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low PSA VS low Free PSA
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low PSA VS low Free PSA

A year ago, my father (65 yrs old) was scheduled for prostate checkup, both PSA & Free PSA were ( 4.5 and 14.5 %) respectively, DRE exam was ok,  his doctor put him on some kind of antibiotic, and 3 months later, tests were taken again and ( no change in both PSA & F PSA), and DRE exam was fine too. During that time, he’s had some symptoms such as urinating more frequently at night, some pain during urinating. So his doctor asked him to take biopsy. Biopsy ( 6 samples), results came out negative. Now 6 months have passed by, results were as following: PSA = 3.91, and Free PSA = 13 %, DRE exam was ok. His doctor asked him to wait for another 3 months and re-take those tests?....

My concern is the decrease in the free PSA, I understand that normal free PSA should be >25%, and I also understand that the decrease in the free PSA is most likely diagnosed as cancer? But the thing is his PSA level is going down, so I m kinda confused?....should I be worried? And do you recommend he’d go for another Biopsy before the 3 months are over?....

Please advice….
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242579_tn?1252114771
Dear Rakan, your understanding of the PSA values and Free PSA is correct. Normal PSA values fall between o and 4, and Free PSA needs to be higher than 20 %.  Keep in mind that PSA is sensitive but not always specific; which means that prostate cancer cannot be present when you have normal PSA readings, but not all elevated PSAs indicate the presence of cancer. Your father's lab values fall within the "gray zone", therefore a biopsy repeat is recommeded. Biopsies that take 6 cores have higher probability of missing the cancerous tissue than 12 core biopsies.



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