new test results = more questions

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Regular Member

Date Joined Mar 2011
Total Posts : 33
   Posted 4/1/2011 7:23 AM (GMT -6)   
Hey Everyone,
Back with an update and more questions, request for feedback. You guys are the greatest.
Got my new PSA tests yesterday, I requested my Uro to add Free PSA rather than follow his "one step at at time" attitude. (Makes me wonder if he's trying to find out what's going on or just run up the cash register)
Anyway, is the update.
- Got my records on Tues from the Uro to see for myself what's in them. Made me feel better that he noted my 3.0/3.1 PSA my be my norm.
- Got my new labs yesterday. Made me more concerned, again.
- PSA 3.0 - Hooray, still stable
- Free PSA 13 - BOO, Low
So it appears a biopsy is definitely in my future. I've also got an appt next week with an different Uro to get a 2nd opinion and parallel path going on the tests and evaluations.
I've searched the net for info on what may affect Free PSA and find nothing. I did find that I'm in the 28% probability group now, which I'm not happy about. All my life, my bodily statistics have been at the "optimum" side of the scales (other than my weight for the last 10 years) so I'm trying to deal with this deviation in that trend.
- What may cause the Free PSA to be low other than PCa?
- The statistics show 15% chance for a 3.0 PSA and 28% for 13 Free PSA, does this mean my "statistic" is 28 or add the 2 together for 43% change of PCa?
Any feedback is appreciated.
age 49, 50 in about a month
5/2009 - 3.0
5/2010 - 3.1
9/2010 - 3.1

Regular Member

Date Joined Jul 2010
Total Posts : 161
   Posted 4/1/2011 7:35 AM (GMT -6)   
Prostatitis can also affect free psa....My husband had prostatitis and had no symptoms at all , that he recognized.........Dr also said his normal psa ran a little high.... Cooper  wink

Veteran Member

Date Joined Feb 2011
Total Posts : 4093
   Posted 4/1/2011 7:54 AM (GMT -6)   
i'd say forget the statistics, have a biopsy and find out what's what.

Not sure "normal" can be defined with us. My last PSA test prior to biopsy was 1.9 and my urologist still felt it was too high for a guy my age (40). Had biopsy and sure enough I had pc.

Biopsy wasn't a big deal at all. I was knocked out for it.

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2461
   Posted 4/1/2011 8:44 AM (GMT -6)   
I was DX at the age of 67 when my PSA was 3.8/3.9 for over 6 months. My free PSA was 11%.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18, 21 months) undetectable
Latest PSA test (2 years) <.008 ?

Veteran Member

Date Joined May 2009
Total Posts : 739
   Posted 4/1/2011 9:15 AM (GMT -6)   
I'm going by memory here, but I also had a low free PSA a few years ago before a biopsy confirmed my PC. My total PSA was 4.1 and the free was at around 12% and the statistics showed about a 50% chance. When I asked my doctor, and did some of my own research, I could not find anything specific that would lead to a low free PSA but, like total PSA, it doesn't mean you have PC, just that there is a higher likelihood. If it's any comfort, though, from what I recall the free PSA statistics were originally done based on a Japanese study, and it was only valid for total PSA over 4. If yours is under 4, I'm not sure the statistics apply.

Long story short, in my case the total PSA went down, then back up, and eventually I was found to have Gleason 4+3 in 25% of my prostate, which led to Da Vinci surgery. So in my case, at least, the free PSA got it right, but your mileage may vary.

Best of luck but, if the free PSA is causing you a lot of worry, I'd go ahead a get a biopsy.

Veteran Member

Date Joined Sep 2009
Total Posts : 6075
   Posted 4/1/2011 10:09 AM (GMT -6)   
with free psa, get the biopsy and insist on a lot of cores, get another uro if he wont do many cores, or you could end up not finding it and having multi biopsies. With many cores, if its negative, than a sigh o relief is in order, but a psa, every 3 mos after, cause it aint , nesecarrily over. Not to increase anxiety, its just a very wily disease. Keep the faith on this in any circumstance.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Veteran Member

Date Joined Aug 2010
Total Posts : 644
   Posted 4/1/2011 2:22 PM (GMT -6)   
My uro said to me "you can read all the statistics you want but at the end of the day you will have 100% of the particular outcome you have."

If we were talking about a procedure with serious side effects then wondering if you might possibly not need it is in order. A biopsy is safe, harmless, uncomfortable but not really painful, quick and relative cheap. Get it done.

Veteran Member

Date Joined Nov 2009
Total Posts : 7269
   Posted 4/1/2011 4:37 PM (GMT -6)   
Here's what I suggest:
Get the PCA-3 test. It is easy (you give urine after a DRE) and quite specific for PC.
That's what I did and it solidified my choice to get a biopsy
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64. Surgery: Dr. Menon @Ford Hospital, 1/26/10. Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- yes.. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13,3/1/11--0.27
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