Possible to have PC with very low PSA?

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Regular Member

Date Joined Jul 2006
Total Posts : 202
   Posted 2/2/2010 1:25 PM (GMT -6)   
I have a friend that has a PSA level below 2.0.  But his doctor felt something suspicious when he did the DRE.
I know the PSA velocity is important, but since this was his first PSA test he doesn't know if there is any velocity.
So, my question is: Can you have PCa without the PSA looking suspicious?  I told my friend he should have a biopsy, but he is of the opinion that since his PSA is so low, a biopsy would be a waste of time and money.  Plus it would hurt.
Any opinions or references that might enlighten us would be greatly appreciated.
Thank you.
PSA 5/22/06: 5.6
DaVinci surgery: 9/14/06
Gleason: 3+3
Organ confined, clean margins.
Both nerve bundles spared.

Regular Member

Date Joined Nov 2009
Total Posts : 254
   Posted 2/2/2010 1:35 PM (GMT -6)   
Please encourage your friend to get the biopsy.  I had a PSA of 1.3 when the urologist felt something that didnt feel right last summer.  As it turned out I did have prostate cancer and had surgery earlier this month. 
diag 9/09
age at diag 54
PSA 6/09 1.3
stage 2b (biopsy done because of firmness felt on right side)
3 positive cores out of 12 (all less than 25%)
Gleason 6
Surgery  1/13/10 at UP- Penn Presby with Dr David Lee. Home 1/14/10 Nerves spared on both sides -Catheter removed 1/19/10  Path report scheduled for 2/11/10

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4849
   Posted 2/2/2010 2:02 PM (GMT -6)   
DITTO. My PSA never got above 1.3....but I too had nodules.

Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 2/2/2010 2:05 PM (GMT -6)   

The National Comprehensive Cancer Network (NCCN) offers an excellent online document called "Practice Guidelines in Oncology--Prostate Cancer Early Detection."  Find it here:


Shortcut to page 7, which says that a positive DRE should be followed by a biopsy, regardless of PSA results.

Hope this helps...



I re-wrote my original posting.  I originally posted about getting a "% free PSA" test, but then recalled that this test is for patients in the "diagnostic gray zone" of between 4 & 10 ng/mL.  I deleted everything I wrote about the "free PSA" test, and left only info on the NCCN document.

Post Edited (Casey59) : 2/2/2010 1:07:52 PM (GMT-7)

Forum Moderator

Date Joined Sep 2008
Total Posts : 4278
   Posted 2/2/2010 2:18 PM (GMT -6)   


1.  If your friend has not seen a urologist, he should.  His PCP is most likely unprepared to deal with this.  And, yes, it is possible to have PCa with a low PSA.

2.  Getting a % free PSA is also probably a good idea however...if a urologist feels something suspicious it is likely that a biopsy will be recommended whatever the free %.

3.  A biopsy does not have to hurt.  Many of us here have had them under IV sedative and there is no pain involved.  My urologist describes this as a "civilized approach".

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 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 2/2/2010 2:31 PM (GMT -6)   
With any kind of positive DRE, a biopsy is in order, and most don't hurt real bad, the pain part can be disucssed with the dr. ahead of time and there are options there too. This is a case where the PSA number isn't the real issue, the positive DRE is, which means something can be felt.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time

Regular Member

Date Joined Feb 2009
Total Posts : 65
   Posted 2/2/2010 2:40 PM (GMT -6)   
My PSA was 0.9 and during my annual physical the doc felt a little something on the DRE. I had a biopsy and they found 3 positive PCa in 12 samples. I had surgery in August 2008.
Age now 45 (43 when dx)
Pre-op PSA:  0.9
Biopsy: 3/12 cores pos  20% 30% 50%
Gleason 3+3=6
Robotic RP:   Aug 2008 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report: Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes

Regular Member

Date Joined Feb 2009
Total Posts : 63
   Posted 2/2/2010 4:20 PM (GMT -6)   
I was diagnosed at Ft Leonard Wood Hospital at psa: 4.6 but the VA Hospital only saw 1.3, but the biopsy was positive on one in twelve needles.

Regular Member

Date Joined Jan 2010
Total Posts : 55
   Posted 2/2/2010 5:04 PM (GMT -6)   
I was diagnosed with a PSA of 3.5 (on retest was 2.7) - but it was up from 1.8 the previous year. I must be the oddball here, but the only pain I felt from the biopsy was the needle with the anaesthetic on the prostate - I could then feel the biopsy needle enter the prostate, but no pain - just the loud click! Afterwards it was sore, but not painful - what I did not like was the blood in the urine for three days, and in the semen for up to a month. I was terrified before the first biopsy - the second was almost routine. Fear of a biopsy is not a reason to put it off, especially if the doctor felt a nodule.
Diagnosed 9/4/09
PSA 3.5, up from 1.8 year before
First biopsy showed 3/10 positive cores, Gleason 3+3, less than 10% involvement in all three cores, diagnosed as T2a
Doc and I decided on Active Surveillance, pending a confirmatory biopsy
Second biopsy showed 5/10 positive cores, Gleason 3+3, left side (4 postitive cores) had 40% involvement
RRP on 12/15/09
Home on 12/16/09
Failed cystogram on 12/23/09, catheter out on 12/29/09
Path report was all good news, Gleason 3+3, no margin involvement, no perineural involvement, everything clean other than core of prostate, tumor on both sides, but more prevalent on left side, 5% involvement, 42 gram organ
Within two days down to one pad a day, now continent except if I sleep more than four hours
Back to work 1/4/10
First PSA 1/28/10 - nondetectable, next scheduled June 2, 2010
ED present, although blood does flow after Viagra. Will try pump in a week

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