have a percent free PSA percentage of 26% - studies show that the probability of cancer in that range is 8 percent.
The sample from a prostate biopsy is relatively small and may miss any cancer. A repeat biopsy may be done via ultrasound guidance to enhance yield. You may suggest this to your urologist. Studies show that 3rd and 4th biopsy attempts yield cancer in 4 to 5 percent of cases.
I would agree with the recommendation of the 3 month PSA test. If there is blood in your urine, you may also consider bladder cancer and further evaluation with a cystoscopy.
To answer your question, I would say that 3 months is not too soon.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Member Comments
by frank1954, Apr 08, 2008 02:42PM
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