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Urology (Expert Forum)
Free PSA
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.
Free PSA
by Bil-R, Aug 04, 1998 12:00AM
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.
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.
Doctor's Answer
by hfhs M.D.-AK, Aug 04, 1998 12:00AM
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’s between 4-10ng/ml ,20-25% of the patients will have cancer. Due to your age,(by urology standard a young man) I would agree with your doctors decision to rebiopsy you they may even consider doing more than their standard amount and biopsy the transition zone if they have not already done so..
If your follow-up biopsy is negative you should continue to follow your PSA closely. If there is not a significant rise a fourth biopsy may not be indicated. It is possible, if you have had infections of the prostate, you may have a falsely elevated PSA, however with the multiple draws over the years the elevation is most likely accurate.
Please remember that an elevated PSA does not mean you have cancer but merely suggests that you are at increased risk and might need a biopsy. Another parameter you could ask your Urologist to look at is PSA density. Patients with very large glands tend to make more PSA. If you have a large gland you might find some comfort in this parameter(PSA density).
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Free PSA
