Here are my 53 year old brother's PSA results:

Aug 27, 2007
PSA :3.93 ng/ml
Free PSA :0.92 ng/ml
cpsa: 3.01

Nov 30, 2007
PSA :3.92 ng/ml
Free PSA :0.72 ng/ml
cpsa: 3.020

Finger examination revealed some hardness on the prostate however ultrasound was clean.

He is inclined to wait for six months for another PSA test. Any suggestions?

Here are my 53 year old brother's PSA results:

Aug 27, 2007
PSA :3.93 ng/ml
Free PSA :0.92 ng/ml
cpsa: 3.01

Nov 30, 2007
PSA :3.92 ng/ml
Free PSA :0.72 ng/ml
cpsa: 3.020

Finger examination revealed some hardness on the prostate however ultrasound was clean.

He is inclined to wait for six months for another PSA test. Any suggestions?

Waiting six months could be reasonable, depending on the circumstances.

The stability of the PSA at nearly the same value is an encouraging sign. :)

The free PSA % is 23.4% for the August test and 18% for the November test. The August result is a fairly comfortable ratio, and the November result is not far from the comfort zone. :) Concern is much increased when the percentage is 10 or lower, though even percents that low sometimes do not result from cancer.

While the PSA level is higher than you would like it to be, it is still below 4.0, which was the standard for concern for many years and still used by many doctors. :) PSA is fairly well associated with the size of the prostate when there is no cancer. The rule of thumb is that each cc of size will generate about .066 ng/ml of PSA ("A Primer on Prostate Cancer - The Empowered Patient's Guide," p. F4) and the size can be fairly well estimated from the ultrasound exam, if the doctor recorded it or has a film. (Mine didn't do that, one of many shortcomings I soon noticed. :( . It wasn't long before I found other doctors and did not see him again.) Therefore,a PSA of 3.92/.066 = 59.3, so if your brother has a prostate in the neighborhood of 59 cc in size, then all of his PSA could be accounted for by healthy prostate tissue. Such a size is not unusual for an enlarged prostate. If his prostate is substantially smaller, then the excess PSA would probably be associated with prostate cancer, as I understand it. In the latter case, or if it's doubtful, moving the next PSA up to the three month point would make sense to me.

There's another test that has been on the market a few years now, though it has not yet been approved by the American FDA. However, I've been told that it is almost always covered by insurance. An early version was known as the uPM3 test, and a current later version is known as the PCA3Plus test. It is based on an intensive PSA so that cells will be sloughed off into the urine. The sample is collected and sent to a lab, which means that the test can be done on a patient located anywhere. It is strong where the PSA is weak, and vice versa, so using the two together creates a strong predictor whether there is cancer. :angel: You can find out about it on the web, and I posted about it in this thread and date: 11-12-2007, 01:03 PM Re: how many biopsies are taken before discovery of prostate cancer.

If your brother's prostate is enlarged, one thing he could do is start a drug with triple benefit: reducing BPH, helping prevent prostate cancer, and improving the effectiveness of diagnostic indicators for prostate cancer including % of PSA reduction in six months, subsequent PSA trend, and the DRE. :) The drug is finasteride, formerly known as Proscar. There is strong evidence from a gold-quality type clinical trial that it prevents about 25% of prostate cancer. There was a concern that it might lead to high grade disease in 1% of patients, but that has been virtually resolved by recognition that it improves detection of higher grade disease rather than promoting it. Recent studies have demonstrated that it improves the effectiveness of the DRE exam. Also, the PSA should fall by about half or more when a patient takes finasteride for six months. If it does, that suggests BPH but not cancer, while a reduction of significantly less than half (typically about 28% from a talk I just heard by Dr. Stephen Strum, co-author of the Primer, on DVD) suggests (but doesn't prove) there may be cancer and is used by some doctors to trigger more frequent monitoring. Research also indicates that the PSA trend from the new, reduced baseline is a more efficient indicator of prostate cancer than the trend is for patients who have not been on finasteride. All of this is backed up by research published in respected medical journals by respected researchers. You can find the research by going to www.pubmed.gov (paid for by US taxpayers and a free gift to the world) and searching for " finasteride AND prostate cancer ". One of the leading researchers is Dr. Ian Thompson, so if you search for " finasteride AND prostate cancer AND thompson i [au] " you will pick up research that includes him as an author. I just did that and got 54 hits.

The drug Avodart, in the same class as finasteride and widely advertised in the US on TV for controlling BPH, based on preliminary data appears to be about twice as effective in preventing prostate cancer as finasteride, :) but several clinical trials are still in progress, so we don't know for sure. However, it has been approved for BPH, so the FDA has determined it to be safe.

Diet, nutrition, proper supplements, exercise, and stress reduction also can aid the cause of a prostate cancer patient, and there are several good books out that cover that. The one I like best is "Beating Prostate Cancer: Hormonal Therapy & Diet," by Dr. Charles Myers. :angel: It is very easy to read and understand. (On the other hand, poor diet, improper nutrition, the wrong supplements, lack of exercise and high stress make it harder to prevent or deal with prostate cancer.)

I have no idea what the cpsa is, unless it means complexed PSA. If so, I know what the initials mean, but that's about it.

By the way, I am an eight year survivor of a challenging case, a circumstance that has motivated me to learn a lot about this disease, but I have never had any enrolled medical education. I can relay what I've read, heard, studied from doctors I consider experts, and learned from fellow patients and researchers, but please take what I've posted for use as leads to your own and your brother's own research and discussion with doctors, but not as authoritative information.

Take care and good luck to your brother and to you in your assistance to him,

Jim

Regarding cPSA or complexed PSA - I had to look it up:

PSA exists in the blood serum in two general forms: free-floating PSA and PSA complexed (attached) to proteins. When a man gets back his PSA result, it is the total measurable PSA, which is the combination of fPSA and cPSA.

Separately, the free PSA test measures the amount of PSA not bound to another protein in the blood and then that value is compared to the amount of bound PSA.

Prostate cancer is more likely to be present if the ratio of free PSA to total PSA is less than 15%; therefore, low free PSA values are more likely to be associated with prostate cancer than high free PSA values.

These compared measurements of free PSA and complexed PSA improve the ability to tell whether a rising PSA is from cancer or benign prostatic disease.

The percent of fPSA in blood is increased in men with BPH because the inner portion (“transition zone”) of the prostate, where BPH predominantly occurs, contains elevated levels of certain forms of fPSA that leak into the bloodstream but aren't naturally there otherwise.