What is the difference between PSA and free PSA?

What is the difference between PSA and free PSA? Do I need to have both tests?

 

Whether you need both tests really depends on your individual situation. That’s why this question generates so much debate and confusion.

PSA, a protein produced by prostate gland cells, circulates through the body in two ways: either bound to other proteins or on its own. PSA traveling alone is called free PSA. The free-PSA test measures the percentage of unbound PSA; the PSA test measures the total of both free and bound PSA.

Prostate cancer can raise PSA levels, but so can other conditions. These include an enlarged prostate, prostatitis, and advancing age. In fact, studies have shown that about 75% of men with an elevated PSA do not have prostate cancer. To determine which men actually have cancer and which don’t, physicians traditionally perform a biopsy. Undergoing a biopsy isn’t as traumatic as surgery, but it does cause discomfort and can provoke anxiety.

Rather than subject everyone with an elevated PSA to a biopsy, some urologists measure free PSA in patients with a total PSA level between 4 ng/ml and 10 ng/ml. Studies have shown that men with a total PSA in this “gray area” and a free PSA greater than 25% are more likely to have a benign condition than to have cancer, making a biopsy unnecessary. Men with a total PSA in the same range and a free PSA below 10% need to have a biopsy. More likely than not, they have prostate cancer (see table below).

In some cases, men with a “normal” PSA actually have cancer, but that low PSA doesn’t prompt a biopsy. A low PSA and a low percentage of free PSA, however, probably would. That’s why some doctors automatically order both tests at the same time. I tend to order a free-PSA test when a total PSA yields borderline results and when the PSA seems to be rising quickly, even if the actual number is relatively low. So, while the free-PSA test isn’t essential, the results may sway your decision on whether to have a biopsy when combined with other tests. In the future, other tests may help determine whether changes in PSA are driven by cancerous tissue or benign causes.

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%
Greater than 25% 8%
SOURCE: Journal of the American Medical Association, May 20, 1998.

Originally published April 2009; last reviewed March 21, 2011.

Comments
126
Karl Isabelle

I am a man of 66 yrs old. I just had a Total PSA & a Free PSA test. The result has shown the following:
T-PSA Result is 73.50
F-PSA Result is 5.15

As I am a bit confused about this result so I would like to have your advice if I have a risk of a prostate cancer.

Grateful to give me your opinion about this result.

Waiting on your prompt reply.

Thanks,
Karl

mary rashad

Hi could you pls answer my question about my father he is 73 years old and his total PSA test was 4.30 and his free PSA is 1.50 and the risk ratio is 0.34 is that results good or there is a risk for prostate cancer and we must do a biopsy for him

Jagdish

I am a man of 55 years old , I just had a total PSA & free PSA test , the result is as follows:
Total PSA is 3.232ng/ml.
Free PSA is 0.845 ng/ml.
Please advise me if i have a risk of prosate cancer.
Thanks in advance , looking forward your opinion,
Thank you,

Ron Adair

I have a total PSA of 5.3, and a free PSA of .34, and a Percent Free PSA of 6.04. Can you advise me of the risk factor?

Thank you very much,

RA

Robert Kocher

I have been having prostate and PSA exams since 2003. My PSA on the first exam was 4.2. The doctor did 12 biopsies found nothing and was diagnosed as acute prostatitis. I was given Levaquin for 10 days and started three month follow-up exams. The PSA went down to 3.1 in 12/2004 then spiked to 7.4 in June 2005. August 2005 more biopsies, found nothing diagnosis chronic inflammation and was given Cipro for 10 days. Resulting PSA went down to 3.4 by 11/2006 and was 6.3 in 12/2010. PSA then went to 6.8 in 08/2011. More biopsies, no malignancies again. PSA last test 06/2014 was at 6.9 up from 5.8 in January 0f 2014 and free PSA at 10% down from 11%. Doctor wants to do biopsies. I am inclined to ask for a prescription for 10 days and then have the PSA redone again in September. What is your opinion. I will be 67 in November. My father lived to 82 years and died of bone cancer.

Al

Usually with recurrent infections an Urologist will prescribe more than 10 days of Antibiotics , 10 days is not good therapy .
I have taken 30 and 45 days of antibiotics for an acute prostrstatis.
And spent 8 days in Isolation in Hospital for an infection of the Prostate that I became Septic .

Mark

I am a 48 year old man. My PSA has been fluctuating over the past four months from 6.8 to 4.2 to 3.6 to 4.6. However, each of the four times I have been tested my “free PSA” has been 0. (Yes, zero). I have been to two nationally recognized prostate cancer centers in southeast Michigan, but no one has ever seen a consistent “free PSA” of 0. I have a biopsy scheduled in 2 weeks.

Any thoughts you may have would be appreciated.

Thanks,
Mark

Richard

I am 72 years old and have been diagnosed with andenocarcinoma in one lobe of the prostate. The size of the tumor is 1.2mm with a gleason score of 6. I also have an enlarged prostate that has weakened my urine flow. This has improved after the Urologist put me on Lucrin hormone treatment for six months. I am on my second dose. I just had my PSA done and the total PSA is 2.35 with free PSA at 1.01 and a percentage of free PSA at 42.9. This high percentage is of great concern to me. Could the high percentage be as a result of the Lucrin hormone theraphy. My testosterone from Lab result is 0.20
Can you please give me your thoughts on the above. Thank you. Richard

Samuel Tso

I am a 65 years old man.

I had my first PSA tested in Jun 2008 and the results were Total PSA: 5.8 ng/ml and Free PSA:1.17 ng/ml. U/S prostate (transretal) followed by Trus Guided Prostate Biopsy were performed within two weeks from PSA test. U/S showed enlarged Prostate gland measurement 6.1×3.4×4.1 cm (TDxAPxCC). There was mainly hypertrophy of the central zone, suggesting benign prostatic hyperplasia. No focal lesin is seen in the peipheral zone. The contour of the prostat gland appears smooth. Biopsy of the protstae gland was perfomred and the procedure was unremarkable.

