Low Free PSA Levels: Should You Seek Further Medical Evaluation?

Low Free PSA

Hello Doctor, I recently underwent a blood cancer screening and found that my Free PSA level is 22% lower than normal.
Is there a need for further examination at the hospital? Also, I am taking Finasteride, 1/4 of a tablet daily (for hair loss treatment).
Could Finasteride affect the test results? If I need to go to the hospital for further testing, should I stop taking the medication beforehand? Thank you.

CWOU5566, 30~39 year old female. Ask Date: 2020/10/16

Dr. Li Minghui reply Urology

(1) In principle, free PSA should be evaluated alongside total PSA.
When the PSA value is between 2-10 ng/mL, a free PSA/total PSA ratio greater than 30% indicates a lower likelihood of malignancy, although this is not absolute.
Other factors such as prostate weight and the rate of increase in PSA should also be considered.
(2) The medications mentioned may have an impact on PSA levels with long-term use; it is recommended to discontinue them for 2 weeks before drawing blood.
Wishing you good health.

Reply Date: 2020/10/16

More Info

When it comes to interpreting low Free PSA levels, it's essential to understand the context in which these values are assessed. Free PSA (Prostate-Specific Antigen) is a form of PSA that is not bound to proteins in the blood. The ratio of Free PSA to total PSA can provide valuable insights into the likelihood of prostate cancer. Generally, a Free PSA percentage below 25% is considered low and may warrant further investigation, especially if the total PSA levels are in the borderline range (typically between 2-10 ng/mL).
In your case, a Free PSA level of 22% indicates that there may be a higher risk of prostate issues, including the possibility of prostate cancer. However, it's crucial to note that Free PSA levels should not be evaluated in isolation. Other factors, such as total PSA levels, prostate size, and PSA velocity (the rate of change in PSA levels over time), should also be considered.
Regarding your medication, Finasteride (known as Propecia or Proscar) is commonly used to treat hair loss and benign prostatic hyperplasia (BPH). This medication can indeed affect PSA levels, often causing a decrease in both total and Free PSA. Therefore, it is advisable to stop taking Finasteride for at least two weeks before undergoing PSA testing to obtain more accurate results. This is because the medication can artificially lower PSA levels, potentially masking underlying issues.

If your Free PSA remains low after stopping the medication, or if your total PSA levels are concerning, further evaluation may be necessary. This could include a repeat PSA test, a digital rectal exam (DRE), or imaging studies. In some cases, a prostate biopsy may be recommended to definitively rule out cancer, especially if there are other risk factors present.

It's also important to consider other factors that can influence PSA levels, such as recent sexual activity, prostate infections, or even physical activities like cycling. These factors can lead to temporary increases in PSA levels, which may complicate the interpretation of your results.

In summary, given your low Free PSA level, it would be prudent to consult with your healthcare provider about the need for further evaluation. Discuss the impact of Finasteride on your PSA results and consider pausing the medication prior to retesting. Your healthcare provider can guide you through the next steps, ensuring that you receive appropriate care based on your individual risk factors and health status. Regular monitoring and open communication with your healthcare team are key to managing your prostate health effectively.

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