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hi everyone,
at this point, i have not been diagnosed but i go in for a biopsy in two weeks. i had psa in 3-4 range for past six years, but this year it went from 3.6 to 4.5 and my fpsa is 11.2. free has been 15-13 past two years when they included the free. my question is, with a relatively low total and a low free, what are my odds going in? i'm 66 now, in good health otherwise, classic BPH symptoms the last three years which took me to the urologist in the first place. my internist felt no DRE problem and thinks i'm ok, but the urologists thought he felt a slight firmness and recommended the biopsy. father had PC which spread in his late seventies. also, does anyone know if SSRI's (lexapro)and/or ambien can skew results?
thanks so much for your consideration.
worried,
john
First things first: The Golden Rule of prostate cancer is that there are no rules, so although I can give you some information about what studies say, individual outcomes can vary significantly.
1. The movement of your PSA has more in common with the way PSA changes in association with prostate or bladder disease or conditions like BPH (Benign Prostate Hyperplasia) which can also affect free PSA readings, often reducing the percentage as the gland grows from the BPH If you haven’t seen the PSA 101 page on the site, you might find it interesting to read that and click on the link which shows the experiment I ran over 30 days five or six years ago which demonstrates how much variance there is in PSA
2. A number of studies would put the chances of a 12 needle biopsy being positive in between 25% and 35% of men with the symptoms and PSA readings you quote: or as I prefer to look at it, being an eternal optimist, there is between a 75% and 65% chance that no cancerous cells will be found.
3. If calls designated “prostate cancer” are found, the expectation in about 90% of cases is that this will be early stage, low aggression disease and very probably what is termed an insignificant tumour in some circles.
If you are unlucky enough to have a positive biopsy, you might like to bear in mind what Dr Jonathan Oppenheimer says on his BLOGFor the vast majority of men with a recent diagnosis of prostate cancer the most important question is not what treatment is needed, but whether any treatment at all is required. Active surveillance is the logical choice for most men (and the families that love them) to make. . He also has some interesting views on the definition of cancer. These tie in with Dr Christopher Logothetis who had been commenting on the relative inaccuracy of the diagnostic process. The question was: "Does this mean that a lot of people who are diagnosed as having cancer really don't?”
His answer was: "Yes, if one accepts the diagnosis that the cancer is a disease that is potentially lethal……. One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.”
I had a PSA rise from 3.8 to 5.4 over a 18 month period with a 19 free psa and biopsy was positive(age 55). Father had PC at age 68. Urologist had said my odds of PC was 25% so its hard to guess. Had robotic surgery in Feb. and am ok. But I have a friend who had a 6 PSA and had the biopsy and his was negative so its hard to give a good guess.
hi richard,
thanks for your feedback. just had one question for you or terry regarding fpsa. since mine has dropped some from 15 in 2006 to 11.2, is there any other possible cause of fpsa dropping gradually like that?
i think terry mentioned it could be because of enlarging prostate but doesn't that usually denote a rise in fpsa? again, thanks for all your help. love the website.
best to all,
john
The studies I have seen merely say that BPH can affect the fPSA but gthe extent was not quantified. My understanding was that the percentage would change but that it might be up or down.
All the PSA tests are very variable and unreliable and are NOT PCa specific. The only real value - apart from the very high numbers, like the 7,000 ng/ml that new member Roy White reports - is in watching the variances. Continuous accelerating PSA increases are associated with PCa - other variances are more likely to be caused by BPH, prostatitis or some other infection
again, thank you, terry. the more i read this forum,
the more i'm beginning to understand. continued good health and thanks for your patience.
best,
john
