Strange freePSA/PSA ratio

[Justfor_]

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?

[SuppWife]

I've read free PSA is only meaningful when the PSA is 10 or under.

[Justfor_ in reply to SuppWife]

Thanks, I will tell him to ask his urologist about such a restriction.

[cesces]

What is freePSA?

[Justfor_ in reply to cesces]

FreePSA is a sub-type of PSA that is believed to originate from benign cells. Thus, the higher it's proportion to the total the less the likelihood of PCa.

[cesces]

So what is the name of the test for freePSA?Maybe I need to get one of those?

[Justfor_ in reply to cesces]

FreePSA in the same units as PSA (totalPSA), so by division you get the rate in percentage.

This table relates percentage of free PSA to the probability of prostate cancer:

10% –15% 28%

15% –20% 20%

20% –25% 16%

Greater than 25% 8% (considered normal)

In my neck of the woods labs charge the same amount for freePSA as PSA, that is 15-20 Euros. So the package costs the double (30-40 Euros).

It is only useful to untreated men at very early stages before mpMRI and biopsy.

After primary treatment is useless, although some papers claim it has the reciprocal effect, i.e. a high freePSA is a bad prognostic factor.

[John42]

Since he has had prior biopsies, he should know his prostate size. He can then determine his PSA density which may provide helpful information. If I recall correctly, PSA density less than .15 is good. (Others, please correct this number, if wrong)