Free PSA + Biopsy ??'s

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New Member

Date Joined Nov 2009
Total Posts : 6
   Posted 11/28/2009 1:33 AM (GMT -6)   
Sorry if this is a silly questions but I keep coming across posts with "free PSA" which I have never really heard of...only known about PSA...I just wanted to know what the difference was if there was any...

Also, has anyone encountered a false positive with their biopsy? I did research about my dad prostate cancer and remember reading about this but that was a while back and my brain is full of tons of things at this time...

I wanted to know if the biopsy confirms prostate cancer 100%....I am trying to see if we can request a second biopsy because my dad is still in denial and thinks the prostate biopsy came back positive for cancer because he had cancerous bladder tumor...Do you just flat out ask the doctor for a second biopsy?

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 11/28/2009 4:26 AM (GMT -6)   
Free PSA:  There is another thread from several days ago on free PSA (and complexed PSA, and total PSA) that should be informative.  Please go here:  The differences are explained there.
The biopsy is the definitive test for cancer.  To my knowledge, a false positive does not exist, except to the extent of Gleason scoring variation which is subject to interpretation of the individual pathologist.  Gleason scoring tells the extent of the cancer cell development.  It is very common to request a second pathologist's opinion of the biopsy slides to confirm the readings.  Bostwick Labs does a lot of this and is considered a prostate cancer them for more info on how to send your slides to them.
Prostate cancer has it's own unique cellular mark.  When prostate cancer spreads to bones, it is not "bone cancer"; rather, it is prostate cancer that has spread to bones.  When it spreads to the liver, it is not "liver cancer", rather it is prostate cancer that has spread to the liver.
My suggestion is rather than ask for a second biopsy, confirm these points in a phone call with your doctor.  I also recommend getting yourself, and reading, a good PC reference book to explain and answer these questions.  I recommend A Primer on Prostate Cancer, The Empowered Patient's Guide, by Strum and Pogliano, which is easily found online. 

Post Edited (Casey59) : 11/28/2009 3:44:19 AM (GMT-7)

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 11/28/2009 9:07 AM (GMT -6)   
Jojo, I am sorry that you and your dad are going through this. I can only imagine how "full" your brain is at this point, and how difficult it is dealing with your dad's denial.

Each type of cancer is different - prostate cancer cells look different than bladder cancer cells which look different than breast cancer cells, etc. A pathologist is trained to look at these cells and determine what type of cancer cells they are. It is very possible to have 2 different types of cancer and have them discovered at the same time, especially when they are in the same area within the body. If your dad's bladder cancer had spread to the prostate, the pathologist would have been able to determine that. When a cancer - for instance, breast cancer - spreads to another part of the body, it is still breast cancer even though it might be in the bones or the lungs. This is referred to as metastatic cancer.

I have never heard of a false positive for a biopsy as cancer cells, especially those that are aggressive, have a very scattered pattern. Normal cells are very well differentiated and cancer cells are less differentiated. The more aggressive the cancer, the less differentiated the cells.

Free PSA is the amount of PSA that circulates within the blood system. The lower the percent of PSA circulating the greater the likelihood of prostate cancer. Free PSA should be around 25% or higher - my husband's was 11%. This, along with the rise in his overall PSA led to a biopsy which led to the diagnosis.

I would strongly suggest sitting down with your dad and his doctor and having an honest discussion about your dad's diagnoses.
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!

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4171
   Posted 11/28/2009 12:07 PM (GMT -6)   
There are a lot of false biopsies; if you have a Gleason 6 and a very low core there is a good chance that tt will be indolant PC. They still use the term "vanishing cancer" to account for no cancer being found in the pathology after radical surgery. Also 3D mapping biopsies after an initial bopsies found no cancer in 27% of patients that had only 1 positive core.
This really doen't mean that there is no cancer, because the chance of having PC cells in your body after 50 years old matches your age. These are small pinpoints of cancer cells that may be pcked up in a biopsy but will never grow into anythng that would hurt you. Unfortunately many people undergo radcal treatments wth permenant side affects for something as inoccuoius as a freckle.
The fact that having bladder cancer will have no affect on having prostate cancer or having a positive biopsy; they are completely dfferent cancers that are not related. If he has had a postive bopsy he must not gnore it and should contact his doctor and reveiw his Gleason score and psa levels and get a good stagng of his PC. Ignorng it is not a good option.

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.


Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 11/28/2009 12:50 PM (GMT -6)   
It would help if you could post your dad's biopsy results -- number of positive cores, % cancer, Gleason score. You might also tell us why his doctors decided to do a biopsy in the first place. You will probably have to call the doctor to get this info. Take a look at the sigs at the bottom of each of our posts to see the kinds of information that we include. Remember -- none of us knew what to ask or what to keep track of when we got here and we were helped by those who were here before us.

In general, a biopsy can give a false negative but only rarely a false positive. A false positive can mean that the biopsy needle got the entire tumor. As others have suggested, have your dads slides sent out for a second reading just in case of the very rare event of a misreading.

Remember that a biopsy is not without its own risk -- if you are thinking of a second biopsy have a very serious talk with your dad's uro about advantages and disadvantages.

Finally, cancer is frightening but PC has many good treatments. Depending on your dad's stats, he may be a candidate for watchful waiting -- monitoring PSA and perhaps doing a repeat biopsy in a year or two. Note that this is a medically supervised treatment -- not at all the same thing as denial.

In any case, we are here for you and your dad -- ask what ever you want.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day

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