Your Prostate Cancer Test Results: What Do They Mean?

Could you please provide the specific test results or values related to your prostate cancer examination?

Hello Dr.
Hsu, on September 30, 2020, my PSA test result was 6.46, with a % free PSA of 19.1.
On October 14, the PHI PSA was 7.64, with a PHI % free PSA of 16.32 and a PHI free PSA of 1.253.
The PSA was 5.66, with a free PSA to total PSA ratio of 0.13 and a free PSA of 0.74.
In November 2020, I underwent an MRI, which showed a 0.5 cm tumor in the right anterior inferior portion of the prostate.
The radiologist mentioned that a 0.5 cm tumor may not yield cancer cells even if biopsied and advised me to continue monitoring.
Based on the test results from March 24, should I proceed with a biopsy for the prostate tumor, or is there no evidence of progression?

Gu Yin, 60~69 year old female. Ask Date: 2021/03/29

Dr. Xu Wencang reply Urology

PHI 16.32 is not high.
The physician will integrate the information and provide further recommendations, which may include monitoring or a biopsy.

Reply Date: 2021/03/29

More Info

Understanding your prostate cancer test results can be quite complex, especially when considering various metrics like PSA (Prostate-Specific Antigen), Free PSA, and other related indices. Let's break down what these results mean and how they relate to your current situation.

PSA and Free PSA Levels
PSA is a protein produced by both normal and malignant cells of the prostate gland. Elevated levels of PSA can indicate prostate cancer, but they can also be influenced by benign conditions such as prostatitis (inflammation of the prostate) or benign prostatic hyperplasia (BPH).
1. PSA Levels: Your PSA levels have fluctuated, with a notable reading of 6.46 on September 30, which is above the normal range (typically considered to be 4.0 ng/mL or lower). This warrants further investigation.

2. Free PSA: The percentage of Free PSA (the unbound form of PSA) can help differentiate between benign and malignant conditions. A lower percentage of Free PSA (typically below 25%) can suggest a higher likelihood of prostate cancer. Your Free PSA percentage was 19.1% on September 30, which is relatively low and may raise concern.

3. PHI (Prostate Health Index): The PHI combines total PSA, Free PSA, and [-2]proPSA to provide a more nuanced risk assessment for prostate cancer. Your PHI values indicate a moderate risk, but they should be interpreted in conjunction with other clinical findings.

MRI Findings
The MRI results showing a 0.5 cm lesion in the right anterior portion of the prostate are significant. While small lesions can sometimes be benign, the presence of a lesion in conjunction with elevated PSA levels raises the suspicion for malignancy.

Need for Biopsy
Given the combination of elevated PSA levels, low Free PSA percentage, and the MRI findings, a biopsy is often recommended to definitively determine whether cancer is present. The concern that a biopsy may not capture cancer cells from a small lesion is valid; however, it is still the best method to obtain a definitive diagnosis.

Monitoring and Next Steps
Since your healthcare provider has suggested observation, it may be due to the size of the lesion and the current PSA levels. However, if there is a significant concern about cancer, especially if PSA levels continue to rise or if there are changes in the lesion, a biopsy may become necessary.

1. Follow-Up: Regular follow-up appointments and monitoring of PSA levels are crucial. If there is a significant increase in PSA or changes in the lesion's characteristics, a biopsy should be reconsidered.

2. Consultation: Discuss your concerns with your healthcare provider. They can provide clarity on the necessity of a biopsy based on your specific situation and the latest test results.

3. Emotional Support: It’s understandable to feel anxious about these findings. Consider seeking support from healthcare professionals, support groups, or counseling services to help manage the emotional aspects of this journey.

Conclusion
In summary, your elevated PSA levels, low Free PSA percentage, and the MRI findings suggest that further investigation is warranted. A biopsy may be necessary to determine the presence of cancer definitively. Regular monitoring and open communication with your healthcare provider will be essential in managing your prostate health. Remember, early detection and intervention are key in addressing prostate cancer effectively.

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