More than ten PSA tests were conducted from 2008 to end 2012 the Free PSA fluctuated from 5.7 to 7.8 and Free PSA from 0.98 to 1.41. In Aug 2013 PSA went up to 8.48 and in Jun 2014 PSA went up to 9.59, the doctor suggests to peerform a Biopsy. I am very concerned to do another Biopsy and would be grateful to have your advice by return.

Thanks a lot.

Sam
10 Aug 2014

Howard Himelstein

I have just been diagnosed with Pca…My Gleason is a 3+3=6, T1c, Total PSA is .65, psad is .01, but my free psa is .11 and my PSA3 test is 58.4…I read in Patrick Walsh’s book that if you have a free PSA under 15, there is an almost certain chance that one’s cancer is the aggressive type. When I asked my doctors about that they told me not to be concerned as it doesn’t apply to my situation. Does anybody know why it doesn’t? Can’t seem to get a solid answer from my uros…

PS – just had an Onotype DX test and it came back at a good and low 15.

Ramon

I am 71 and I was diagnosed with prostate cancer last December (Gleason 6; 1 core less than 10%). I have been taking Avodart for BPH for several years. My total PSA has been around 1.9- 2.5 for several years). The latest PSA test has the following reading:
PSA % Free= 28%
PSA Free: 0.39 (ng/ml)
The test result does not list the total PSA. Doing the math I calculated the total PSA as 1.39 ng/ml. Please confirm if my calculations are correct: (0.39*100)/28.

Thank you for your help,

Ramon

Don

I live in Brazil, 58 years old, and my blood test revealed the following:
Total PSA = 0.76 ng/ml
Free PSA = 0.42 ng/ml
Free/Total Ratio = 0.55
GP’s NOTE: “Results suggest BPH: Free-Total PSA ratio > 25%. Send to urologist.”
I SUSPECT THERE IS SOME ERROR IN THE GP’s INTERPRETATION/OBSERVATION ABOVE. PLEASE CONFIRM.
Thank you.

Maurice H

Your honestly worrying about 0.76? Come on dude, is that really fair to all those on this site with scores of 5-10?

reza

I am a man73years old and living in Iran .I had a total PSA and free PSA test .The result is as follows :
Free PSA 0.4
PSA 1.41
Free psa/PSA 0.28 ratio
Will you pleas advise me if i have the risk of prostate cancer?
thanks in advance .looking forward your opinion .
best regards : REZA

steve

60 yo excellent health, fitness. lifestyle and diet. No meds except TRT since 2006. Annual DRE always completely non-remarkable.

2006 – 2012 PSA = 1.8
2013 PSA = 2.1 Free = .21 so 10%
2104 PSA = 2.8 Free = .28 20 10%

Active surveillance or biopsy here?

reza

i am 53 years
my prostate is calsificate and shows bellow test
P.S.A =0.362
FREE PSA =0.154
free psa ratio =0.43
pls guide me
thank you
regards

frank

I am 44 years old I have a total psa of 5.9 with a free psa of 0.8 and a 0.14 free psa ratio . I am confused please advise me of what this means

Alf

I am approaching 59 and healthy person. My latest test results were Total PSA of 2.33 and Free PSA of 0.44 (free PSA first time tested). My DRE check up with Urologist specialist was normal. My Total PSA over the years have been around 2.5 with little change apart from one case where the total PSA went up to 3.3 and down again to 2.6 and then 2.33. Shall I continue as it is testing once a year? My consultant reassuring that everything is normal. Also can diet help to improve results effectively? Many thanks.
Regards,
Alf

Levy

I am 71 years old. in June 2014 my total PSA was 4.48 and today it was 4.05. The free PSA is 0.96 and the ratio is 23.73%.
Should I be concerned?
Thanks

Vijay Mahadeo Bartakke

I am a man of 71 yrs. old. RecentlyI had a Total PSA & a free PSA test. The results are:

PSA-Serum by CMIA 5.145
Free PSA serum by CMIA 1.54
Free/Total PSA ratio 29.99

I had undergone thrice TURP in 1996,1999 & 2009. With histopathological reports ware negative.

PSA concentration has remained elevated since 2006.

Please note that I had TURS guided Biopsy in Feb.2014. Which result was negative.

So I am very much confused and anxious. I am very grateful to have a advice and opinion about the results.

Waiting for your prompt reply.

Thank you,

Vijay M. Bartakke

roni

Hi , iam 67 years , my psa diagnostic is. Total. 3.260. Free 0.88. Free/total. 27.0% laboratory of american university of beirut. Please let me know your opinion about this result. Espcially for free psa which was befor one year 0.78. Laboratory evarage up to 0.72. ,please is it bad indication. Thank you in advance ,best regards. Roni

david

I have an enlarged prostate and PSA readings between 5-6.0 on average. My FPSA is usually about 1 and % varies between 16-22%. I am 64 and had one biopsy 4 years ago but want to avoid more! My last test had a crazy high FPSA reading a little higher than my PSA of 5.3 so my % is 100% meaning no cancer risk??!!! Could this FPSA be so high due to other factors like a mild infection etc. ..maybe a follow up test next month to see if FPSA is back to normal??
Thks for any advice.

