Variable PSA levels

I am 53 years old, caucasion and have had annual PSA tests along with other blood work since my 50th birthday. My PSA levels for the first 2 years were both 1.0 but after a routine physical this year it jumped to 6.1. My General practioner sent me to a Urologist who also did a DRE (as did my GP) and it was normal both times. He retested with a free PSA and this time the PSA lowered to 4.8 but the free PSA was 13% which I am told is suspicious. He now is scheduling a biopsy in a couple of weeks. I have no physical symptoms other than a minor chronic low back ache which I have had for many years (at least 3 or 4). I have no family history of Prostate Cancer as far as I am aware and am very healthy, working out 3 times a week and maintain my weight well within a reasonable weight range.  My question is, how likely is it that any cancer, early or advanced could exist and should I seek a second opinion on the biopsy since the second PSA has come down to a level not too far above what would be considered in the high normal range?

[Kevin Pho, MD]

Hello - thanks for asking your question.

It is difficult to give "odds" on whether you have cancer or not.  However, a free PSA percentage of less than 14% increases the likelihood of cancer.  

Note that there are many other diseases that can increase PSA - most notably prostatitis and benign prostatic hypertrophy (BPH).  

To be on the safe side, I definitely concur with obtaining a prostate biopsy - it is the best way we have to determine whether cancer is present or not.  

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.