Q. Please evaluate my prostate PSA biomarker test for any abnormality.

Answered by
Dr. Ankush Jairath
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Apr 24, 2020

Hello doctor,

I need a urologist to look at my labs. I also have prostate PSA biomarkers like total PSA, free PSA, and prostate-specific antigen free ratio.



Welcome to icliniq.com.

Let me tell you, your reports are absolutely fine (attachment removed to protect patient identity). This ratio has got significance only when your total PSA (prostate-specific antigen) level is out of normal range. You can repeat this test annually. No intervention is required right now.

Some of my questions are why did you get PSA done as it is not indicated at 31 years of age? Do you have any urinary complaints (frequency, urgency, poor stream, nocturia, dribbling, etc)? Do you have any previous episodes of UTI (urinary tract infection)? Are you diabetic or hypertensive or on any medications?

Thank you doctor,

I did an online test and this was an additional one I elected to have done since I do have frequent urination. Why is this ratio showing abnormal and elevating concern? It is low which I read is not good.



Welcome back to icliniq.com.

That is what happens when you choose to do tests yourself which are not indicated. The earliest age at which PSA (screening) is recommended is 40 years. That too only total PSA is to be done. If it is deranged i.e. falls between 4-10, then only one should go for free PSA and ratio. This ratio has got no significance if PSA levels are within the normal range.

I will try to clear your doubts with an example. Higher total PSA levels and lower percentages of free PSA are associated with higher risks of prostate cancer. This line is a double edge sword as here it does not mention age, prostatic infection, and history of prostatic manipulation. Free or total PSA ratio is a powerful predictor of future prostate cancer morbidity in men with initial PSA levels of 4.1 to 10.0 ng/mL.

In your case, the normal PSA level in < 40 yrs is < 2, if your PSA is < 2 then free PSA and total vs free PSA ratio has got no significance. Even in literature they do not even mention this ratio significance when your total PSA levels are within normal range and your age is < 50 years. So chill out, you are just normal, and you do not have prostate cancer.

I hope this helps.

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