Bob

Hi, i,m 64 and 18 months ago my psa was around 0.70 for years and then 6 months it went to 2.1 and stayed there for 3 months now it went to 3.3 with a free psa of 0.4 ng/ml, 25% i have the normal symptoms of bph and my rectal is enlarged but smooth. I drink 2 gallons of milk a week and lots of eggs and cheese and dairy. Do i need a biopsy? Thank you

Richard

Hi, I am 65 yrs old and saw a urologist for hemospermia.that I had for about 2 months. He did a psa which came back at 5.3. It had been 3.5 about 18 months prior. He said to give it time. I returned in 2 months and the hemospermia seems to have cleared up . He took a new Psa after a DRE that was normal and the psa was 7.2. My Free Psa was 19%. His recommendation was to take 5mg of Proscar for 6 months and if psa does not go down at least 50% than a biopsy would have to be done. My concern is that the PSA rose so quickly in 2 months. I also have BPH. Size 65 grms. Is it ok to wait 6 months? Thank you

Alex

Hi, I am 42 years old. My PSA has fluctuated for the last 10 years between 1.9 and 3.2. The PSA was 3.2 and my free PSA % was 20.3% on 12/12/13, at that time the doctor prescribed levoquin and my PSA went down to 3.0 and my % to 26.7%. I still felt some discomfit and irritation in my prostate, so my doctor kept me on the levoquin for another 60 days. My PSA as of 1/21/15 is 2.6 (which I am very happy with), but my free % is now 18.8%, which is scaring me. I have never had any biopsies, my doctor has shied away due to my age and potential risk. However, now I am concerned, should I be?

Also, what is an Onotype DX test and would this be a good test for me to take?

Thank you for your help!

Mark Oliver

hello, I am 47 and my PSA is 4.6, I am so scared and depress. I am schedule for a biopsy on Feb. 16, 2015. I have a history of prostatitis 8 yrs. ago. But then my PSA was .04. Any ideas wil be helpfully.

Gary Hoga

I am a little confused. According to the article that preceeded this blog 2 speciic tests were discussed.

Total PSA
Free PSA

In a number of the comments posted I see reference to numbers for %Free PSA.

It has always been my understanding that Free PSA is expressed as a percentage of total PSA. i.e., .20 = 20% of Total PSA is free. Meaning if I had a biopsy done there is a 20% probabilty (according to the chart) that cancer would be found. Am I correct in my assumption?

Fred

Hi I had a psa test in January 2015 and it came back as 10.1. This was a total psa not free psa i. I had follow up total psa last Monday and it was 1.5. Can anyone explain?
Bit embarrassed to say but for first test I had had sex an hour before? Could this explain such a variation? I had a psa done 2/years ago and it was 1.7. I am 57 years old

Maurice H

No sex 24-72 hours before. That my friend is the rule! Your second test confirmed it. I didn’t have sex , and in Oct 15 it came in at 1.2. At 65 I am very happy with that number and you should be to! Stop worrying, as most men our age don’t come close to our numbers! Just remember, the schlong stays inside for 3 days prior😎

Charlene Crosthwaite

My husband had a PSA test in Oct. 2014. Total PSA…7.06 with Free PSA of 19%. DRE showed prostate enlarged. Urinary and ED issues. Dr. prescribed Cialis 5 mg every other day and 0.4 mg Tamsolusin daily and to have test repeated in January 2015. Total PSA…6.84 with Free PSA of 13%. Husband is 75 years old. His older brother also had prostate cancer several years ago. Dr. never mentioned Free PSA, but gave another appointment for November 2015, 9 months from now. I think that is a big drop in the Free PSA. Am I wrong to be worried about the Free PSA result?

Maurice H

Unfortunately Ms C genetics is very strong with the Prostate. Father can easily give it to either or both sons! It stinks, but those are the cards we are sometimes dealt’ Hope he feels better!

Ron Davis

I am 73 years old and my PSA is 2.4 and my PSA free is 16%. My Prostate is moderately enlarged and should I be concerned and if so what is your suggestion on my next step. Thanks

Azzam Jarrar

I am 64 years and my PSA is (3.98 ) and Free PSA is( .261) and PSA ratio is(.o7)
what is my next step should be.. thanks

Sandeep Gupta

I am 49 years old man. I have a total PSA of 5.07, and a free PSA of 1.11, and % free PSA of 21.89. Please advise whether I should go for Prostrate biopsy or not.

Roger Smith

I was beenDx with agressive prostate CA in September, 2014. I have been on alternative treatment since then. No chemo,radiation or surgery.
My PSA then was 9.0ug/L,
Free PSA 1.2ug/L and
%Free PSA 14.0%.
Now on the 13/02/2015 the values are as follows:
Total PSA-5.1ug/L
Free PSA: 0.88ug/L
% Free PSA: 17.3%
Please can you explain these figures to me, am I going in the right direction?
Thanks

Sue

My 83 yr old father has just been biopsied and diagnosed with prostate cancer. I learned his PSA was 10 at least 6 months ago and this 6 month check has jumped to 17. After researching and reading posts I am beside myself wondering why he was not biopsied long before now. I am in another state and my dear dad is a private person. He does not want me to go with him to his dr. Appt. after the scan happens next week to see if it has spread. I think he needs an advocate to say that he is important, loved and worth the treatment. Does anybody have any knowledge or experience that can help me ask the right questions to get the right care for my beloved dad.

Merrin

A 55-year-old man whose is free PSA and total PSA 0.31 ug/L and 1.5 ug/L respectively is concerning about if he needs to have a biopsy. Three years ago, three polyps were found out, and diagnosed that all polyps were benign. Therefore, that patient has PSA testing every year to make sure a biopsy is needed once those polyps become malignant.

So, could any experts here tell me if he needs a biopsy now?

Thank you so much!

κουκακης ηλιας

10 ΜΑΡΤΙΟΥ EIMAI 43 ΧΡΟΝΩΝ ΑΠΟ 35 ΚΑΝΩ ΤΣΕΚΑΠ ΚΑΙ ΟΛΙΚΟ PSA ΕΙΝΑΙ ΑΠΟ 1 ΕΩΣ 1,5 ΠΡΙΝ 9 ΜΗΝΕΣ ΕΙΧΑ PSA ΗΤΑΝ 1,8 ΤΩΡΑ ΕΙΝΑΙ 8,35 ΚΑΙ FREE PSA ΕΙΝΑΙ 1,14 ΚΛΑΣΜΑ ΑΥΤΩΝ ΤΩΝ ΔΥΟ ΕΙΝΑΙ 1,14 ΤΙ ΠΟΣΟΣΤΑ ΚΑΚΟΗΘΙΑΣ ΠΡΟΣΤΑΤΟΥ ΕΧΩ ΕΥΧΑΡΙΣΤΩ

Kim

My husband is 52, has been on fluctuating doses of testosterone ink for 1.5 yr. PSA last April 2.1- in July 2.8- in Feb the following yr-PSA 2.79- free PSA 0.51 and free psa % 18.3. Hx- dad had prostate ca. Bx scheduled 4/3. Nervous. Suggestions?

