I am a 36 year old male. I am currently based abroad. I had some pain urinating this past summer after I spent many days sitting on a stool at the office and was seen by a urologist at an American certified hospital. After some urine tests, UTI was ruled out. Since I am a black male and since my father was diagnosed with prostate cancer last year at 65, the doctor asked me to take a PSA test as well as a free PSA test on Aug 30 (PSA 8.880 ng/ml and free PSA 1.37 ng/ml). He also put me on antibiotics and anti-inflammatories. The urination issue was resolved thereafter and there was nothing odd detected during the the DRE. Follow up tests (free psa and psa) were taken on Oct. 25. (PSA 7.460ng/mL and FPSA of .55 ng/mL). The doctor asked me to get back on antibiotics and asked that I be tested again in November but was too busy to follow through with recommendations. He's not sure if I have prostate cancer or prostatitis.
Interestingly, when I was 24 and 30, I had visited doctors regarding pain around my left testicle. During the first visit at 24, the dr. had a scan done on the testicle and it was fine. On the second visit at 30, the urologist thought it was the vericose seal and put me on anti inflammatories. Apparently, the spinning classes were responsible for the pain. Issue was resolved after taking the meds.
Now, any advice on how to proceed? I will take the test again but I feel like I will be asked to take it again and again and again....
Thank you for your question. PSA is a protein created by the cells of the prostate gland. The prostate is made up of small glands and ducts that secrete PSA and it is usually washed out of the body via urine. As the prostate changes through BPH, prostatitis, cancer, the glandular architecture changes and the more PSA is secreted into the blood stream; making PSA a useful test in examining prostate disease.
Depending on who you ask, a PSA level above 2 - 4 ng/mL is a call for biopsy. Often times BPH, prostatitis, and prostate cancer are not mutually exclusive events. It sounds like you had a bout with prostatitis. Unfortunately, short-course antibiotics often times does not treat the condition fully and it can turn into a chronic condition.
Other confounding factors related to a PSA rise include 1) ejaculation prior to testing 2) DRE prior to testing 3) lab variation (although two consecutive tests have been elevated this is less likely to be the case).
Given your PSA levels, family history of PCa, and African American race, a biopsy may be in order to rule out prostate cancer.
Thank you for your question and good luck.
Ashutosh (Ash) K. Tewari, MD
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What I don't seem to understand is the relationship between PSA and Free PSA. In most of these forums, the FPSA is presented as a percentage but the data I received is as mentioned above. I heard that the lower the FPSA and the higher the PSA, the higher the likelihood of prostate cancer. is that true? Also, based on what you see from my PSA and FPSA results, should I worry? The doctors were not clear with me regarding these results and I want to get an additional opinion.
Serum PSA is also known as tPSA or Total PSA. Most simply this is made up of fPSA (free PSA) and cPSA (complexed). Complexed means attached to proteins.
Published literature suggests that prostate cancer is more likely to be present if the ratio of fPSA to tPSA is less than 15%; therefore, low free PSA values are more likely to be associated with prostate cancer than high free PSA values.
These compared measurements of free PSA and complexed PSA improve the ability to tell whether a rising PSA is from cancer or benign prostatic disease (e.g. BPH).
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