Hi JW, and welcome.
It's never too early for men to learn about prostate cancer (PC), but hopefully you are not ready to join our ranks as a PC patient at this time. Keep in mind that one doesn't "have" prostate cancer until a biopsy is performed and a pathology exam confirms PC in the tissue sample.
Your PSA is a little high, but there are several non-cancerous reasons for elevated PSA. In fact, the majority of biopsy results do NOT find cancer in patients with slightly elevated PSA.
The fact that your PSA went down so much in a month seems to indicate that there are "assignable causes" which might have driven January's value temporarily up. Perhaps a prostate infection (very common), possibly sexual activity the night before the test, perhaps you rode a bike, or motorcycle, or scooter the day before. Any of these things could have caused a temporary, short-term spike in PSA. Prostate cancer, on the other hand, tends to NOT cause PSA to fluctuate up & down...it's a pretty steady producer of PSA in the bloodstream, and tends to slowly increase over time as the PSA-producing PC cells continue to slowly multiply.
It sounds like you have already visited a urologist who wisely ordered a Free PSA test along with your follow-up total PSA test in February...very good step. This test result might lead to putting off a biopsy altogether. I will provide you with a good link to read about the PSA test (and it's limitations) and also the Free PSA test. I suggest reading up on these before visiting your specialist later this week. The smarter and more informed you can be about the terminology, the better.
In summary, the Free PSA test is expressed in ng/mL (same as total PSA), and is frequently converted into a percentage of Free PSA to be more meaningful relatative to one's total PSA.
It is normal to have both some PSA that is "attached" to proteins in one's blood AND some PSA which is unattached, or "free." However, as the percent of free PSA goes down, the likelihood of prostate cancer goes up—restated in different words, benign prostate tissue contains more free PSA than cancerous prostate tissue.
The general rule of thumb is that a percent free PSA of 25% or greater is normal and unlikely to have PC.
Less than 10% free PSA is a high likelihood of PC.
Between 10% and 25% is an intermediate range.
From your February test, you had 0.98 ng/mL of free PSA and 3.42 ng/mL of total PSA, which according to my calculator gives about 28% free-to-total PSA percentage. If these numbers are all correct (please do re-verify with your doctor), then I would think it highly unlikely that your doctor would recommend a biopsy for you at this time. More likely that he will send you home and ask you to re-submit to another PSA in 3- or 6-months, just to be sure.
Here is a link to an excellent free, online document about PSA (and free PSA). It is lengthy, but about half of the document is the section of References. I'd say that just about everything you wanted to know about PSA is right here (it's called the American Urological Association's "Prostate-Specific Antigen Best Practice Statement -- 2009 Update":
It's never too early for men to start learning about PC because after skin cancer, it is the most commonly occurring cancer in men. But hopefully, you will learn that it is unlikely that you have to be too worried about it at this time...
Post Edited (Casey59) : 2/21/2010 7:12:37 PM (GMT-7)