PHILIP SMOLEN

had my prostate removed in 2007….ORIGINAL PSA WAS 23.9 HAD PROSTATE REMOVED AND RADIATION TREATMENTS. then it started to rise after a few months to 3.8, luprin shot reduced…..second shot given and then after 0.0 in 2013 it finally budged to 0.05> now it is 2015 ….what are your thoughts? I am getting another test soon….does history tell you I am ok? Phil

Gerald Carter

I recently moved and currently looking for a new Urologist. I am 66 years old and found a new Family Physician finally after a year. Both my Dad, brother, and a cousin had prostate cancer. I had two biopsies in the past, but were negative. I have also been treated in the past with Levo & cipro. My current PSA level is 15.9 and the FPSA is 4.0. Would a repeat biopsy be warranted at this time based on family history and current values? Both my Dad and brother have died, Dad from additional complications (80) and my brother at 60. Thank you

Dr. leo Karkas

Men over 50 are concerned about what they hear of the possibility of prostatic cancer. When to screen, when to perform a rectal exam and when to undergo prostatic biopsies and also at what intervals. Bad biopsies may give a whip to the prostate to develop CANCER.
When the PSA is in the gray zone between 4.00 and 10.00 there is no need for biopsies or medications if the free PSA level is not high and the ratio above 25.
One of the signs to remember for further investigations is the steadily rising PSA from yeah to year by one percent.
This is to say that anxiety in men should be controlled by good advice rather by extensive invasion of privacy. However trouble in urination and alike symptoms and abnormal values of free PSA and any ratio between the free PSA and the total less than 10 become a compulsory rule for investigation.

Maurice H

I am fortunate that my father was healthy in that area which may explain why at 65 I have a P S A score of 1.2. Although I have genetics on my side I still do not smoke or drink, I swim 2-3 times a week, and I add Lycopene, Saw Palmetto, X
Zinc, and other supplements. I find Urinozinc with Beta Sitosterol a great find!

Dr. leo Karkas

Men over 50 are concerned about what they hear of the possibility of prostatic cancer. When to screen, when to perform a rectal exam and when to undergo prostatic biopsies and also at what intervals. Bad biopsies may give a whip to the prostate to develop CANCER.
When the PSA is in the gray zone between 4.00 and 10.00 there is no need for biopsies or medications if the free PSA level is not high and the ratio above 25.
One of the signs to remember for further investigations is the steadily rising PSA from yeah to year by one percent.
This is to say that anxiety in men should be controlled by good advice rather by extensive invasion of privacy. However trouble in urination and alike symptoms and abnormal values of free PSA and any ratio between the free PSA and the total less than 10 become a compulsory rule for screening and investigation.

khalid qureshi

Sir 4 month before I come to realize that I have urine weak flow, so I consulted urologist, hr checked with rectum and disclosed very enlarged prostate, I went for total PSA and result was 19.780, he put me on cipro and cantiflow 0.4
After one month PSA reduced to 10 And now its 8.01 after 4 months, SME gym I have slight pain in prostate area when belt of trouser s tight.
I would like to have ur expert advise.
Best regards,
Khalid qQureshi
Muscat,
Oman

Gary Johnson

I am a 60 year old male. A paraplegic for 29 years

I have a total PSA of 0.6 and a free PSA of <0.1. The prostate is hard.

Should I be concerned?

Jack

I am 67 years old. Last 5 yr PSA’s (2 free PSA results included):

3.58psa / 17% free psa 4/2015 (Abbott Architect)
3.89psa 12/2014
2.73psa 12/2013
2.87psa / 18% free psa 12/2012
2.16psa 11/2011

High Anxiety here. Second appt with Urologist soon. Any guidance deeply appreciated. Thank-you.

Ehsan

i am 63 years
my prostate is calsificate and shows bellow test
P.S.A =7.8
FREE PSA =6.1
free psa ratio =0.78
please guide me
thank you
Best regards

Gary

I’m 64 and had a PSA of 5.1 with a normal DRE exam.
Had another PSA and PSA free test 6 weeks later and my PSA was 4.7, with a Free PSA of 15.5
Should I get a biopsy or could I get a MRI with the same degree of accuracy ?

Andrew Anderson

I’m 69 and have had several PSA test done, increase year after year from 4.8 in 2008 to current of 10.93, Have had digital exam which indicates enlarged prostate. Have had two biopsy’s 1 with 12 samples w/one sample indicating High Grade PIN. Second biopsy of 20 samples showed no cancer or PIN. Weak urine flow and occasional problems emptying bladder. On occasion a sharp needle like pain in the prostate region. Have never had a free PSA.

Any suggestions?

H.Soltan

I’m 58 years old, and have had several PSA test done during previous years, increased from about 5.65 in 2011 to current of 10.74, on sept.8 2015, last week. Before that, it was approximately fixed around 6.7 during previous months and years. Ratio of free PSA to total PSA is 13.5℅ with a free PSA of 1.45. I Have had one biopsy operation about 1 year ago, Needle biopsy of prostate with diagnosis of benign prostatic tissue and no cancer. 40*47*61 mm are dimensions of prostate and regular size.Weak urine flow on occasion and occasional problems emptying bladder….
Any suggestions?
Thank you very much in advance your help.

