Is there cause for concern in decreasing free psa when the overall psa score drops?

[w1lsonky]

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.

PSA History
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

[JGF25]

I guess my question to you is what is going to make you feel better?  The DRE was normal but if this is going to haunt you every day, then I say go ahead with the biopsy.  I am CL of OCD forum so I know all about overthinking.  Hubby never had an MRI.  At 15% chance my husband had cancer....Gleason 7 totally confined to the prostate and undetectable PSA levels since his prostatectomy a year ago.  It happens but I hope not to you.  I will monitor the page for any updates from you.  I obviously did a lot of research into the best options for my hubby and may be able to help you a bit there IF it turns out positive...but I'm betting it won't.  :)  JGF25

[w1lsonky]

Well, since it dropped in total instead of rose, I am leaning toward doing another psa in 6 months as opposed to a year.  We will see.

[w1lsonky]

I guess the reason for my question was to understand from another source why, with a score that is so low, and that had dropped, would a biopsy even be brought up.  Is there another opinion on the numbers.  Thanks for the input.

[JGF25]

Hi there....so I'm not a guy but my husband had prostate cancer with a PSA of 3.  That put him at the 15% risk level if you go by PSA levels of 4 and below.  His father also had prostate cancer at an older age...my hubby was 57.  You have I believe you said 0.6 PSA level.  Did the doc say anything about the digital exam?  Any findings there?  

I think when it comes down to it, for you anyway, it may be a matter of anxiety due to family history.  I hate percentages.  My friend had a higher PSA level than my hubby and had a normal biopsy result.  You just can't go by the numbers sometimes.  

My advice is see if it goes higher...if you near the 3 to 4 range with your history, I think you should consider a biopsy.  They are not pleasant at all according to my hubby.  

[w1lsonky]

DRE was normal.  The only risk issue was that the free psa dropped to below 25%. Took me from a 5% risk to a 12% risk. However, the total psa dropped as well, from 0.9 to 0.6.