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High PSA with Low Free PSA

  My PSA rose from 5.0 in June of 97 to 7.0 in November 97 to 10.3 in March of 98 to 18 in June of 98 (no history before June 97).  Free PSA in June of 98 was 10%.  Ultrasound and needle biopsies after all four PSA tests were negative.  Prostate enlarged but no reduction in urinary flow.  No urinary tract infection or prostatitus indicated.  I am aware that an elevated PSA can be the result of an enlarged prostate but would it be has high as 18?
  I am 50 years old and there is history of PC in my family.  My father and his two brothers all have PC.
  It there a corellation with the rate of change of the PSA and PC?  If so, can you advise what it is?  What is the probability of PC?  I am scheduled for another PSA and Free PSA test in September but I am at a point of not wanting to have the test or know the results.  I think I might be better of not knowing since this is weighing heavily on my mind.
  Thanks for any information you can provide.
Dear John,
PSA (Prostate Specific Antigen) is an important tool used by urologists to detect prostate cancer. A PSA level of greater than 4.0ng/ml is associated with prostate cancer. Recently research efforts have been directed at assessing the rate of rise in PSA over time as well evaluation of free PSA. It is currently felt that a rise in PSA of greater than 0.75ng/dl in one year or a rise of greater than 20 % over 2 years is suspicious for cancer. There are several factors that can falsely elevate the PSA including  urinary tract infections, foley catheterizations, recent prostate biopsy ( less than 6 weeks ago) and a severely enlarged prostate. Prostate biopsy is performed when the PSA is greater than 4.0 ng/dl to evaluate for prostate cancer.
In your case  the rapid rise in your PSA was appropriately evaluated with a biopsy. In the absence of infection or  the other causes of falsely elevated PSA  previously mentioned, a repeat biopsy is wise . You are young and apparently otherwise healthy. Early detection of a cancer would result in a very high chance of cure. A repeat biopsy is warranted in your case.Some men undergo three or more biopsies before the cancer is detected. It is worth the effort because the cure rate is quite high when detected early in the course of the disease.
A family history of prostate cancer  is important also. Repeat PSA and or biopsy is imperative in your case.We would be happy to see you here at Henry Ford Hospital. There are many urologists  here who specialize in this area . This information is provided for general medical education 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).
*keyword: PSA

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