Interpreting High PSA Values & Free PSA | Mark Scholz, MD | PCRI

Medical oncologist Mark Scholz, MD answers questions from our YouTube comments on the topics of "free PSA," factors that can affect a PSA result, and other questions about PSA.

0:09 What is "free PSA," how does it differ from PSA testing, and is it still relevant in 2022?

3:07 What are some factors that can potentially affect PSA results?

4:10 How soon can someone repeat a PSA after a suspiciously high result?

4:22 Is a high but stable PSA a sign of cancer?

5:24 What is the lowest PSA you have seen with metastatic activity?

7:05 How high have you seen the PSA go without there being any cancerous activity in the patient-- being caused by BPH and/or prostatitis instead?

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[emugglsu]

recent spike from 2.5 to 4.4 over a year period alarmed me and my concerned high mileage biking (6, 000 miles) was off bike two months and redid PSA and happy report went down to also did MRI to be safe and it came back clean and confirmed 52cc gland another possible reason for higher PSA (age always thanks Alex and Dr Scholz for providing generous education service to many men

[sdnewy]

Great information for all men! My PSA has been elevated since I was in my 40s...20 sample biopsy, 2 MRI's later...cancer free.

[peterz]

Brother-in-law just diagnosed with PC Gleason 8, with some mets to bone and lymph glands. PSA was under 5, just somewhat higher than previous year.

[frankdimercurio]

Thank you for always providing informative facts. It’s been extremely helpful to me as I continue my journey with prostate cancer. I really appreciate your input!!

[arneysmits]

At the 2:57 time mark, it states: "PSA density - the ratio of the size of the prostrate to the amount of PSA - and that gives you . . ." Shouldn't the PSA density be the inverse of that? In other words: The amount of PSA/Size of the Prostrate ?

[keithmoore]

Great channel! Very informative. Recent test showed Elevated PSA 21.9 and PSA ratio of 12%. My doctor pressured me to have a biopsy- in fact I had one scheduled for August 21. I cancelled it and opted to do an mpMRI instead - booked for mid September. Trying to manage my anxiety - but it’s challenging, and in the meantime (over the last 8 weeks), cut out virtually all sugar, eliminated red meat and dairy and increased vegetable intake, started walking average of 6, 000 steps per day- lost 11 pounds. Thanks again for this very informative channel!

[Combat]

I also had a blood test done recently by my new primary Doctor to get a baseline blood panel, and part of the test included a PSA test. Well, my PSA was 6.3, with free PSA of 1.10 and PSA percentage of 17.2. All of my PSA tests in the last 10 years have typically been 1.9 to 2.0. Because I’m a new patient, the Doctor was not aware that I’m a cyclist, and that the day before the blood test, I had ridden for 2 hours. The test is going to be repeated soon, and I will not be cycling for at least 48 hours before the test. I’m expecting to hopefully see a return to normal range on the next PSA.

[hn]

Extremely useful information, thanks, Dr. Scholz and Alex.

[xtob]

I think a discussion of PSA velocity would be educational (sorry if that's already been discussed).

[litonmolla]

Thank you very much. Very well explained and clear to understand. This was very very helpful for me.

[pedroemiliopereira]

Appreciated a lot the interview with Doctor Scholz, this's very good. Here in my country, we live a "mistical time" when the subject is PSA analisys. The unic diagnostic to hight PSA is a potential cancer and the patients go soon to cancer treatment. Beside of imediate emotional damages, comes after the consequences to errored treatment.

[dubhainoceanntabhail]

My PSA is 9 so after watching this video I'm hoping its just an enlarged prostate which is something I have known I have for a few years. And cycle around 150 to 200 miles a week so maybe this is the cause of my PSA reading. Anyway my GP is sending me off to a urologists and I have never been so nervous in my life. This video has reduced some of my stress. Thanks for posting,

[Its_just_me_again]

this was great info thank you. what id like to know as a follow-up to the last response that it is possible to have high PSA as a result of BPH and / or prostatitis but does that high value oscillate. i.e if it is prostatitis, would u expect psa data points to not have a relatively straight gradient. im 56, my psa over the last 4 years has risen from 3, 3.5, 4. every value in the middle never once going down, and now 9.0 - free psa of 10%, prostate of 70cc, 3 negative biopsies, a pirad 2, then 5, then 2, then 2 MRI and a petpsma with mild uptake local to the prostate asymmetrically. they want a 4th biopsy in as many years... im starting to feel like a pin cushion :P

[jerryodom]

my PSA 71, all the Nashville VA wants to do is surgery and not once a multi parametric testing MRI machine 1st….which can tell them where if anywhere needs to be looked at further…so, 3- cathators and 3-months later, still no MRI, and I’ve declined any surgery at this time before an MRI can be done….they’re just really concerned it’s cancer…one doctor told me…

[julieschneider]

My Dad is 79 and has been in treatment for prostate cancer for the last 5 years. His most recent PSA is 4660 (up from 3240 the previous week….no mistake, there are no decimals in either number). How would you interpret such dramatically high scores?

[larry__]

Dr. Scholz stated “Now we have all these new scans like PSMA Pet scans that can tell you with far more precision as to how much cancer is present and where is it located…” . Is there a list of facilities that offer the PSMA PET scans? The UCSF website indicates there are only two facilities in the U.S. that are offering it. Is that the case, and if so, can you name any more that will be offering it in the near future? Also, does the PSMA PET scan include a CT scan, and is there a difference between the following three terms: (1) PSMA PET, (2) PET/CT, and (3) PSMA PET/CT.

[happycat]

Problem is that very little is actually known about what PSA levels are and how PSA levels affect the body. People with high PSA levels over 11 and people with PSA levels under 4 both get prostate cancer equally....

[stephenpisani]

Im 65 yrs old and my psa has been over 12 for the past year. My Urologist sent me for an MRI scan. Results came back as inflammation of the prostrate and enlarged prostrate. No cancer showing. Im just a little concerned as both my Father and Grandad both passed away with Prostrate cancer. Im thinking how accurate is an MRI scan.

[kamalsh]

Is there some test / method to quantify the breakup if one has Bacterial Prostatitis + BPH + Gleason 3+3 (and some 3+4) with a PSA of 40. What does one do when deciding the treatment modality? Will a Cyberknife treatment tackle all three issues ?

[T-Hogie]

It's said that sexual activity can affect PSA. What kind of sexual activity? Is it only activity which results in ejaculation or can other non-ejaculatory sexual activity affect PSA too?
I've heard too that ejaculation more that 20 times per month (obviously over a long period of time, perhaps decades) regardless of the modality can have a protective effect. Is this true?