Q. I am concerned about my PSA and free PSA values. Kindly guide me.

Answered by
Dr. Raja Ramesh
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 03, 2017 and last reviewed on: Oct 09, 2018

Hi doctor,

On a recent visit to the doctor, my PSA was 4.7 and free PSA was 0.78. The prostate was swollen on the right side, but no bumps or nodes felt. I had another PSA test three weeks later and the result showed PSA 2.5 and free PSA 0.60. Under what percentage do the 0.78 and the 0.60 values fall in? What would you do at this point? My age is 73, and of course, I am concerned. Thank you.



Welcome to icliniq.com.

  • Free PSA (fPSA) and %fPSA (free-to-total prostate specific antigen ratio) are called as PSA derivatives. There is no fixed normal range for fPSA.
  • For your age, in the case of PSA above 4 malignancy or cancer needs to be ruled out by doing a biopsy. The %fPSA helps to decide regarding the need for prostate biopsy or repeat prostate biopsy when the initial biopsy is negative, and PSA is between 4-10.
  • The %fPSA is calculated as follows. %fPSA = (fPSA/PSA) x 100. The value more than 25% is normal, between 18% to 25% is equivocal and less than 18% is more chance of cancer, and there is a need to do a biopsy.
  • In your case,  the first %fPSA is 16%, and it is suggestive of the need for biopsy. The second %fPSA is 24%. It is more towards normal. Since total PSA is 2.5 (normal <4) and so there is no need for biopsy.
  • Such variations in PSA are common due to a lot of normal activities. Hence, repeat PSA testing was done. Thus, unnecessary biopsy avoided.
  • If you are still concerned, I would recommend a PCA3 (prostate cancer antigen 3) test to decide further.

For further doubts consult a urologist online --> https://www.icliniq.com/ask-a-doctor-online/urologist

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