Free PSA

  Total PSA rose from 1.4 in 1995 to 2.6 in 1996 to 3.4 in mid-1997 to 4.83 in December 1997 to 4.0 in July 1998.  Free PSA in July 1998 is 5 percent.  Ultrasound and needle biopsies in December 1997 both negative.
  Question is how serious is this?  Chances of cause other than PCa or pretty much a certainty?  That is, false positives in this range?  Scheduled for another ultrasound early September.  Age 55.
  Bill R.

[hfhs M.D.-AK]

Dear Bill,
There are many parameters that one can look at to determine in a patient should have a biopsy of the prostate.  Your numbers are very suspicious and I agree with your doctors wanting to rebiopsy you.  It would be important to know if you have a family history of prostate cancer and what you past prostate biopsy reports have shown.  If they show anything other than BPH I would recommend another biopsy.  There are also different areas of the prostate that can be biopsied mainly the transitional zone that can harbor prostate cancer.
Your PSA by age related criteria is on the high side.  Your PSA velocity, or the rise in your PSA related to time is also concerning.  Finally your Free PSA is in a concerning range that would indicate a need to rebiopsy.
Studies have shown that patients with a PSA