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What is more important, a low PSA number or a high PSA free number
In the last 6 years I've had 2 biopsy. Why, because my PSA in a year went from 2 to 5.9, (do not know about the free). First biopsy found one sample with atypical cells, the rest of the 11 were benign. Second biopsy 9 months later, all benign. All though out the years PSA has jumped around but never as high as 5.9. I usually have 2 test, one with my primary doctor, which was 5.1 six months ago and one with my urologist yesterday. So with the urologist the PSA was 6.04 and free PSA is 51.3 %. The urologist always said we will not do another biopsy unless my PSA is 7 or above. Have not talked to him about these current numbers and don't expect too until next spring unless he calls. He did a DRE and it was fine, no knots or hard places. So in 6 months I went from 5.1 to 6 and free PSA 51.3%. The email I got from him stated at my age 74, having a normal DRE and enlarged prostate, that a PSA between 4 and 10 and percent free greater then 26%, the chances are 12.5 % having prostate cancer. Don't know. He may call tomorrow and say lets do another biopsy.
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That is a very good fpsa number.
There are, of course, other tests like the 4K Score, which might provide more information, and an mp-MRI can spot suspicious areas and provide a score for liklihood of cancer. You are receiving good advice.
Checked in with my urologist today. She recently worked with a patient with a persistent psa of 23. No cancer on MRI or biopsy. Don't get worried about yours
DOB: May 1944
In Active Surveillance program at Johns Hopkins
Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
Hopefully, I can remain untreated. So far, so good.
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 Originally Posted by ASAdvocate
Checked in with my urologist today. She recently worked with a patient with a persistent psa of 23. No cancer on MRI or biopsy. Don't get worried about yours
What did your urologist suspect is causing his high PSA number?
DOB 12/62
November 2011 - 1.2 PSA
June 2014 - 3.6 PSA
October 2015 - 4.5 PSA
November 2015 - 4.7 PSA
Feb 2016 - 6.1 PSA
March 2016 - 12 core biopsy with all negative
October 2017 - 11.3 PSA
November 2017 - 15.6 PSA
December 2017 - MRI - PI-RADS 5: THERE IS A DISCRETE AREA OF T2 SIGNAL HYPOINTENSITY AND RESTRICTED DIFFUSION IN THE LEFT ANTERIOR ASPECT OF THE TRANSITIONAL ZONE/ANTERIOR FIBROMUSCULAR STROMA NEAR THE APEX, CONCERNING FOR PROSTATE MALIGNANCY, prostate at 49.0 grams
December 2017 - MRI guided biopsy (3 cores in target area and 12 others) all negative
February 2018 - ConfirmMDX test on recent biopsy samples are all negative
April 2018 - 12.2 PSA
July 2018 - 14.2 PSA
Oct 2018 - 14.6 PSA
March 2019 - 19.2 PSA
April 2019 - repeat MRI with the same results as what I saw in December 2017, prostate at 56.6 grams
July 2019 - saturation biopsy with 93! cores with all negative
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Top User
Originally Posted by 35coupe
...The email I got from him stated at my age 74, having a normal DRE and enlarged prostate, that a PSA between 4 and 10 and percent free greater then 26%, the chances are 12.5 % having prostate cancer. Don't know. He may call tomorrow and say lets do another biopsy.
So let's round it to 13 in 100 men. Overall stats are what they are, but if it were me, I would want more information about my specific case. A mpMRI could refine (but not guarantee) your chances of having significant PCa. Your insurance would probably cover it, especially since you've had negative biopsy, which some insurers require. It's a non-invasive procedure, and you could probably avoid a biopsy (for now) if nothing above a PIRADS 2 is fond on the MRI.
Djin
69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
7-05-13 TURP for BPH (90→30 g) path neg., then 6-mo. checks
6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
Bone scan, CTs, X-rays: neg.
8-7-17 Open RP, neg. frozen sections, Duke Regional
SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
Dry; ED OK with sildenafil |
9-16-17 (5 wk) PSA <0.1
LabCorp uPSA, Roche ECLIA:
11-28-17 (3 m ) 0.010
02-26-18 (6 m ) 0.009
05-30-18 (9 m ) 0.007
08-27-18 (1 yr.) 0.018 (?)
09-26-18 (13 m) 0.013 (30-day retest)
11-26-18 (15 m) 0.012
02-25-19 (18 m) 0.015
05-22-19 (21 m) 0.015
08-28-19 (2 yr. ) 0.016
12-18-19 (24 m)
Avg. = 0.013 |
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Originally Posted by guitarhunter
What did your urologist suspect is causing his high PSA number?
She did not describe the case beyond not finding any cancer.
In the past, I have seen posts from a handful men with PSA over 25 who had multiple clean biopsies. Don't know what conclusions, if any, were reached in their cases.
DOB: May 1944
In Active Surveillance program at Johns Hopkins
Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
Hopefully, I can remain untreated. So far, so good.
