According to Patrick Walsh, in Guide to Surviving Prostate Cancer, your
PSA is borderline high for someone your age.   But there are a variety
of causes of higher than normal PSA, so it doesn't necessarily mean you
have prostate cancer.   There are two kinds of PSA, free and bound.  (If
you have interested in the chemistry, see Walsh's book.)   If total PSA
is high, but the ratio of free PSA to total PSA is also high, then you
are more likely to be free of prostate cancer.   Whether or not to order
a biopsy is a matter of judgement, and different doctors may come to
different conclusions, depending on the details.   If the ratio is low,
your doctor is likely to order a biopsy, but even in that case, the
result is likely to be negative.  Unfortunately, biopsies may miss a
small cancer, and you may need further biopsies, particularly if the
free PSA percentage is low.

You probably don't have prostate cancer, but even if you do, it will
have been caught at an early stage, so the chances of a cure will be
quite high.   Also, at your age, treatment, done by a skilled
practitioner, is less likely to lead to serious side effects such as
incontinence and impotence than would be the case in an older man.

The word 'cancer' is always scary, but don't let all this get to you.
Just take it one step at a time and go about living your life normally.

I strongly recommend Walsh's book as a source of information.

AJ,

Rather than trying to explain and not doing a very good job I'll send
you a link to a web page which will explain PSA and Free PSA.  At the
bottom you'll find a graph which may help to understand the numbers
involved with the Free PSA test and what it means.

http://www.marinurology.com/articles/cap/learning/psa.htm

Dale J.

AJ,

Put yourself at ease.  First, few get PCa at 46.  I did, but the chances of
that are small, especially if your father didn't have it at 46.  Second, 2.7
may be higher than what it had been or higher than someone with a perfect
prostate, but it is not extraordinarily high.  Until a couple of years ago,
most docs didn't even look hard at a pattern unless the PSA was 4.0 or
higher.  Third, PSA usually rises when there is cancer present, especially
in a 46-year-old.  Yours went down a notch.

I suspect your doctor is a very good doctor.  He is alerted even with a 2.7,
and he is trying to diagnose what you have.  The first thing he'd want to do
is elminiate cancer as a possibility.  A free-PSA test will go a long way
toward that end.  The higher percentage of free-PSA cells you have (versus
binded), the less likely you are to have cancer.

I finally suspect that if your free-PSA comes back at a good percentage, he
will start looking at other possible prostate problems.  Or, if you are
asymptomatic, just keep testing you every 2 or 3 months.

Many thanks.  Your opinions and insights are much appreciated. I hope to
stay the course as recommended by my urologist and I'm sure I'll be posting
here to give updates. Having a forum like this really does help.  Have a
great New Year!  AJ

PSA of 2.7?  Not too bad.  The fPSA is just another blood draw.  If it is less
than 25% it increases the concern.  You didn't say if a DRE revealed any
hardness or lump.  Otherwise, five years ago, you would have been told
everything was fine.   Was that 2.7 an INCREASE of 75% or more over the
previous year?  You have a very cautious doctor.  At this point, it doesn't
seem likely, to me, that you will need a biopsy.