56% probability of having cancer -

Jimmy, you are very young to have Prostate Cancer. I'm not saying it doesn't happen, it does. But it's rare.

First of all, retake the PSA. Ejaculating within 48 hours is known to raise PSA. So there's a high likelihood that the 3.2 PSA number won't hold.
Second, PSA is not an indication of cancer. neither is Free PSA, they are an indication that further investigation may be warranted.

Third, sounds like you've been dealing with an enlarged prostate for many years. Also unusual for your age, but not indicative of Prostate cancer. Enlarged prostate, or Bph/Benign Prostate Hyperplasia, by itself, will raise PSA, without the presence of cancer. This is likely the cause of your frequent urination.

Did the Dr do a physical exam of the prostate? Did he indicate any lumps, or firmness existed?

Ask for a retake of the PSA test. And don't ejaculate for a few days before. Also don't lift weights or ride a bike. Or other strenuous exercise.
Then if the PSA is still high, a biopsy might be warranted. But even that is questionable. You might want to ask the urologist about an MRI first, if it gets that far.
Keep us posted. And take a deep breath. One way or the other you will be fine.

Jimmy, one writer has called the PSA test your 'check engine light'. It simply indicates prostate activity of some kind. Your PSA is still very much at the low end.

Where are you located? Someone here may be able to suggest where to find the real experts near where you are.

Welcome to HW.

First, go on your vacation. Nothing here to stop that.

PSA isn't a test for cancer. It just says something is wrong with the prostate. Personally I vote for a PSA retest in three months.

Infection, enlarged prostate are more likely causes of elevated PSA. Seeing a URO to get it all checked out is good.

Don't go into panic mode now - plenty of time later for that. All you know is the numbers aren't what you'd want.

And even if its PC, you've caught it very, very early. Also PC is a slow growing cancer. It takes years to become a serious problem so you've got time for that nice vacation with your fiancee. All you need to tell her, if you tell her, is that your prostate test isn't right and you've got to get it checked out. You could even wait for the URO appointment until after you get back.

Hang in there and let us know what the URO says,
Andrew

I met Dr. Pugach today and he performed DRE and said there is no lump or hard spot but he wants to do biopsy because free PSA ratio at 0.1 is too low. I will have the biopsy after my vacation.

Dr. Pugach is in Los Alamitos, CA.
Many thanks,

Jimmy,
Out of 1,000,000 biopsies performed each year 750,000 are negative. It is one of the most over used tests. As others have recommended it would be prudent to get another psa or a more sofisticated test as Allen suggested in 3 months.

Thank you for all your input. My urologist said that the biopsy will take only 15 minutes. I told him about the activities that might have affected my PSA results. He said he understands but the free PSA should have increased along with total PSA and since the free PSA ratio is low at only 10% he has some concerns. Amazingly the urologist also mentioned about the 56% probability of having PC which I didn't think it is appropriate considering my age and race. I read on some websites about the low ratio of free PSA and at 10%, the probability of cancer is different for different age group and younger age has lower probability for cancer at 10% free PSA ratio. I also have problem with grouping 1% to 10% and 11% to 15% together. Obviously difference between 10% and 11% free PSA ratio shouldn't be 56% and 28% chance. Ethnicity also has a big impact. I found one website that calculates the probably of cancer by using PSA, free PSA ratio, ethnicity, IPSS score, DRE exam result and input everything in my chance of having any prostate cancer is about 12% and 6% of high grade cancer with score higher than 7. I hope this calculator is much more valid than the simple free PSA ratio number. Have you tried this?
http://sunnybrook.ca/content/?page=occ-prostatecalc

Anyway, I think I will go through with the biopsy even though some of you advised against it for now. I have too much anxiety because of this and a negative result would allow me to relax. I already booked an appointment on June 17 for biopsy which is after my vacation.

Many thanks,

Post Edited (JimmyNguyen) : 5/26/2015 9:22:23 AM (GMT-6)

they didn't test for PHI.

  I encourage you to be aware of the “slippery slope” you are headed towards.   Knowledge is empowerment.   Simply because you are 40 means there is a roughly 40% probability you have some form of prostate cancer…a little bit of elevated PSA (there are multiple possible causes) and that likelihood is going to go up from there.   Simply considering men’s ages alone, the probability goes up roughly linearly as one ages at a probability rate roughly equal to age in years…60 year old has a 60% probability, an 80 year old has a 80% probability.   We know this from autopsy studies of men of all ages who died in accidents.   BUT, simply HAVING prostate cancer does not mean panic…particularly when you understand the complete facts:    Most adult men never run into the set of circumstances which has led to a biopsy.   (Biopsy rates in the US are simply not that high.)    So, putting these two facts together, one realizes that in the big picture most cases of prostate cancer are both undetected throughout a man’s life and not harmful in effect.   This same point stated in other words:   there is high probability (based on age) of HAVING prostate cancer and never being affected by it.     The corollary to this is that a fair number of men DO encounter circumstances which lead to biopsy.   In today’s era with the capabilities of finding tiny, microscopic specks of “weird cells,” there are a lot of men labeled as “having cancer” even though they don’t have any more PC than the other men who also have it and are never diagnosed.   The slippery slope comes when those diagnosed with PC get pulled into the chain-of-events which is very difficult to reverse once that label is applied—treatment for benign cases which would have otherwise caused them no harm.   Now is the time—as you are headed into a biopsy—to become aware of the facts as well as the reality of prostate cancer overtreatment.   There was a poll taken at this website to ask experienced PC members about letting possible newcomers (like yourself) know about PC overtreatment…overwhelmingly members voted that they would rather have known about it.   (See the 2013 poll HERE .)     PC overtreatment is not widely known by newcomers.   Prostate cancer is one of the most commonly occurring types of cancer and one of the least lethal types of cancer, leading to high rates of overtreatment.   To be clear, there are men who are affected by prostate cancer.   It is in the tens of thousands in the US per year.   But the numbers of men who are overtreated – perhaps largely due to unjustified fears of the word “cancer” is actually much larger.   So again, my advice:   simply be careful of the slippery slope you are approaching.   For too many men, a single biopsy, motivated by a single standard PSA test, has led to overtreatment and lifelong consequential side effects.   Keep in mind today’s perspective of prostate biopsies:   The primary purpose of a biopsy today is not to find prostate cancer (you already have a good chance that it is present); rather, it is to find the small percentage of cases of aggressive cancer.  

I need a second opinion. Does anyone know of any good Urologist in Orange County who is conservative in term of biopsy and avoiding overtreatment? Currently I am going to doctor Pugach. I read about doctor Thomas Ahlering and he has many good reviews mainly from patients who benefited from his robotic surgery. My worry is that he will push me into surgery unnecessarily since he has operated over 1200 cases. Should I get a second opinion or just go with biopsy and get a second opinion afterward if I have cancer?

Many thanks,

Hi All,
I had the biopsy done last week and got the results today and it was all benign. I was extremely relieved. 3 of the 12 samples has inflammation the doctor said they were prostatitis. I understand that many of you advised me against getting a biopsy but I had too much anxiety about this and both my family doctor and the urologist told me to do it so I was under pressure to go through.

The urologist told me to get another PSA test in 4 months because he couldn't explaining the low Free PSA ratio and that biopsy is only 75% accurate and there is a chance that the biopsy missed the cancer. Should I go through another PSA test in 4 months?

Many thanks,

Jimmy, I don't think it would hurt to do another PSA test in 4 months, it's just a blood test. Congrats on the negative result.

Maybe have a round of Cipro for the inflammation first though, as that COULD be, the cause of the PSA.