I don't envy your situation, but don't panic yet. Dr. Epstein is considered at the top of the list of expert patholigists. I suggest that you get another biopsy in a reasonable period of time and have them extend it beyond 12 samples of the prostate. i had 29 samples and i really don't believe that 12 is enough. having fewer samples can result in a false negative biopsy. from what i have read, 20 would be a more likely minimum.
you say you have a free PSA of .20--what does that mean? are you saying 20%? i have never heard of a free PSA defined that way. I had a free PSA of 27% at the time of my biopsy, which gave me a risk of about 18% of having prostate cancer, but unfortunately I ended up in the prostate cancer group. The lower the percentage of free PSA, the greater the risk of having prostate cancer (i.e., generally below 25%). You need to clarily your free PSA statistic.
Chances are that you are still in an earlier stage of PC based on your statistics, especially the low PSA. I would not get treatment until you have clarified your situation which is essentially what Dr. Epstein is saying. Get that 2nd biopsy as soon as medically feasible after the 1st biopsy--I believe that they generally prefer not to do another biopsy too soon after the first one. If you are ultimately found to have PC and are in an early stage, being treated with proton therapy may work well for you--that is what I decided for my treatment. Best of luck to you!
This is quoted from an article on Free PSA
High free PSA -- above 25% -- usually indicates BPH (benign prostate hyperplasia).
Low free PSA likely signals prostate cancer. Most men with prostate cancer have a free PSA below 15%.
If free PSA is below 7%, prostrate cancer is most likely. According to American Cancer Society and National Cancer Institute, men with free PSA at 7% or lower should undergo biopsy. If biopsy is negative but free PSA remains low, repeat biopsy is in order.
I found a recent study on the basis for a 2nd prostate biopsy that may be of interest to you. I don't know to what degree it fits you situation, but I think you should read it.
You might also want to refer to these websites for more information on prostate biopsies:
This is being quoted from the American Cancer Society
Sometimes when the pathologist looks at the prostate cells under the microscope, they don’t look cancerous, but they’re not quite normal, either. These results are often reported as "suspicious." They generally fall into 2 categories -- either "atypical" or "prostatic intraepithelial neoplasia" (PIN).
PIN is often divided into low grade and high grade. Many men begin to develop low-grade PIN at an early age and do not necessarily develop prostate cancer. The importance of low-grade PIN in relation to prostate cancer is still unclear.
With atypical findings or high-grade PIN, cancer may already be present somewhere else in the prostate gland. When high-grade PIN is found, there is a 30% to 50% chance of finding prostate cancer on a later biopsy. For this reason, repeat prostate biopsies are often recommended in these cases.