Steve Coetzee

Please be so kind to let me know if my number are a risk of cancer.
PSA 6.3
PSA FREE 0.6
PSA % FREE 9.5
Truly will appreciate your thoughts.
Regard
Steve C

For many years I suffer from prostate problems such as pain, poor urine flow, BPH, frequency and many more symptoms. I am a 69 years old man and PSA has always under normal levels. The last one was done a month ago. The results were as follow: Total PSA 1.5 ng/ml; prostate specific antigen(PSA), free 0.98 ng/ml; specific antigen (PSA) free 65%. What chances of getting prostate cancer do I have?
Note: 1. All my urine tests are normal
2. I am taking Flomax and Finasteride
3. I get prostate pain after each orgasm which last for more than a day
4. All DRE’S appear to be normal.
5. In the past I was recommended to undergo surgery to reduce the prostate size but I refused to do it

Please advise what I should do.
I am in despair, anxious and depressed for this situation

CSurber

I am a 62 year old man who was recently diagnosed with Parkinsons–am currently taking mirapex and levadopa (minimal improvement in broad range of symptoms). 6 weeks ago my internal med doctor referred me to a superb urologist due to PSA score 6.3 (previous score 5/14: 4.56). New blood work: PSA 5.3 and Free PSA 9%. DRE normal. Ultrasound: at least 3 nodules found in peripheral area. I am scheduled for biopsy under sedation (thank God) where I understand the uro will take 20-24 samples. Bacteria resistant strain in urine put me on a 10 day antibiotic regimen; and in addition a rectal culture. i have additional immunological concerns. I’m in very good medical hands but am worried, not scared. I’ve read that any Free PSA below 10% is indicative of aggressive cancer. Is this true? (There is no history of prostate cancer in my family.) If I get an infection as a result of the biopsy, how long is the window before I’m clear?

G.Keenan

After having read all of these posts and being a fellow sufferer(watchful waiting)I have a number of observations to make.
1. All of the inquiries listed can and should be answered by your physician.
2. If you do not have confidence in your physician then you need to find a new one now!
3. There is a great deal of “FACTUAL” information on line including this website. Make note of the date of the article as new information is coming out all the time.
4. Stay away from blogs regarding personal experiences. Remember they are subjective and are not the best source for you to base decisions on.

In the end your course of treatment is your decision. Be informed.

Terence Daly

I am a 53 year old male. a recent PSA test during routine physical came back at 4.1 following a 2.0 the year prior. I was referred to a urologist who retested the PSA and added a PSA free % test. PSA came back at 4.1 and PSA free % came back at 8.8. The doctor then biopsied and it came back negative. I understand that a prostate biopsy is only 40% accurate. I am still concerned. Any advice? Thank You

M Sorota

I am a 59 year old man, with an enlarged prostate. Currently taking Rapaflo. Total PSA 5.3 July 2015 – then 6.1 October 2015. Free PSA July 2015 0.8 to 0.7 October 2015. % Free PSA 15% 7/2015 to 11% October 2015. Total PSA 2.7 5/2010, Total PSA 4.7 6/2014, PSA 5.3 2/2015 I have had biopsy couple of years ago and came back negativeI am concerned and would consider any advise you can give me.

George Gerges

I have 49 of age,My psa results:
Psa 0.61ng/ml
free psa 0.22ng/ml
Free psa/total psa 36
Can tell me an advice what I must do plz.
Best regards.

P. Vanapruk

I am 85. After several DRE, my Doctor diagnosed my case as BHP with percentage of FPSA/TPSA tests over a period of two years (2014-2015) sliding from 28 to 25 to 23 to 22 and the last one on 11/14/2015 was 21.2%(1.43/6.76). Do I need a biopsy?
Thanks for your kind responses.

John S

My PSA climbed from 3.8 to 5.4 to 7.1 in two years. My free PSA was 9.8 and my father had prostate cancer, so I knew I was a cancer patient. The doctor ordered a biopsy but I refused, stating that it was barbaric use the same dinosaur method of detecting cancer that they used 50+ years ago. Urologists who learned the same techniques in med school while ignoring technology. Doctor said they would radiate if the biopsy was positive (which I already knew it was). I said no way to that as well.

Found a urologist in FL who performs a 3 Tesla MRI and an ultrasound. Showed EXACLY where the cancer was with no needles and possibility of sepsis or serious infections. Went down to Mexico and got treated by a method not allowed in the U.S. No biopsy, no radiation, no prostatectomy. The cancer is gone and I have full “manly functions”. Doctors here are barbaric and could care less that your quality of life gets destroyed!!

JOE MILLER

i justas a PSA test on December 14,2015. I am 64.
The results are as follows:
PSA (FREE and TOTAL)

TOTAL PSA 1.7
FREE PSA 0.4

Lab report says OUT OF RANGE 24 L

Can you help with any conclusions. Your cooperation in this matter is greatly appreciated.

Thanks so much,

Joseph Miller

math.83

I am a man of 60 yrs old. I just had a Total PSA & a Free PSA test. The result has shown the following:
T-PSA Result is 22.07
F-PSA Result is 4.61

As I am a bit confused about this result so I would like to have your advice if I have a risk of a prostate cancer.

Grateful to give me your opinion about this result.

Waiting on your prompt reply.

Thanks,

John Labib

HI,
My father has 74 years old , PSA result is as the following
Total PSA 10.3 ng/ml
free PSA 1.2ng/ml
ratio 0.12%
Ultrasound examination “estimated Prostatic weight is 100gm
pre voiding urine is 80 CC
post voiding urine is 40CC

Thanks for your advise as i am confused if there is a Prostatic cancer or not
Thanks , Warm Regards

Visitor

Lots of people reported their PSA elevated and had to go for the endless biopsy. No one even doctor tells you that sex and ejaculation can cause your PSA rising. If your PSA elevates, you can stop sexual activities and ejaculation for at least three months and redo the PSA. The PSA will probably drop. If you see your PSA drops, you may think about the necessity of the biopsy, especially you had the biopsy before. The change of the PSA is closer related to men sexual activities and ejaculation. The more sexual activities and ejaculations, the faster the PSA elevates. It does not matter you have no ejaculation 48 hours before your PSA. The BPH and prostate cancer are closer related to man sexual activities and ejaculation. If a man does not irritate his prostate, how can it quickly become enlargement? A man who never marries such as a monk probably rarely has prostate related disease.

mazyar

Hi
i am 43 with positive family history of prostate ca .
my screening result is
T.PSA: O.50
FREE PSA: O.15
FREE/T.PSA: 30
please advise me about prevention of prostate ca & guide me about above results.
with great thanks.

