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 Is It Prostatitis or Prostate Cancer? 
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Joined: Wed Jan 20, 2016 7:51 pm
Posts: 2
Post Is It Prostatitis or Prostate Cancer?
hello, everybody. i'm new to this forum. my name is samuel. this past december, i turned 42. in july of 2014, my psa was a 5.5. my MD, referred me to a urologist. i had a negatiive DRE and was scheduled to have a biopsy. biopsy results came back no cancer seen, but have BPH and asymptomatic inflammatory prostatitis.

in july of 2015, my PSA was 5.9. my urologist said because of BPH and inflammation, that is to be expected. he suggested i have a total free PSA ratio test in six months. well, this past thursday, i had that test and the result weren't as good as i'd hoped. i would like to share with you his comments, first then the results. before i share with you my results, is it possible for a low total free PSA be a result of prostatitis or just cancer? here are his comments and results:

PSA still high, with concerning free-fraction, making risk of having prostate cancer around 56% (normal risk with high PSA is around 30%). But you had inflammation on last biopsy, so the slightly higher PSA could easily come from that inflammation.

There is another test performed on post-prostate massage urine sample that measures gene expression called PCA3 test. If the gene expression is low, the 75% negative predictive value that you do not have prostate cancer. If it is abnormal, then the 57% positive predictive value that you do have something. Thus, it is much better at reassuring us that there is nothing concerning there when negative, and sparing you from another biopsy. The PCA3 test is FDA approved, but insurance does not reimburse enough to cover the test, so patients are directly billed $175 for it. For most men, that price is worth it to avoid another biopsy. If you want to have that done, make an appointment for RV (return visit) and we can get that done quickly.

If the PCA3 test is positive, then I would recommend getting a multi-parametric MR of the prostate which can identify suspicious areas for biopsy. We then would fuse the MR images with a 3-dimensional prostate ultrasound to get targeted biopsies of those suspicious areas rather than the 12 "template" biopsies with standard prostate sampling.

You could skip the PCA3 test and go to the multi-parametric MR if you were concerned about the cost of the PCA3, but I think it is worth the price to avoid another biopsy if possible.

here are the results:

Prostate Specific Antigen
7.66 ng/mL

Free Prostate Specific Antigen
0.67 ng/mL

Prostate Specific Antigen Ratio
8.7 %

Wed Jan 20, 2016 10:47 pm
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