Originally Posted by phds2
I am 58 years old. My baseline full PSA for many years was .65. This June when I had a physical my PSA was 1.25. So I had it retested two weeks ago and it was 2.95! My doctor referred me to have a Free PSA test. I just received the results and it was (Full= 2.52), (Free .43) and the precentage was 17%. He seemed to downplay the results. Should I be concerned about the PSA Velocity and the low Free PSA percentage?
Thanks for all your help,
I'm with shs50: it's time to be careful and act!
Did the doctor just say "Wait til next year?" That sure would not seem right to me.
Or did he say, "Let's do some follow-up work, but it's not yet time to be alarmed?"
Here is my view of the facts (as a layman - no enrolled medical education but lots of time in the School of Hard Knocks):
You did not mention whether the doctor commented on infection as a possibility. That could explain a rapid PSA rise.
Your baseline PSA at .65 is below the median for men in their 50s, putting you at very low risk of prostate cancer, according to Dr. William Catalona, one of our foremost experts.
But your PSA is now much higher,
and I would bet that Dr. Catalona would be concerned and recommend a biopsy. He is the leading advocate of a new threshold of just 2.5 as the trigger for biopsies, instead of 4.0, with some adjustments perhaps for age. (Many experienced doctors have not yet accepted that new threshold, and I have my own doubts about it too. But it does clearly give an early warning for a few percent of significant prostate cancers.)
That free PSA % at 17% is somewhat encouraging, but that result is toward the gray area. It would be more encouraging if it were, say, 25%. It's a good sign about the doctor that he wanted to see free PSA results.
Your PSA has now risen to 2.95, more than 2.0 PSA units above the original .65. If the .65 was about a year ago, then that rise of more than 2.0 is an important clue that you may be developing an extra aggressive case of prostate cancer (based on highly regarded work by Dr. Anthony D'Amico and colleagues, published in 2004 and 2005)
Also, the last two PSAs suggest a PSA doubling time of four to five months or so, just eyeballing the trend. That too is a clue that there may be a fairly aggressive cancer.
Along the same line, recent research has indicated that a PSA velocity of more than .35 per year is grounds for concern (H. Ballentine Carter, Johns Hopkins,2006); the old threshold was .75 per year. Your PSA velocity is obviously well above .35.
Since you had a highly favorable PSA just a year ago or so, IF you do have cancer, it probably has not had a long time to grow. In other words, by acting soon you would be catching it early.
Expert prostate cancer pathologist Dr. David Bostwick wrote (1999, ACS cancer book) that it takes about 30 to 35 cancer cell doublings for the cancer to reach 1 cubic centimeter in size, about the size of half a peanut, which is about as small as can be detected by Digital Rectal Exam (DRE). A cancer that is doubling say every 4 months would be unlikely to be very large by this time, in my layman's view. Cancer therapy is a lot more effective when the cancer is caught early, and that is emphatically true for challenging cancers!
There is one tactic you could use now that might rule out the need for a biopsy: a PCA3 test, probably the PCA3Plus version, which seems to be the most advanced. That test can be done basically anywhere, as it simply requires a doctor that can give a DRE that is "attentive" (meaning extra time, perhaps a minute). That causes some prostate cancer cells to be shed into the urine, and the urine sample is sent to one of the few labs that can do the test. That test appears to add more robust, better and a lot more definitive information than the free PSA test.
However, if it were me with your facts, I think I would want to go straight to the biopsy, especially because of that rather short PSA doubling time. As with so much in the prostate cancer arena, that's a judgment call.
Good luck with this! Hopefully that increase will simply prove to be the result of an undetected infection.