Strange freePSA/PSA ratio: I have a... - Prostate Cancer N...

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Strange freePSA/PSA ratio

Justfor_ profile image

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?

7 Replies

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

Justfor_ profile image
Justfor_ in reply to SuppWife

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

What is freePSA?

Justfor_ profile image
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.

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

Justfor_ profile image
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.

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)

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