I'd say prostatitis is a more likely diagnosis because the PSA keeps
fluctuating and the free-PSA is ... well, not high... but in light of the
fluctation, high enough, I guess.  Still, it could be cancer.  I do hope he
is on Cipro and a very close rein.

This sort of thing is fairly common, particularly in older men.  Other
things except prostate cancer can cause high PSA readings.  One is
prostatitis,  which may or may not be treatable by antibiotics.  The
marginal free PSA readings are of some concern, but he has no choice but
to continue to monitor the PSA readings and to have followup biopsies
when his doctor thinks them appropriate.

Fred...Please make sure that your friend understands that the standard
(trans-rectal) biopsy does not sample the entire prostate.  It might
be wise for your friend to first undergoe a course of antibiotics.  If
the PSA remains elevated and unchanged, then some method to better
sample the entire gland needs to be employed.  I'm not sure if a color
doppler ultrasound can image the entire gland or not.  A perineal
biopsy (he'll probably have to do some searching to find a urologist
well versed in this method) can sample the rest of the prostate.  A
good urologist could help him figure out a good sampling technique.
I've read too many posts where a trans-rectal biopsy comes up negative
2 or 3 times.  In the meantime the PCa is growing, presumably in an
unsampled region.  Eventually the PCa is widespread enough that a
trans-rectal biopsy detects it, but by then it may be too late for
curative treatment...Best wishes and good health, Ron

hi fred - here's my opinion if you break it down to the numbers

his psa over the last 12 months was -
9.3
12.2
8.2
7.7
11.0
9.0

notice that the end psa number is no greater than it was at the
beginning. also notice that the numbers didn't go up and increase as
time goes on.  this is how pca behaves.  but if you have a prostate
infection, what you see here is common, depending on what is passing
through the urinary track over time.

now, let's look at the free psa numbers -

Free PSA ratios:
19
16
18
26
16

first, the numbers are down below the cutoff for regular free psa
numbers.  but again, there is a drift of the free psa number to go
lower.  this means that there is less free psa going around inside his
body, now the question is.  where is it going?

if you put to two groups of numbers in motion,  it appears to be that he
has a prostate infection, but the possibility of slow growing pca.

i'm surprised that they have had him on different types of antibiotics
to see if they could change the numbers and see what's behind the
curtain - so to speak.

again, my opinion.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."