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Top User
Originally Posted by ASAdvocate
She did not describe the case beyond not finding any cancer.
In the past, I have seen posts from a handful men with PSA over 25 who had multiple clean biopsies. Don't know what conclusions, if any, were reached in their cases.
I can speak from some experience with a much lower PSA that slowly rose, with fluctuations, over several decades to 8.6 (finasteride-corrected). My BPH required a TURP in 2013 to reduce its compression of the urethra, and it restored an excellent urine flow (I could put out small brush fires). Path exam of the TURP-removed tissue (8th biopsy I think) showed no PCa.
Over the two decades of BPH, the several uros I have had all advised biopsies whenever my PSA went up a bit more than what they expected. Every one of these biopsies came up negative, and the chances that this series of 9 biopsies were missing long-standing PCa was extremely small if you do the probability math of any one biopsy missing cancer at, say, 33%. So you may ask, why continue biopying? We're my uros just interested in donations to their vacation funds?
Having a rising PSA because of BPH, or any other benign condition, affords no protection whatsoever against PCa either being present or arising. Another jump in PSA and a nodule felt on DRE prompted my final biopsy: one G9 and one G10 core (surprise!). My own view is that my PCa (which was about 5% of prostate volume) had not been around for that many years given my biopsy series.
Is my history unusual or exceptional? Perhaps, but PCa is not the only source of high PSA and you want to be prudent if you have it. Negative biopsies always come with a caveat: they can miss existing cancer and, even if you choose to infer no cancer, tomorrow is another day.
BTW, while biopsies do sometimes have complications, I never had anything of concern, only a day of a bit of blood in my urine, a bit of discomfort urinating, and sometimes a tiny amount of blood in first ejaculate.
Din
Last edited by DjinTonic; 10-03-2019 at 04:43 PM.
69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
7-05-13 TURP for BPH (90→30 g) path neg., then 6-mo. checks
6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
Bone scan, CTs, X-rays: neg.
8-7-17 Open RP, neg. frozen sections, Duke Regional
SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
Dry; ED OK with sildenafil |
9-16-17 (5 wk) PSA <0.1
LabCorp uPSA, Roche ECLIA:
11-28-17 (3 m ) 0.010
02-26-18 (6 m ) 0.009
05-30-18 (9 m ) 0.007
08-27-18 (1 yr.) 0.018 (?)
09-26-18 (13 m) 0.013 (30-day retest)
11-26-18 (15 m) 0.012
02-25-19 (18 m) 0.015
05-22-19 (21 m) 0.015
08-28-19 (2 yr. ) 0.016
12-18-19 (24 m)
Avg. = 0.013 |
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Top User
Over 16 years, on annual checks, my PSA slowly increased from under 1.0 to 2.3
I then had a TURP, because I hated urinating 10-12 times a day. PCa (G3+4) was discovered in the TURP.
When I had surgery, my PSA was 2.5
Several months after surgery, my PSA was 0.54
After SRT, my PSA is shown below. Hovering at about 0.08
I've never stopped urinating 10+ times a day. 
For what it's worth.
72...LUTS for the past 7 years
TURP 2/16,
G3+4 discovered
3T MRI 5/16
MRI fusion guided biopsy 6/16
14 cores; four G 3+3, one G3+4,
CIPRO antibiotic = C. Diff infection 7/16
Cured with Vanco for 14 days
Second 3T MRI 1/17
Worsened bulging of posterior capsule
Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
Grade Disease 81%, Likelihood of Organ Confined 80%
RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
G3+4 Confirmed, Organ confined
pT2 pNO pMn/a Grade Group 2
PSA 0.32 to .54 over 3 months
DCFPyl PET & ercMRI Scans - 11/17
A one inch tumor still in prostate bed = failed surgery
All met scans clear
SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
Radiation Procitis, and Ulcerative Colitis flaired after 20 years
PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19, .116 11/19 
We'll see....what is not known dwarfs what is thought to be fact 
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Well, got an email stating they want me to have a MRI. I just love having things stuck up my butt. I assume they put the balloon up you. Have not talked to the doctor yet so not sure what type of MRI.
Last edited by 35coupe; 10-08-2019 at 11:59 PM.
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Originally Posted by 35coupe
Well, got an email stating they want me to have a MRI. I just love having things stuck up my butt. I assume they put the balloon up you. Have not talked to the doctor yet so not sure what type of MRI they have at Vanderbilt.
Enjoy it while you still have a prostate.
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Originally Posted by 35coupe
Well, got an email stating they want me to have a MRI. I just love having things stuck up my butt. I assume they put the balloon up you. Have not talked to the doctor yet so not sure what type of MRI they have at Vanderbilt.
If you mean the endo-rectal coil, most centers stopped using them when they upgraded from 1.5 to 3 Tesla machines.
Johns Hopkins hasn’t used an ERC since 2012.
DOB: May 1944
In Active Surveillance program at Johns Hopkins
Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
Hopefully, I can remain untreated. So far, so good.
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