Ron

I’m 48 my psa a year ago was 2.3 this year 3.6 I have frequent urination and some burning after urination was given cipro a year ago for same symptoms they went away but are back . Could this be prostrate cancer

Mohamed Mabrouk

Mohamed Mabrouk
I am a man of 80 yrs old. I just had a Total PSA & a Free PSA test. The result has shown the following:
T-PSA Result is 13.08
F-PSA Result is 2.09

As I am a bit confused about this result so I would like to have your advice if I have a risk of a prostate cancer.

Grateful to give me your opinion about this result.

Waiting on your prompt reply.

Thanks,
Mahmoud

Larry

I have read every comment left here. I see alot of men with great concern and anxiety. I too have an elevated PSA. 6.8 was the first reading after my Dr did the DRE (digital rectal exam) and did not tell me to refrain from sex 48 hrs before the blood test. Turns out I found out that you should not have a PSA test if you had sex or ejaculation 48 hrs prior to the test and have had a DRE prior to taking blood. Anyway I was sent to a Urologist who I discussed this with and he advised me 1 week no sex and repeat the blood test. It then came back as Total PSA 5.3 a little lower….but he said I should not have that high of a score at the age of 56 and recommended biopsy that I have been putting off. My free PSA was good at 25% meaning the probability of cancer is lower but he still wanted a biopsy even though the DRE was normal too. I learned of a Dr now in Florida but started his practice in New York area……Dr Sperling….Do a google for him. He uses a 3t MRI to check for Cancer and if found and can be treated uses a laser to oblate it that is guided with the MRI. But the head nurse failed to answer 2 of my emails to her asking if the MRI can find small cancers like a trus needle biopsy could. I spoke to her once on the phone but failed to ask that question. My urologist nurse when I asked her said Insurance requires a biopsy first and thats all the answer I got. SOOOO confusing. I am with the hundreds of other men concerned about the PSA scanning results and my own family Dr told me before he did the PSA not to be alarmed if it was high but then sends me to a urologist….My family dr also talked about the controversy over screening and the anxiety it can cause. It makes a guy feel like the PSA testing is not the KNOW all of screening although Im sure it does. But then you hear of men with LOW PSA and still have cancers but the Drs tell you that some cancers will not affect the PSA….So again what to do. Eventually every male with get cancer of the prostate but its not always the cancer that will do the guy in it might be something else as we all age. Anyway….you can see the frustration here. Wish there was a Dr or Urologists that would comment here too.

michel abou

Sir
i am 55 years old from beirut my name is michel abou
i just conducted my annual test and the results shown are :
PSA 0.51
FREE PSA 0.14
FREE PSA?TOTAL PSA 29

can i have an idea please of this test.

Brian P.

I am 50 YO
Jan. 2013 to Jan 2014 PSA jumped from 1.3 to 2.4
Jan 2014 to 0ct 2015 PSA = 2.4 on three tests

Jan 18 2016 PSA 3.1

Jan 21, 2016 PSA 2.2 Free PSA .4 Free % PSA = 18

15 year History of Chronic BPH (Probable Acute in the last 5 years).

Overall question – % likelihood of Pcancer and if I were your brother, would you tell me to get biopsy?

1. What is the argument for biopsy in my case now? I read that free% around my level of 18 many doctors order biopsy.
2. Do you favor 12 needle or 18 needle biopsy?
3. Is the new MRI test for Pcancer available and reliable?

Brian P.

I am being followed by a reputable Urologist in Atlanta. My PSA info above. I echo the anxiety of grey area results and Doctor does not order biopsy. Especially when I have conflicting advice from doctors and cancer patient. My best friend, a surgeon, sees Urologist at his hospital. He is 50 YO with PSA 2.2 no family history of PC. Urologist Dr. X immediately orders his doctor colleague get a biopsy and they find Prostate cancer. My friend recommends I see the same Urologist. I have worriesome velocity of 1.3 to 2.4 in 12 months. He orders another PSA a year later it is 2.4. Does not order biopsy. I’m same age as my doctor 2.2 P cancer friend. My PSA stays stable at 2.4 for 12 months then jumps to 3.1 (34% increase), and 48 hours later take free test it shows 2.2. .4 and 18 (though I had sex day before test). Now here is the intersting part:
-Urologist in Miami says get biopsy now. Unequivocal. Based on age, PSA 2.4 and prior velocity. -Heart Surgeon friend says biopsy is inevitable and to get it now because he had 2.2 and Pcancer At same age of 50.
-Urologist heart surgeon went to says just test PSA every 3 months (huh??)
-Read above that “Many” doctors recommend biopsy if Free PSA Is 20 or below even with PSA BTW 2 and 4 and mine is 18.
-Chronic BPH can increase PSA but it is also correlative with Pcancer (that’s a difficult conundrum).
-I have anxiety – particularly when I get conflicting advice from two well respected Urologists, and read the public policy over diagnosis of PCancer debate slow growth and aggressive prostate cancers. The overall impression is that there are too many prostate removals when slow growth cancer represents large percentage of all P cancer dx. Yet 15% of Dx is aggressive and can kill within short time. Who wants to take that chance of being in that 15%?
-The inevitable biopsy test is compelling and strongly recommended by one Urologist who has seen all my results and knows my BPH history, but not by my treating Urologist. That’s a difficult inconsistency to reconcile.
-Anxiety out there? Yes. Frustration over the state of the science and the different doctors opinions. At the end of the day I can insist on biopsy, but even the biopsy is hit and miss.

