PSA and FreePSA increase

[Sunfire]

Had another PSA test prior to decision making. PSA up from 5.68 to 6.60 G6 diagnosis. However Free PSA is up from 15 now 20. Two mpMri over this year Pirads2 with significant BPH no lesions showing to biopsy. Increasing PSA not good but increasing FreePSA and negative MRIis giving me pause. At this point and after looking at all options SBRT is in my near future. Thoughts on FreePSA increase?

[Tall_Allen]

Ask your doctor about tracking with Prostate Health Index (PHI) instead (it includes both PSA and free PSA) but is less influenced by BPH and prostatitis. IMO, PSA should not be a reason to come off AS - only a grade increase.

[Sunfire in reply to Tall_Allen]

Thank you will do that this week. An increasing FreePsa gives pause. PSA alone is influenced by to many other issues.

[Sunfire in reply to Tall_Allen]

Question how is PHI test different? The test was PSA and FreePSA?

[Tall_Allen in reply to Sunfire]

It includes a third variant kind of PSA, called -2ProPSA, that is only associated with prostate cancer, and all three biomarkers are incorporated into a formula that has good predictive value. It has a cutpoint that simutaneously has good (not great) sensitivity and specificity. It also goes up with higher grade. A similar test is called "4Kscore" but PHI is cheaper and guaranteed covered by insurance.

[Sunfire in reply to Tall_Allen]

Thank you again valuable information to go forward with. All so complicated.

[Darryl Partner]

Read this re free psa. health.harvard.edu/blog/wha...

[Sunfire in reply to Darryl]

Thanks for sharing. Good article. I'm rather sure doc won't focus much of freePSA increase. He will focus more on the doubling time/velocity of PSA increase over time.

Since a Pca diagnosis has already occurred being on AS the increase will indicate time for treatment.

[Darryl Partner]

I think you might be misinterpreting FreePsa. A “rise” from 15 to 20% is a good thing.

[Sunfire in reply to Darryl]

Thank you we were to uro oncologist this week and unless there is an upgrade in Gleason pathology he stated we can be comfortable staying on AS. Had 2 negative mpMri and an increase is most likely due to bph. Due for another biopsy as part of AS protocol in October. If anything changes we can treat at that time. PSA alone is not a reason to treat. Oh and yes agree a rise in PSAFree is a good thing yea!