Understanding PSA and FREE PSA Scoring

I have results from 2008 October and 2009 November. I know PSA scores going up are cause for concern, but I dont understand the free PSA scores and what they indicate relative to PSA results.
Thanks for any help


2008
PSA 6.2
fPSA 1.9
DRE no indication of tumors; smooth w/ no lumps

2009
PSA 7.8
fPSA 1.9
DRE no indication of tumors; smooth w/ no lumps

Go-dash, did a Google search on free PSA and found the following information:

Typically, men have a percent-free PSA above 25%. Between 10% and 25% is considered an intermediate range and below 10% is considered to be low. PSA occurs in 2 major forms in the blood. PSA comes in two forms. One form is attached to blood proteins while the other circulates free (unattached). The percent-free PSA (fPSA) is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.

This test is sometimes used to help decide if you should have a prostate biopsy if your PSA results are in the borderline range (between 4 and 10). A lower percent-free PSA means that your likelihood of having prostate cancer is higher and you should probably have a biopsy. Many doctors recommend biopsies for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers while helping some men to avoid unnecessary prostate biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy.

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Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!

Sephie is correct. When my PSA first hit 4, my doctor ordered a free PSA and it was 12%. He suggested a biopsy then, telling me that a score around 10% or less is an indicator of PC, but since my total PSA was borderline, I could afford to wait.

I decided to wait, and the next year my PSA was in the threes, but my free PSA was still around 10%. Following year my total was over 5, I had a biopsy, they found PC, and the rest is history.

Moral of the story, in my case, the free PSA was indicating PC more so than the total PSA. However, there's a lot of noise in the free PSA number, so there are also a lot of false negatives.

What I understand is that a high PSA combined with a high free PSA, say around 30% or so, indicates a good chance of benign prostate disease (swelling, infection), rather than PC. In that case they oftentimes give you some pills to reduce inflammation in the prostate before retesting.

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Age 64 yrs
DX 5/2009
8 out of 12 cores positive
PSA 5.6
Gleason Score 3+4=7
Stage T2a
Da Vinci Surgery 08/07/2009
Upgrade Gleanson Score 4+3=7
Stage pT2c
Neg Margins and Nodes
Extracapsular extension noted but neg Extraprostatic Extention
Dry immediately
First PSA 11/3/09 <0.1

My PSA was 9.83 and my fPSA was 8% and the rest is history but it was the fPSA convinced the doctor for me to have second biopsy of 24 cores

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Age 64 From UK now in Thailand Baby boy born 2/14/2009 First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08  1/28/09 Biopsy carried out 12 core results show no adenocarcinoma 5/15/0924 Core biopsy results Gleason'S Grade 3+2=5 Involving approx 30% of one out of 12 cores on each side no perineural or angiolymphatic invation identified One side PIN High Grade Bone scan clear  Open surgery 7/27/09 Prostate Gland weighting 34 grms lost one nerve bundle Gleason upgraded to 3+3 Tumour not close to prostatic capsule Seminal Vesicles not involved by Tumour 6 Lymph Nodes negative for Malignant cells First PSA Nov 2009 was 0.06 Continence 99% occasional stress dribbles no ED from first day after catheter removed

Thank you all for the information.
When I look at my blood work up results, I see fPSA 1.9. It does not say high or low. It does not use a percent either.
Is it 1.9 %? If so, that is quite low...

Yikes!

Not claiming to be expert on this area I have heard that this test is useful for people whos normal psa levels are like(approx.) 4.0 to 10.0 range. Higher psa's especially much higher (say)20.0+ they are saying the test is not useful. Supposedly worthless test for higher ranges of normal Psa's. In fPsa testing looking for the unbound-"free" antigens that are basically floating around freely vs. bound together antigens I believe is the concept. 

Generality fPsa >25% level is supposedly less than 10% chance of PCa (makes the test look worthy on this basis)

fPsa level of 10%< about 50% chance of having PCa (leaving alot of middle ground and unknowns for other levels in between these percentages)

Not all that definitive, as is almost everything in PCa including biopsies, psa, scans, etc.

Post Edited (zufus) : 11/17/2009 6:17:06 PM (GMT-7)

Maybe silly question, but why is free PSA only applicable if PSA is between 4 and 10? As you can see in my stats, PSA has risen pretty sharply since Dec. 08 and fPSA was at 15%. My uro said it was inconsequential since my PSA was not at a 4. Biopsy was negative in June 09, took regimen of antibiotics, but PSA keeps rising. Have appt. in December with uro. and we'll check again. Can anyone answer the fPSA question only being of concern if the PSA is between 4 and 10?

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DOB=March 1959
PSAs (*s done @ uro's lab; others @ family doc): 10/05=1.2; *10/06=1.22; *12/07=1.68; 08/08=1.5; *12/08=1.93; 04/09=2.9; 04/09retest=3.4; %fPSA=15%; *05/13=3.17; *08/09=3.45; 10/09=3.7; DRES=neg.;
06/09 Biopsy=12 benign cores, 3 cores show prostatitis.

Go-dash, in every report I've see, fPSA is reported in the same units as PSA, and the percent is also included, but not by itself. Your PSA was 7.8 so your free psa is about 25%, pretty good.

Okboy I had the same question with my low fPSA and a PSA of 4.1. I was told that fPSA has only been studied between 4 and 10, so they don't really know how well it applies below 4.

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Age 64 yrs
DX 5/2009
8 out of 12 cores positive
PSA 5.6
Gleason Score 3+4=7
Stage T2a
Da Vinci Surgery 08/07/2009
Upgrade Gleanson Score 4+3=7
Stage pT2c
Neg Margins and Nodes
Extracapsular extension noted but neg Extraprostatic Extention
Dry immediately
First PSA 11/3/09 <0.1

The following article is the best I've ever seen in explaining how to use PSA and psa dirivatives in DXing PC from BHP.
http://www.prostate-cancer.org/pcricms/node/119
JohnT

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64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

Go Dash-

My PSA / Free PSA test results are always reported this way:

Test Name: PSA (Free and Total)

  Total PSA               (PSA value)                                              ng/ml
  Free PSA                (value, normally 0.5 to 1.5 for me)           ng/ml

Test Name: % Free PSA

  % Free PSA          (value, normally 7 to 11 for me)

Unless your doc requested a specific % free PSA diagnostic test, you probably received the results for PSA (Free and Total), which does not give the actual %, just the amount (in ng/ml) of free PSA present.

You may want to search to find the recent post by Nodaker about her husband's color doppler biopsy and % free PSA info.

Dan

 

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Age 49
PSA 6/2003 1.5
PSA 7/2/2008 4.8, % free PSA 8
PSA 7/14/2008 5.2, % free PSA 8
3 weeks Levaquin
PSA 9/2008 5.8, % free PSA 7
Biopsy 10/08 10-core all neg, no sign of PCa, told prostate was enlarged
PSA 12/2008 5.2, % free PSA 7
PSA 2/2009 4.7, % free PSA 8
PSA 5/2009 5.2, % free PSA 8
Biopsy 6/2009 12-core all neg, no sign of PCa, prostate "slightly enlarged".

My PSA was 3.7 and my free PSA was 11%. My doctor told me that I had a 33% of having PC and suggested a biopsy which turned out positive for PC.

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Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1