Barani

My Free PSA is 0.28 NG/ml and PSA is 0.7 NG/ml do I have prostate cancer or not. Please mail me. Thank you for all your support!

Terry Sproule

Previous PSA 9.9; biopsy results: T2, Gleason 9. While
awaiting proton therapy was started on Lupron Depot (3 mo).
Adverse side effects (diarrhea 84 day and counting) have
caused a delay. Now, being concerned of what might be happening to my diagnosed cancer I requested a new PSA.
Results: total PSA = .2 with free PSA <.1 . Testor was not able to calculate %. My doctor was elated with the
low PSA, I'm not so sure. Can you offer any help here?
Thanks,
Terry

Al

Have had several psa tests. I’m 60….last one was 3.8…down from 5.2 after antibiotics. Free psa 18.9%. Doctor just wants to check every six months….is 3.8 normal at 60?

John Piag

I am 56year old male
I have a total PSA @ 3.6
I have a free PSA @ .8
Does this indicate a risk for cancer ?

serpa

I am 69 years old I had a psa of 4 in two months it went to 6. my free psa was 15. do I need biopsy? real worried!

mohammad abbani

i just made a PSA Free test and the result is:

1.244 ng/ml

iam 65 years old .Please advise me if the result is normal

and if not what should i do in this case

Rakhu

I’m 52 years old, and I still don’t understand the difference between T-PSA and F-PSA. And have no idea which PSA test the VAMC uses, but I do know my PSA levels been going up over the past five years. The lowest 2.6 and highest 4.1.

So, should I be really concerned?

Dear Rakhu I’m 52 also and was just diagnosed with St2 PCa( stage 2 prostate cancer) and my Psa levels were very similar to yours. Going from 1.1-2.2-4.2 in three yrs. Please get a biopsy, don’t let nobody tell you otherwise! This is for your peace of mind and Life!!!

selam

I am 50 years old. I did biopsy four months ago and result was negative.

Current total PSA 6.13; Free PSA 1.01; ration of Free to Total PSA 0.16. Please advise what this means.
Thank you,

Sujan Ghosh

Hi,
3rd Feb 2016 plenty of blood came out with urine. Previously I was having sudden pain in my groin area. After the painless haematuria doctor advised for USG and PSA test. The USG shows Grade I enlarged Prostate. PSA 5.37. CECT of abdomen is normal. Doctor kept me on antibiotics and again on 9th March FPSA and PSA was done. FPSA was 0.114 and PSA was 1.47. I am 38 years old male. FPSA is 7.9 %. I am having Urinary Incontinence and little pain in lower abdomen. Can anybody throw any light whether I am having Prostate Cancer or else. My father at the age of 67 was told by some doctors that he might be having Prostate Cancer. I went through his medical records and found his PSA was 18.40. On 70 my father passed away. Biopsy was not done at that time as we were not aware of Prostate Cancer then.
Thank you for any kind of information.

Faruk

Prostate issues are inevitable for man of senior years or early for some.Sooner or later we will face the reality.We have to accept the fact and do our best to follow the advice of health pros like yr urologist.LEARN AS MUCH AS YOU CAN and adjust yr lifestyle accordingly.Eating healthy and organic,especially licopen rich tomato and tomato juice,selenium rich garlic ,broccoli,brussel sprout,zinc rich pumkin seeds HELP prostate health according to cancer researches.

It is better to see yr urologist regularly to monitor yr situation than asking advise from somebody else, because each patients case is different despite similar.Not all medical problems are solved by Scientists,doctors etc but medical technology is advanced over the years.Life is so short.We are born out of our mothers womb and will leave this world one day in our coffen leaving loved ones behind.So do yr best to enjoy this world but only those who believe in God and his messengers will be happy in hereafter.

Jamie Morales

I am 70 years old.

October 2014, Total PSA 7.9 ng/mL, Free PSA l.62 ng/mL, % Free PSA 20.5%
January 2016, Total PSA 8.3 ng/mL, Free PSA 2.44 ng/mL, %Free PSA 29.4%

According to my doctor, my right lobe is larger than the left, but the prostate is smooth. I drink about 48 ounces of filtered water daily, but no alcohol. My urine is free of blood and my urination flows freely and on average 12 ounces or more per void. Usually I void about once every 4 hours during the day and once in the middle of the night, although on certain nights I don’t have to void at all. Lately, If I wait too long after first needing to void, I tend to leak. I’ve never had erectile disfunction. I am in good health, have never been on medication of any kind.

My younger brother (he is 65) had prostate cancer at age 63 and underwent radical prostatectomy the same year. His last PSA test, taken two months ago, showed a detectable level (I think close to 4.0 ng/mL). Now he is going to have further tests.

My question: should I request a biopsy? My doctor has not advised me to have one but I can’t help noticing the total PSA jump from 7.9 ng/mL to 8.3 ng/ml 14 months later. I am also worried about my brother’s prostate cancer. How important are genetic factors?

Solly Ngoasheng

My case is as follows: In 2012 June 11 I took a test and the result were as follows:
PSA = 3.43
Free PSA = 0.49
PSA/Total ration 0.142
In 2015 the result were the following:

PSA = 4.10
Free PSA = 0.54
PSA/Ratio = 0.131

What does this mean? Cancer?

Peter Rouse

I am a 51 year old male with the following PSA readings
PSA Total = 1.03 and a Free Total PSA 0.17

Should I be concerned with either of these readings?

In advance thank you for your feedback.

