Sorry Dan but a needle biopsy is far from perfectly accurate, especially
in such a big target such as yours. You'll need to keep getting poked until
your PSA drops, or they find the evil "C".

I'm not an expert other than going through this myself, (with a lot of
research) a rise from 2001 psa 2.6 and to 2005 psa 4.9 can be cause for
concern it's not a definite positive certainty for cancer.

The free PSA threshold of less than 25% can be specific for a diagnosis
of cancer.

Ok, that's good.

BPH? Could be a possibility.
The biopsy will tell more in March.
Concerns do come to mind with your free psa numbers though.
Even if PCa is the case, seems like you've been made aware of it early
enough to make decisions for a positive outcome.

B.A.

Based on your PSA, you have gone up 4.0 in almost 7 years.  That may
indicate a prostate problem, but elevated PSA can mean cancer, enlargement,
infection or even be the result of recent trauma.  Of those, BPH is the most
common reason.  It is common for a man to have PSA of 10% of his prostate,
so if you have an enormous prostate, you PSA could be low at 5.0.

When graphed, it shows a straight line projection from 1999 to 2005.  Cancer
would normally show a doubling.  If yours is doubling, it doing so in more
than two years.

And that 18% is in that gray area.  It is under the 25% safe mark and under
the 19% that some use, but, remember, FPSA is used more as a predictor
justifying biopsy, not in predicting cancer.

My only question would be, how many needles were used in the biopsy?
Originally 6 were standard and 6 could easily miss cancer in the single
digits PSA and enormous prostate.  Mine was 12.  I've read of those here
that had 20.  Recent discussions talk about 30 and 60.

From: tripper648@hotmail.com

I'm hoping someone can help me to understand my situation. Here are the
quick facts:
58 years old
June 1999 PSA 0.9
Sept 2001 PSA 2.6
July 2005 PSA 4.9
Re-tested in July 2005: PSA 5.0, free 18%. Uro did a DRE and felt no
suspicious areas, but he did comment that my prostate is "enormous". I'm
not a big guy - 5' 7", 155 lbs.
Biopsy in Sept 2005: No sign of cancer in any of the samples.
I have to have another PSA tests in March.

I'm thinking I have (or will soon have) a problem to deal with. I think
the probability of the biopsy missing active cancer is very low, but the
numbers make me feel pretty certain that trouble is coming. I can't
think of any other explanation for the velocity and the free ratio.

I have no other related problems. Flow isn't what it used to be, but not
a problem. No ED problems. No pain.

I'm hoping there is a good explanation for my numbers, but if there's
only a bad explanation I'm anxious to mentally prepare for a fight.
If you can shed any light I would appreciate it.
Dan
=========

hi dan - a rise in psa as fast as you have may be indication of
something going on.  the large prostate doesn't help matters any.   when
they did the TRUS, they should have taken measurements as to how large
your prostate is and be able to tell you so you would know.  the average
size prostate is between 20 - 30 grams.

i believe that you are mistaken about the probability of missing the
cancer is low.  this has been a long discussed topic here and at best,
it's a guessing game.  they are going to areas that show up on the scope
as suspicious.  a color doppler TRUS could help pin point the areas
better, but most don't have that unit.

keep an eye on your free psa readings because with the large prostate,
this can give your false psa readings, but the free psa will tell the
tale in your case.

i put together a few paragraphs that may help explain some of this.  

hope this helps.

~ curtis

--------

The PSA level in the blood can vary by about 20% from day to day.
Nevertheless, the data are clear that a single abnormal PSA value puts
one in the higher group for prostate cancer. Now that we know the test
can be falsely elevated by trauma, infections, and intercourse, we
inquire after these factors before accepting the validity of the blood
test.

The general rule is that PSA is normal from 0 to 4.0. If the level is
between 4.0 and 10.0 then about 35% of men have prostate cancer. If the
level is between 10.0 and 20.0 then about 65% of men will be found to
have prostate cancer. Levels above 20, in the absence of infection, are
usually associated with more advanced prostate cancer.

Free PSA is that percentage of the total PSA which circulates in the
blood without a carrier protein.

Most patients with prostate cancer have a free PSA less than 15%.

Patients with free PSA over 25% usually have benign prostate
hyperplasia.

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."
http://community.webtv.net/PALMER_ENT/doc

Thanks so much for the information - you are very generous to share
what you have learned (often the hard way).

Just to clarify, I am having a PSA/FPSA test in March, but at this time
I don't have another scheduled biopsy.  However, glassman may be right
that I will have lots more biopsies in my future.  Ugh.

Also, I did not have a TRUS.  The uro took 9 samples in a random
pattern.  He said the probability of finding cancer if it was present
was 97.5% or something in that order.  That sounds suspiciously like
something I learned (and promptly forgot) in intro stats class -
something like two standard deviations or something.  Anyway, there is
clearly room for error.

Last PSA test was in the summer when I was riding my bike a lot.  This
is something new for me and I wondered if that wicked bike seat was
irritating my prostate.  But my uro rides a lot, too, and he told me
that was hogwash.  Anyway, before the re-test I stayed off the bike for
a week and the PSA result didn't improve.

I have not been on the bike much this winter, so my March test should
prove that the bike is not the culprit.

Thanks again for all your help.

Dan