I have a friend who's PSA is climbing, his freePSA does so but at a higher rate, making the ratio improve by time. Six months ago his PSA was 11.68 and the ratio 22%, now 14.59 and 33%.
He is monitoring the situation for more 15 years now, had already 4 negative biopsies, the latest two Fusion after two mpMRIs (PIRADS 3 the first, PIRADS 4 the later). His urologist is puzzled.
Can anyone offer some explanation on the fact that while the PSA worsens the ratio improves?