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I just got my patient's PSA test back: PSA, free = 0.4, PSA,

Customer Question
I just got my...

I just got my patient's PSA test back: PSA, free = 0.4, PSA, total 2.3 and PSA, % Free low at 17. My understanding is that the PSA % Free helps to determine if a biopsy is indicated and becomes important if the PSA is greater than 4ng/mL. However, I am concerned that it is still low at 17.

Doctor's Assistant: Any pain or burning sensation while urinating? What color is your urine?

No

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Hemochromatosis in history

Submitted: 5 months ago.Category: Urology
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Answered in 2 hours by:
11/21/2017
Urologist: Dr. David, MD replied 5 months ago
Dr. David
Category: Urology
Satisfied Customers: 49,178
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Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

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Urologist: Dr. David, MD replied 5 months ago

how old is your patient?

usually free PSA levels below 10% can increase risks for prostate cancer

When total PSA is in the range of 4.0-10.0 ng/mL, a free:total PSA ratio < or =0.10 indicates 49% to 65% risk of prostate cancer depending on age

a free:total PSA ratio >0.25 indicates a 9% to 16% risk of prostate cancer, depending on age.

free PSA of 17 is not that high

have you referred the patient to consult with urology doctors?

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Customer reply replied 5 months ago
Hi Dr. David,
I went through all the literature today, as this was the first time getting back a free PSA test result. I already knew the risk of prostate cancer with a PSA range of 4.0-10.0 ng/mL and a level below 10%. I don't have any previous record of testing for this 64 year old patient and he had no complaints. What would your care of plan be for a patient with a free PSA of 17 when the other values don't meet the risk for prostate cancer. The last thing I want to do is cause the patient any unwarranted concern. His prostate was enlarged on the DRE.
Urologist: Dr. David, MD replied 5 months ago

I think he has a low risk of prostate cancer

most prostate cancers are not lethal and not deadly for most patients.

he could have a slow growing gleason 6 cancer possibly, many of these don't need to be treated necessarily

there is a lot of controversy about whether or not even doing PSA testing will help him live longer.

I would just keep watching his PSA level and watching the trend of his PSA levels. if they stay relatively level, I would just keep watching them

if they start to march upwards steadily, I would refer him to see urology for a prostate biopsy

let me know if you have questions.

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Dr. David, MD
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