Hi everyone looking for advice. - Prostate Cancer N...

Prostate Cancer Network

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Hi everyone looking for advice.

Airborn16 profile image

I'm 53. Had a recent PSA and free PSA. I'm baffled by the free psa ratio, I understand the meaning but unsure about the accuracy. Total psa is 6.05 and free psa 8%. According to the lab report: 68% probability of PC. Anything under 10% is trouble.

I have had a psa every year which has been under 4 averting 3.5. In a 6 month period my PSA rose from 3.69 to 6.05 and with the free psa on the latest. I'm looking to get the 3T MRI, there is only one in the city and I'm not sure insurance will approve.

The research shows that guys with inflammation or bph have a higher ratio of free psa. Anyone know anything about this or had anything similar?

14 Replies

% free PSA is very much affected by prostatitis, BPH, sex w/i 48 hours, and recent bike riding. Ask for PHI, which includes both and is less affected by benign sources.

I was diagnosed gleason 8 with a PSA reading of only 2.7. An abnormal DRE finding is what got me sent for a biopsy. Don't mess around. You didn't mention DRE so I would suggest that you consider that, given my experience. The 3T MRI might be the kinder, gentler diagnostic tool but it might be time to just get the darned conventional biopsy. Best to catch this thing early.

aceace12 profile image
aceace12 in reply to WSOPeddie

im curious what is considered an abnormal DRE finding ?

WSOPeddie profile image
WSOPeddie in reply to aceace12

It is the digital rectal exam. Doctor found unusual "firmness" on one side and not the other. Indication of a tumor. Biopsy confirmed it. BTW, I sometimes refer to this as the "fickle finger test". Not pleasant for patient or doctor. My previous PCP had performed this test at every physical from my 40's onward. With my new doctor I insisted on it.

carlo8686 profile image
carlo8686 in reply to WSOPeddie

My prostate had the same hardness on one side. Tumor out of the prostate on one side. Nothing on the other side. Get the mri.

carlo8686 profile image
carlo8686 in reply to carlo8686

The mri that insurance will cover will tell the story

Your doubling time is concerning. The 3T MRI is far more accurate, but is also operator dependent. If you live near a cancer center of excellence, consider going there.

Airborn16 profile image
Airborn16 in reply to bobdc6

The soonest appt I could get is February 26th at MD Anderson. The insurance here is denying most imaging and there's alot of miscommunication. I tried to get in sooner but they dont have anything. MDA has all my records.

bobdc6 profile image
bobdc6 in reply to Airborn16

MDA is an excellent choice, there's no hurry, Feb 26 is just fine.

Could be you don't have much of a problem, but an accurate diagnosis is a must.

carlo8686 profile image
carlo8686 in reply to Airborn16

Last one I had at md I asked how many they did a day. One building with six mri machines did 84 a day. They have two more buildings with mri machines. Busy place

Here's a good book giving a lot of information on our problem,


PSA is initially synthesized in the prostate cells as a large protein that they secrete. Inside the prostate ducts an enzyme cuts this protein into the actual "free" PSA protein and a residue that is discarded. If the PSA in your blood started off in properly structured glands, much of it will have been cut into the "free" form. If it started inside a adenocarcinoma (typical prostate cancer), the ducts aren't there, or aren't right, and most of what gets into your blood is the original large protein ("bound" PSA). So a high PSA with a low % free PSA suggests the PSA came from a tumor, not from an enlarged or inflamed non-cancerous prostate.

Median PSA at your age is about 1.0 so I would take this very seriously. Multiparametric prostate MRI is the best investigation technique (lowest risk and more accurate than transrectal biopsy without an MRI first). So I'd push for the MRI but if they refuse, get a biopsy. My PSA at age 52 was 6.1 and I had 20cc of stage 3a slow growing prostate cancer.

Airborn16, You already stated well your situation. You have a 68% chance of having PCa - it's more likely that you have it than not. The next most prudent steps are an MRI followed by a biopsy. You can choose less rigorous steps if you like.

Here is where I am at now. I havent done anything too invasive yet. I saw 2 urologists at UNM School of medicine, it's also a regional medical center, I saw them in the same visit, one was a fellow the other was chief of urology. I didn't agree with their mindset. The 3tMRI was scheduled at UNM I still have the appointment open for a year. But the chief said "even if your MRI shows no lesion, we still want the biopsy" I'm thinking MDA doesnt do this, that's the whole point of the MRI is to avoid any ongoing invasive procedures. I also still have my appt with Dr. Ward at MDA along with a 3t, I've just pushed it out into the summer. The reason I'm double stacked on appts is partly cost and I'm trying to see what other facilities recommend. The bottom line is 6 weeks ago I had another PSA, 3.9 total, and free I believe was 11%. So the free PSA numbers only showing a 50% probability. I have another PSA next week, the urologist here under my insurance plan has said hold off on MDA and UNM and let's see what this next blood test shows; he said a dramatic drop was favorable. Basically in a 6 week period the PSA dropped from 6.05 to 3.90, and my urination stream was better.

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