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Prostate Cancer

Interpretation of Decrease in Low PSA and % Free PSA

11/12/2008

Question:

A year ago, my father (65 yrs old) was scheduled for prostate checkup, both PSA & Free PSA were (4.5 and 14.5 %) respectively, DRE exam was ok, his doctor put him on some kind of antibiotic, and 3 months later, tests were taken again and (no change in both PSA & F PSA), and DRE exam was fine too. During that time, he’s had some symptoms such as urinating more frequently at night, some pain during urinating. So his doctor asked him to take biopsy. Biopsy (6 samples), results came out negative. Now 6 months have passed by, results were as following: PSA = 3.91, and Free PSA = 13 %, DRE exam was ok. His doctor asked him to wait for another 3 months and re-take those tests.  Is it okay to wait? My concern is the decrease in the free PSA, I understand that normal free PSA should be >25%, and I also understand that the decrease in the free PSA is most likely diagnosed as cancer? But the thing is his PSA level is going down, so I`m kind of confused? Should I be worried? And do you recommend he’d go for another Biopsy before the 3 months are over sooner? My father has no history of prostate cancer in the family, he quit smoking 15 yrs ago, he’s on some medication for blood pressure (very mild). Please advise.

Answer:

PSA and % free PSA are not 100% sensitive, they are great screening tests. It sound like your father is being followed appropriately. Following his PSA velocity sound very reasonable. If his % free PSA goes below 10, I would consider another biopsy, possibly a saturation biopsy (more cores -24).

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Response by:

Lee E Ponsky, MD Lee E Ponsky, MD
Associate Professor of Urology
School of Medicine
Case Western Reserve University