4.57 PSA total free PSA 7%

[johnlinda]

My father is 73 years old.  He had a recent PSA of 4.57 with the total free PSA of 7%.  I have heard if the free PSA is below 15% it is most likely cancer.  Is this true? Also, he is scheduled for a biopsy and ultrasound later this month. Please note that his PSA was 3.4 nine months ago.  His father had prostate cancer in his 80's and a first cousin (in his 60's) has also had prostate cancer.  If it is cancer do you think it will be in its earliest stage since his PSA nine months ago was within the normal range? Also please note that over the past few years it has been slowly rising.  Also, do all prostate cancers require chemo and or radiation?

[Ash Tewari, MD, M.Ch.]

Hello,

Unfortunately with a rising PSA and a total free PSA which is less than 20% these findings are consistent with diagnosis or prostate cancer. It is not possible to say definitely without obtaining biopsies but all factors taking into account, the PSA of 4.57 and the total free PSA of 7% is low which is suggestive of malignancy.  Also the family history is in the favor of malignancy with his fathers diagnosis, and his first cousin as well. The staging of the cancer is not possible to predict as there are studies being conducted on PSA velocity currently. A "metastatic workup" might be necessary depending on the biopsy result, if benign, than likely nothing more will be done. If malignant, a bone scan, CT abdomen pelvis and endorectal MRI could be indicated to determine any spread. If the tumor is organ confined, surgery in the form of radical prostatectomy has been curative in almost 100% of cases at 5 year follow-up. If the tumor has spread, lymph nodes positive, or bone mets, chemotherapy or radiation could be required. First things first, get a biopsy.

Thanks!

[johnlinda]

Thanks for  your time and honesty!