Does the Free Psa help in the decision making process?

Not really. It helps in whether to have a biopsy. Once you have the biopsy and it shows cancer, then the pathology specifics help with  the decision about what to do.

The Free Psa helps a patient and doctor decide whether or not to do a biopsy. In other words a patient has an elevated Psa and has been sent to the urologist. Let’s say the rectal exam of the prostate is normal, the patient is in his mid seventies, and his disposition is not to “mess with the prostate.” (Some patients will tell you, “Won’t a biopsy let air get to it? Air getting to a cancer makes it spread!”)

So…enter the Free Psa (no you still have to pay for it and it is more expensive than doing a regular Psa). If the percent unbound Psa (Free) is low there is a higher chance of a positive biopsy and if it is high there is a lower chance of a positive biopsy. In the patient mentioned above a high Free Psa would incline him not to have a biopsy and to maybe repeat a Psa in 3-6 months. See how it works…it helps the aggressive minded patient have a biopsy if the value is low and helps the “foot dragger” forego a biopsy.

Anecdotally, I have a neighbor who had a Psa of 6 and a free Psa of 25% (high) which would make one believe he did not have cancer or at least a low probability of it. Well…you guessed it, he ultimately had the biopsy and all of the samples were positive for a Gleason’s 6 prostate cancer. (Remember the song by Joe Jackson- Is she really going out with him? Well there is a line in the song that applies here…”Well there goes your proof.”)

In my case the Free Psa was low and it prompted me to do my biopsy. The “unsmiley face” you see is what my nurse wrote on the lab report when she handed it to me. Here’s the story from the my book, “The Decision.”

Your PSA, rectal exam and biopsy report – Understanding the specifics of your disease is key to making the right decision.

I had been checking my PSA for years and had watched it slowly creep up to just above normal. I decided to obtain a Free and Total PSA to see if it would offer any guidance regarding pursuing a biopsy. (In your blood, a portion of PSA is free (unbound), and a portion is bound by blood components. A low Free PSA indicates a higher possibility of a positive biopsy.) The day after my blood was drawn, my nurse Tina approached me with the lab report indicating a very low Free PSA.

She had drawn a frowny face next to the lab value. I was crestfallen. “Tina, did you really have to put the little unsmiley face on it?” I decided at that moment that the time had come for me to have a prostate biopsy. I asked my partner to do it at lunch that very day, and the pathologist had the tissue samples in his hands by 1:30 p.m.

 

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