Free PSA & Biopsy Question
Hoping someone can help me out with some questions regarding free PSA and the biopsy decision. It appears to me that free PSA typically increases as you get older. For example, when I look at my free psa number (16.4) the odds of having prostate cancer at that level are greater for a 65 – 75 year old (23% odds) than for a 50 – 64 year old (17%) per Catalona JAMA estimates. (they do not provide a range for men under 50) Note: These free psa stats are independent of the overall psa number.
I’m 44 and am awaiting the results of a PCA3 Plus test (current PSA of 3.6). I know urologists typically want to see a free psa of 25% to avoid a biopsy, however am I correct in assuming that given my age my free psa numbers and odds would typically be lower than the 50 – 75 year old statistical guidelines?
Secondly I have a question about the decision to undergo a biopsy. My psa was a stable 1.4 in Feb (huge jump to 4.9 in June) and has bounced around for the last 60 days to the current 3.6. I understand I will eventually want to have a biopsy if my numbers don't go down, but is there any harm in waiting another 30 days or so to see if the psa lowers on it’s own? I find it interesting to read where the majority of men are told to take their time regarding pca treatment options (given the cancer typically grows slowly) however there appears to be a real rush to biopsy as opposed to letting some time elapse to see if things resolve on their own.
Given my very rapid psa increase (300% in 4 months), the bouncing of my psa levels, no family history, a 17% chance of pca using the free psa stats it seems very plausible that infection of inflammation is the cause here. Is it unreasonable/unsafe to wait another 30 days to see what happens (assuming of course that me pca3 plus test comes back with similar odds)?
Thanks for any and all input