free psa question

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OKboy
Regular Member


Date Joined Apr 2009
Total Posts : 55
   Posted 5/25/2009 10:31 AM (GMT -7)   
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?
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


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4018
   Posted 5/25/2009 2:27 PM (GMT -7)   

Dear OK:

Some urologists will begin looking at % free PSA when PSA reaches 2.5.  In your situation it's a moot point anyway...a % free of 15% is totally inconclusive and doesn't point to anything.  Probably of more concern is the continuing rise of your PSA, i.e. the velocity. 

What is your urologist suggesting at this point...biopsy? Repeat PSA tests?

Tudpock 


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 5/1/09.

OKboy
Regular Member


Date Joined Apr 2009
Total Posts : 55
   Posted 5/25/2009 2:40 PM (GMT -7)   
Biopsy scheduled for June 5. Thanks.
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


riverbend
Regular Member


Date Joined Mar 2009
Total Posts : 39
   Posted 5/25/2009 5:40 PM (GMT -7)   
I had a PSA of 3.25 and my (old) Uro would not give me the free PSA test...said it would be inconclusive with that low of a PSA.  Though I have seen others here who had free PSA with similar scores.  Best wishes on the biopsy.
Dx T1c in April, 2009 at 45 years old after recent PSA tests ranged from 2.93-3.25
2 of 14 cores positive at 5% and Gleason 3+3... 2 cores taken from a "protuberance" were "ASAP"
Proton radiation at LLMC May-June 2009


farfel
New Member


Date Joined May 2009
Total Posts : 6
   Posted 5/30/2009 4:09 PM (GMT -7)   
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.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/31/2009 2:26 PM (GMT -7)   
Oncologists are much better at knowing about PCa issues than uro-docs in general. I would not put all my trust into a uro-doc, I have personally seen errors, agenda and border line malpractice and this is from an experienced one and he has plenty of customers, always had people waiting to see him. Leading onco-docs like Dr. Strum is where you should get your PCa information (his books, seminars etc.). His thoughts on fPsa are different than this uro, has also has corrected many uro-docs about all kinds of PCa parameters, etc. Not saying fPsa test is all that reliable anyway, but the uro herein is not the potential patient having PCa, there are many tests mentioned in Strums book(s) that can be revelant and useful. When in doubt see an experienced onco-doc escpecially a PCa onco-doc, second opinions are most valuable when it comes to your family jewels and living longer.
 


Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 5/31/2009 5:55 PM (GMT -7)   
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
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!

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