65 yo, in good health, active. I've had BPH and mild cessation incontinence ~2yrs. Semiannual PSA tests have been 2.2-3.8, very weak upward trend. MRI last April was neg.
Latest reading was 4.5 ng/ml, free PSA 9%. First time urologist has mentioned free PSA. He recommends another MRI in April '24. Consensus guidance seems to be that biopsy is indicated if free PSA <10%. Is there reason to wait?
The Prostate Health Index (PHI) test is more specific than free PSA. What is "free TSP"?
Mixing up my acronyms, sorry! Free PSA. He didn't mention PHI. This is supposedly a sophisticated practice in Beverly Hills (I live in "regular LA").
4KScore is similar.
He didn't mention 4K or PSA density either. He also didn't explain what free PSA was, just that greater than 25% was "good" and that less than 25% was "of some concern." I looked it up when I got home. According to a Harvard post on PSA, free PSA less than 10% indicates a biopsy is indicated without any qualifiers. I'm not used to seeing language like that in background information being presented to the public. The doctor in question specializes in robotic and laproscopic surgery. Perhaps his strengths are not as a diagnostician or case manager.
Don’t be a fool. Get a biopsy.
Thanks to everyone! I'm seeing my GP next week. I'll get a referral for a 2nd opinion. Will get biopsy with genetic profile and any additional data that may help. Good info is necessary for good decisions. I'll feel a lot better about what to do with good histology. I'm in very good health otherwise and I've got decent insurance. 🍀
I'm not sure I would rush to get a biopsy with your negative MRI. I think your DRs recommendation to get another MRI next spring seems reasonable. I had a low PSA (3.0) and had an MRI based on a small nodule that could be felt on the DRE. MRI came back with a PiRad 5 on the opposite side of the prostate from the nodule. The nodule side was benign. Had a subsequent biopsy to confirm cancer. Make sure you get a multiparametric MRI. They are very good at detecting cancer and from what I have read the standard of care is to get an MRI first, and then if something is found, you will get a targeted biopsy that will be able to focus on the problem area more precisely.
To clarify, MRI was 6 months ago. I figured first thing would be to get PHI and go from there on whether to biopsy. I don't understand why wait 6 months if there's additional info that could be gotten from serum or urine tests right now. Also the specialist managing case is a surgeon (robotics and laparoscopic). I would like perspective from med and rad oncologists.
It sounded to me like you were looking to get a biopsy prior to getting another MRI. Additional info from urine/serum tests now makes great sense - I was just commenting on getting a biopsy with your negative MRI. Not sure why you feel the need to see a med and rad oncologist if you don't have confirmed cancer.
yes, I wasn't clear in my prior post, and my thinking has evolved a bit, too. appreciate your input on this.
I've found a world class MO at USC Keck. I had surgery there for sinus polyps (benign) a few years ago. Greatly improved my quality of life. Booking an appointment asap.
I was in similar situation. Psa 4 something and free psa 24%. I drove myself crazy. Don’t do that 
the protocol is get a mpMRI and then a targeted biopsy. Then treatment or AS based on results. Slow down. Don’t be I am surprised I didn’t have a heart attack during the entire process. Slow it down
PSA
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