free psa question

Urologist said percent free PSA figure was of no consequence unless total PSA was over 4. What are some of you hearing from your uro's about this? Any information?

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Current age 50
Married - 4 children, 2 grandchildren
General health good - meds for hypertension; mitral valve prolapse (no meds)
No known family history of PCa
PSA 10/2005 = 1.2 (free testing site)
PSA 10/2006 = 1.22 (urologist)
PSA 12/2007 = 1.68 (urologist)
PSA 08/2008 = 1.5 (family doc)
PSA 12/2008 = 1.93 (urologist)
PSA 04/2009 = 2.9 (family doc - routine physical)
PSA 04/2009 = 3.4 (family doc sent in to different lab)
PSA 05/13/09 = 3.17 (urologist)
%fPSA 04/2009 = 15% (family doc)
4 DREs over the years - all unremarkable

Biopsy scheduled for June 5. Thanks.

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Current age 50
Married - 4 children, 2 grandchildren
General health good - meds for hypertension; mitral valve prolapse (no meds)
No known family history of PCa
PSA 10/2005 = 1.2 (free testing site)
PSA 10/2006 = 1.22 (urologist)
PSA 12/2007 = 1.68 (urologist)
PSA 08/2008 = 1.5 (family doc)
PSA 12/2008 = 1.93 (urologist)
PSA 04/2009 = 2.9 (family doc - routine physical)
PSA 04/2009 = 3.4 (family doc sent in to different lab)
PSA 05/13/09 = 3.17 (urologist)
%fPSA 04/2009 = 15% (family doc)
4 DREs over the years - all unremarkable

I don't know the current percentage, but it used to be that 70% of the biopsies were negative, so here's hoping yours is, too. My psa was always +/- 2.8, then in one year it went to 4.85, so the uro said a biopsy was in order. With no history of PCa, I instead chose a course of Levaquin to see if it might infection. Since my psa was then still 4.8, I did a biopsy, which found 7 out of 12 core samples positive! 4 were Gleason
2+3, and 3 were 3+4, which means I was a Gleason 7. I chose to do proton therapy last summer, and it was an incredibly positive thing. With this kind of therapy, your psa comes down slowly over 2 years. At 9 months, mine is now 1.05 and falling steadily, so I couldn't be happier! I know lots and lots of guys with relatively high psa's (some over 20) who have had several negative biopsies. In most cases, their higher psa was related to an enlarged prostate, which is not uncommon as guys age. I am pushing 65 and have never had the enlarged problem fortunately.

As to free psa, I think the range is between 10-20% for a potential PCa. Anything lower than 10% they assume it is a given, over 20% assume it does not exist. After treatment, I'm not sure what the point of even looking at it is, although they do it regularly.

Way back in another life when I had been discussing with my Uro and PA whether we should get a FreePSA reading before doing a biopsy, they said that it was not really necessary since no matter what it came back for a value they would still want to do the biopsy anyways (my PSA velocity certainly indicated PCa going on -- which turned out to be the case).

But, another Doc I was seeing for something else drew up a list of tests he wanted that did include FreePSA. At that time, which was only about a month after the Biopsy, showed the free PSA to be 19.6% which was below the >25% cutoff point. And yes, at only one month after biopsy my prostate was still pissed off at being stuck with needles and my total PSA was around 10.7 -- Around 3 points higher than the pre-biopsy values. We knew it was very early for it but did it anyways for the heck of it.

And the rest is (medical) history!

jim

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Age 58, 195lbs, 6'4", 57 at DX, PSA Aug2008 7 4 ... June2007 4.7 (BPH + LUTS)
Biopsy Nov2008 1 of 12 cores 5%, Gleason 3+3 - Sona showed 140+ cc (110 grams post op) prostate size.
02/03/09 open RRP surgery , Nerve sparing both sides, 1 day in hospital, Day 4 first BM,
Pathology Report: All margins clear - No Invasive spread - no change in Gleason score.
02/18/09 Cath out, passed a 1cm STONE within hours.
Using pump (Encore) daily since catheter out - working good with 2 rings.
04/01/09 Was Oxalate stone -- usually from kidneys -- X-ray Kidneys @ next PSA).
03/06/09 Started Levitra 20mg rehabbing -> no real effect yet (04/01/09) . (Same for Viagra @ 100mg)
04/01/09 PSA <0.1 (And starting Cialis daily @ 5-10mg) -- 04/19 nocturnals finally starting!