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Thread: What is more important, a low PSA number or a high PSA free number

  1. #1
    Senior User
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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.

  2. #2
    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.

  3. #3
    Quote Originally Posted by ASAdvocate View Post

    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

  4. #4
    Quote Originally Posted by 35coupe View Post
    ...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

  5. #5
    Quote Originally Posted by guitarhunter View Post
    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.

  6. #6
    Quote Originally Posted by ASAdvocate View Post
    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

  7. #7
    Top User garyi's Avatar
    Join Date
    Apr 2017
    Posts
    1,473
    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

  8. #8
    Senior User
    Join Date
    Jan 2013
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    130
    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.

  9. #9
    Top User
    Join Date
    Aug 2016
    Posts
    1,944
    Quote Originally Posted by 35coupe View Post
    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.

  10. #10
    Quote Originally Posted by 35coupe View Post
    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 hasnít 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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