Peter, it's hard to offer good advice in this situation and virtually impossible without a lot more
detail.

PSA alone is neither sensitive to disease nor specific to health - meaning that both false positives
(high values, no cancer) and false negatives (low values, cancer) are regrettably common. 4.2 is
outside what is generally regarded as the healthy range, but inflammation or vigorous sex the night
before the test can raise the level just like cancer can.

For what it's worth, I'm 54. My PCA was found on the first biopsy on an initial PSA of 5.6 but I had
an abnormal rectal examination with one lobe larger than the other. I think you need advice from a
very experienced and trustworthy medical adviser who has all your details and best interest at
heart. Biopsy tends to have a very low false positive rate but even well performed biopsies can be
false negatives - if a small cancer is present, it can be missed, but if cancer is diagnosed by a
competent pathologist, it's certainly there!

However, since you asked, I think that if I'd had a negative biopsy, I'd probably have wanted
regular PSA/DRE and another biopsy in a year or two if nothing had changed or sooner if something
did change. On the other hand, if I'd been 84, I'd probably just have got on with my life.... It's a
difficult and very personal matter. I wish you well - may your biopsies continue to be true negatives!

The scale is correlated to age - how old are you?

It's hard to tell what the PSA means.  Age and prostate size are
factors.

My pre-biopsy PSA's were 4.7 and 4.3 with 17% free PSA (age 48).  My PG
was enlarged and my Uro said he full expected that my large PG would
explain the high PSA and there would be no cancer.  However he found 2
positive samples in the right lobe and my RRP found 'considerable'
cancer on the right side.

My only observation would be with regard to my own case, where my PSA
was in that range for many years--when it rose to nearly 6, biopsies
showed the prostate to be completely filled with cancer that had
spread from the bladder lining.  Had biopsies been done sooner I might
have been spared considerable misery... but then again, maybe not.

  This is strictly your doc's place to answer, not us novices. If you don't
have confidence in your Uro, find one that you trust. Do don't want to wait
too long if the doc suspects something do you?

"Peter" wrote :

This could be similar to my case.

I had a RPP at age 66 in April 2004.

My PSA had been wavering between 4.8 and 6 between 1997 and early 2003.  My
PSA was tested twice a year during this time with Free PSA Index mostly
between .18 and .22.

I had a negative 6-core biopsy in 1998.

A PSA increase to 7.1 in late 2003 triggered another biopsy.  One of 12 cores
showed Gleason 6(3+3), T1C.

The pathology report says:
Focal Andenocarcinoma (Maximal dimension 0.9 cm on slide A26)
Tumor site Right Lobe (Slides A25, A26,A27)
Gleason 3+4=7
TNM Stage PT2A, PNX, PMX
(T2A = 1 slide, <50%, T2B = 1 slide, > 50%, T2C = Bilateral)

I take this to indicate that the tumor was relatively small.

My Uro reported that my prostate was huge at 150 grams, although this was not
mentioned in the pathology summary.  I asked whether my history of elevated
PSA was due to the prostate size and my Uro replied "maybe".

Al