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I personally would consider just getting my PSA rechecked in 6 or 12 months. Your velocity is low. My PSA was 3.2 but my velocity was 85 % so I had a biopsy where they found a little low grade ( gleason 6 ) cancer. I was 58. The biopsy was no fun...lots of blood in my urine for about a month.
You appear to have established a baseline of 3.5 to 3.8 over the past two years. Regarding 3.78 as the top of the baseline range, I find a bump up to 4.7 in five months ambiguous; not an emergency, but not to be ignored either. I would suggest a repeat PSA in three to six months. A urologist would have a better idea of the appropriate time interval.
I had two biopsies, didn't have much trouble with either. The procedure wasn't bad; each needle insertion produced a sensation which was very startling, I couldn't help bu jump, but it was not painful. I had blood in my urine for a few days, but it was expected, and I didn't find it a problem.
Thanks for all the responses. Seems like there are worse case scenarios - worse then what my friend had. None the less they still seem to be fairly rare.
I am getting a free psa test tomorrow then will get results probably 4 days later. If it is low I will definitely get the biopsies. If it is high - over 25 then I have to decide.
Seems like everything before biopsy is just guessing. Even a low PSA does not really say much I guess. It tells you percentages. Not whether you have something or don't. So biopsy = a much better chance at knowing something solid.
Probability of finding prostate cancer based on % free PSA in men with a total PSA between 4 ng/ml and 10 ng/ml
% free PSA ---- Probability of prostate cancer
0%–10% ----- 56%
10%–15% ---- 28%
15%–20% ---- 20%
20%–25% ---- 16%
More than 25%--- 8%
SOURCE: Journal of the American Medical Association, May 20, 1998.
16% chance still seems pretty high. 8% chance - hmm - is that worth not doing the biopsies? It could come back under 10% - which then means 56% chance of cancer - then it is a no brainer I think. But 20 to 25% free?
I'm glad to hear that. On second thought, I decided sooner would be better, and returned to the thread to suggest that, but you beat me to it. Good call.
"I am getting a free psa test tomorrow then will get results probably 4 days later. If it is low I will definitely get the biopsies. If it is high - over 25 then I have to decide."
When I researched it back in 2009, I found that a very low free PSA ratio correlated highly with a higher grade tumor. I don't recall anything about the probability of any tumor, but I might have missed that or forgotten it.
"Even a low PSA does not really say much I guess."
One PSA doesn't say much. But a change from an established baseline is significant. If you've been bumping along between 3.5 and 3.8, 4.7 is a spike above an established baseline. I am less concerned with free PSA ratio than if the 4.7 repeats. If PSA repeats at 4.7, I think a biopsy is probably advisable, regardless of free PSA.