Mobeen Jawaid

I am 37 years old man, During MRI of lower limb for another disease , it was revealed that there is a hypointense area in peripheral zone of my prostate. Doctor did DRE with normal results and check PSA level. Free PSA was 0.39 and total PSA was 2.1. doctor starter antibiotic for 1 month and after completion of course again did PSA , Now PSA level was free PSA .39, and total eas 3.1. Doctor did TURS and found that there are 2 nodules one is central zone size 1.8 x 1.4 cm and one in peripheral zone size 0.8 x 0.4 cm. Doctor again did DRE with vegetative results and also perform PSA what was again free PSA 0.36 and total PSA 2.76. Now doctor decided to do Biopsy through TURS. I want advise of any one. Is is cancer? and Is there any chance of infection after biopsy.
I am really worried about

Regards

Juan Rojas

My total PSA was 5.74. After 1 months in cypro treatment Total PSA was 4.3 and free PSA=.7
Ratio of free/total PSA = 16.3 .
My age:67, Prostate size=59 cc.
It is unnecessary a biopsy?

S.P

Hi all. Wish u all well. Watch Dr. Pankaj Naram and other Ayurvedic and Islamic medicine before going through any other harsh allopathic treatments

Dr Sharad Vijayvargiya

I undergo psa test result is Psa free 1.205ng/ml and free psa/total psa 23.39 % if it is normal range? Or

Subir Datta

Hi

My father is 78 yrs old. He had a total PSA of 10.9 around 1 month back. After visiting Urologist and undergoing medication for a month, the latest results are : Total PSA = 1.43, Free PSA = 0.248 and % Free PSA = 17.34. Pls suggest whether biopsy is required or not.

Matin

Hi
I am a 44 year old male with the following PSA readings
PSA Total = 1.93 and a Free Total PSA 0.34 and free PSA/Total PSA ratio 17.62

Are this Ok?

In advance thank you for your feedback.

B Gopalan

Hi
I am a 72 year old male with the following PSA readings
PSA Total = 9.94 and a Free Total PSA 2.05 and free PSA/Total PSA ratio 20.62

Since the results are on the border, is advisable for me to undergo biopsy? Kindly convey your considered opinion.

Thank you,
B Gopalan

ASIM Kumar Ghosh

I have made apsa test.reading is 8.15. As per Dr.advice free PSA test to PSA test done. Free PSA read 2.47% to total PSA read 0.73%.I think possibility of prostrate cancer.pl. advise

Manoranjan Das

I am a 41 year old male with the following PSA readings
PSA Total = 0.46 and a Free Total PSA 0.182 and free PSA/Total PSA ratio 39.60

my rectal is burning only daytime after bowel. Please advise.

arman micael

Arman Micael

I am a 41 year old male, single with the following PSA readings:

TOTAL PSA (TPSA) QUANTITATIVE – Result: 2.25
FREE PSA QUANTITATIVE – Result: 0.54

Please advise.

Thank You!

Jay

I’m 54 years old my PSA was 9.1 on 12/18/2015 and is 14.3 on 7/31/2016 Had MRI and they said I have BPH enlarged prostate but now they want to do a biopsy. I don’t want to do it cause from what I’ve read they want to just keep doing them in the future. Any thoughts on this???? Thanks Jay.

Mahmoud Nabavi

I am 64 years old man. I had my gall bladder removed on May 5th. Before that my total PSA and Free PSA tests showed normality. During above operation, they had to pass a tube to my bladder to urinate more easily.
On July 10th my total PSA was 18.8 and Free PSA 2.6.
On July 18th my total PSA was 9.47 and Free PSA 1.63.
On August 10th my Total PSA was 5.0 and Free PSA 1.3.

Should I undergo a biopsy?
I thank you in advance.

David Tweedley

Thankyou for all the information on this page.
I am a very fit and healthy white male, 64 living in South Africe, from British origin.My parents both passed on just on 80. I do not recall my father ever being found to have any Prostate issues in his life. He was, though a heavy smoker and passed on due to lung and throat cancer.
I have never touched a cigaret in my life.
It was discovered on my FAA annual medical that 2 years ago the PSA was 3.7
On my current bi-annual tests ( August 16) with PSA at 4.3,I have been advised to go for Biopsy after a rectal inspection, where I have not yet received a written report, but was very shortly advised that the Prostate was large and there appears to be a lump.
I then read your page and noticed that In the blood tests done, there was no PSA Free test, so I demanded this through my GP, where the resutls came out at PSA 4.6, Free PSA 0.33 and Total Ratio at .071.(These tests were done through a different pathologist, inside 4 weeks where PSA was 4.3 and then 4.6)
Based on your chart, I interpret that my risk is below 8%.
Would you based on these revised results after the physical inspection still suggest that I go through the Biopsy, or would you rather suggest, as I think I should do, do PSA and Free PSA tests regularly in 6 month intervals and see if the variations will motivate the Biopsy?

John Lee

My last few test result here:

Date PSA PSA % FREE
Jan-15 8.9 33.9
Oct-15 8.6 36.0
Sep-16 8.2 39.1

Do I have to Biopsy?

David Le

I’m 49 yrs old and always had normal PSA in the past but this year it spiked almost 4x see below. I went to see Uro and he said my DRE was normal and put me on 30-day Cipro antibiotics then retest again in October.
Looking at the PSAs between 2015 and 2016, it seems to double then double again, hence 4x. The PSA velocity tween 2015/2016 is very concerning. Can PSA double then double again within a year?

4/2013 = 1.69
6/2014 = 1.43
6/2015 = 1.77
8/2016 = 6.96

Rakesh Sharma

I am 60 years old man, live in Hong Kong . My PSA jumped from 3.5 to 4.7 in a span of 1 year. Free/ Total PSa ratio was 7% as result of which Biopsy was carried out with 10 needle samples. One of the sample showed that I am having first stage Prostrate cancer Ca Prostrate – T1c (T2a) Gleason 3+3, PSA 4.7. Please advise the best treatment with above results, I want to know if the removal of Prostrate by surgery is the best solution among all available treatments

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