I am a 47 year old male, with a family history of prostate cancer. My father was diagnosed at age 56, had prostate removed via robotic removal and is doing fine. My paternal grandfather was diagnosed in early 60's. He was diagnosed late. It had spread to his seminal canal/vesicles and eventually spread to his liver. He died about 4 years after diagnosis.
I've been getting tested since age 42. PSA tests had been 0.9 total psa, with 0.41-0.42 free psa. This put me above the 25% mark (46%) for free psa which my urologist advised meant that I had only a 5% chance of having cancer. Each test going back to 2012 resulted in a 0.9 total psa.
I just took another test this year, last week. Total psa was 0.6, however the free psa was only 0.14. This put me at the 23% mark for free psa. According to my urologist this has raised my risk of having cancer to 12%. While he didn't recommend it officially, he offered to order an MRI which he said "typically resulted in" setting up a biopsy. The information he uses, according to the literature states that this approach of using the free psa percentage as an indicator for a biopsy is for men with total psa scores between 4.0 and 10.0. I brought this up and he stated that he finds it useful outside of those parameters.
So right now I am trying to research what my best approach is here. The reality is that my total psa score dropped three tenths of a point, from 0.9 to 0.6. I was expecting the visit to be routine, and officially it was, kind of. I would appreciate any advice but would like to hear a second opinion from a urologist if possible. Should I consider going down the road of MRI and biopsy with these numbers? Or should I take my 0.6 score, be happy with it and keep doing annual tests. Is this a smart move taking into consideration my family history. I appreciate all responses and appreciate this group.
11/2012- Total PSA=0.9 Free PSA=0.41 PSA free pct%=45.6
12/2014- Total PSA=0.9 (did not run the free psa that year)
02/2016- Total PSA=0.9 Free PSA=0.42 PSA free pct%=46.7
04/2017- Total PSA=0.6 Free PSA=0.14 PSA free pct%=23.3