What Causes High PSA Levels?

Posted on Fri, 24 Oct 2014

Question: My psa levels in april 2014 were 1.5. new test last week came back 3.4. I met with a urologist and he is wanting to do a biopsy. I went for a 2nd urologist meeting with another doctor and he is suggesting waiting 3 weeks and then take another blood test and he said if the results come back the same have a ultra sound done before the biopsy. I have had a 2nd blood test this week and the psa was 3.0 and free psa is 15.3. I called the 2nd doctor and he is still wanting me to wait 3 weeks and redo. The first doctor is requesting the biopsy be done. i am very confused and looking for advice. should I listen to the first doc or the 2nd doc. Is the ultra sound a good choice before a biopsy? thanks,

also I am 51 years old and my father had prostate cancer

Answered by Dr. Manuel C See IV (34 minutes later)

Brief Answer:
What is your free PSA value or ratio?

Detailed Answer:
Good Day and thank you for being with Healthcare Magic!

What is the unit in your free PSA? it should be lower than 3.0 since 3.0 is your total PSA. What we look for in the serum free PSA is the ratio of free PSA from the total PSA. A free PSA ratio of 25% or less would have a 95% chance of detecting cancer and the lower the free PSA compared to the total PSA the higher the risk of harboring prostate cancer.

Unfortunately the only way to detect and diagnose prostate cancer is with a TRUS biopsy. PSA will only guide us to screen men who may have prostate cancer and needs a biopsy. Factors that would urge me to offer biopsy to you would be 1) Father having prostate cancer 2) A fast doubling time of your PSA from April to present time 3) and lastly your young age. Cancer is still a race against time and the earlier we catch it the better are the treatment outcomes.

I wouldn't see how a prostate ultrasound would help us decide and it wouldn't provide much information.

In the end, It is your decision if you want to sit this one out and wait for a few more months and ask the same questions you have now.

Regards, Manuel C. See IV, M.D. DPBU FPUA

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Manuel C See IV (15 minutes later)

it says PSA Free 0.46 ng/ml

% of free PSA 15.3

what does this mean

Answered by Dr. Manuel C See IV (2 hours later)

Brief Answer:
A ratio of less than 25% would require a Biopsy.

Detailed Answer:
It means that your free PSA to total PSA ratio is 15%. Accepted cutoff for the ratio would be less than 25% meaning men with less than 25% ratio would need a biopsy. This would be another reason to get the biopsy done.

Regards, Manuel C. See IV, M.D. DPBU FPUA

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar