Disclaimer | About this site

Home | MedNews | Blog | Foodnews | Books    

Click  for latest stories on our home page

The "free" PSA test (PSA-f)
and how it may spare you a biopsy

Click for CHART below

The free PSA test, often written PSA-f or FPSA, sometimes called PSA II, helps your urologist decide whether you need a biopsy.

Low free PSA may indicate prostate cancer. High free PSA along with other factors may indicate that you have BPH and no need of biopsy.

The free PSA test measures the proportion of free PSA to bound PSA in the total PSA in your blood sample. It's called this because PSA-f circulates in the bloodstream "unbound," without a carrier protein.

Combined with prostate volume, percent free PSA calculation helps reduce the number of biopsies based on "false positive" PSA test results. This may spare you an unnecessary biopsy.

High free PSA -- above 25% -- usually indicates BPH (benign prostate hyperplasia).

Low free PSA likely signals prostate cancer. Most men with prostate cancer have a free PSA below 15%.

If free PSA is below 7%, prostate cancer is most likely. According to American Cancer Society and National Cancer Institute, men with free PSA at 7% or lower should undergo biopsy. If biopsy is negative but free PSA remains low, repeat biopsy is in order.

If total PSA is low, rate of PSA rise over a series of tests may send a warning. PSA velocity is an independent measure of likely prostate cancer.

Remember, a single PSA test is seldom enough to call for a biopsy. A study published in JAMA (May 28, 2003) says: "An isolated elevation in PSA level should be confirmed several weeks later before proceeding with further testing, including prostate biopsy."

In 2002 a study in Finland found that "Prostate cancer probability depended most strongly on the percentage of free PSA. Total PSA, prostate volume, and DRE also contributed to prostate cancer probability, whereas age and family history of prostate cancer did not." Estimation of prostate cancer risk on the basis of total and free prostate-specific antigen, prostate volume and digital rectal examination. Eur Urol. 2002 Jun;41(6):619-26

The CHART below may help you see the process. The chart is based on information from the American Cancer Society and National Cancer Institute. These charts are not intended as medical advice. Please consult your doctor(s) about prostate cancer and any other prostate and health problems.
For an American Urological Association Chart (March 1, 2000) click here.


Free booklet
Seven Steps download
from Johns Hopkins

Prostate Cancer Detection By "free" PSA Score

Do you have an elevated PSA and

 chart arrowchart arrow
Signs of prostate inflammation such as urinary frequency, urgency, burning?


Treat with antibiotics and repeat PSA before deciding if biopsy is necessary.

chart arrow
chart arrow

Is the digital rectal exam
(DRE) normal?



chart arrow
chart arrow


chart arrow
chart arrow

How high is the PSA?

PSA 10

chart arrowchart arrow


2.5 to 10

chart arrow

Biopsy or
free PSA test

chart arrow

If percent free PSA is low >> BIOPSY

If percent free PSA is high (above 15%)
repeat bood tests and rectal exam in a year.

chart arrow
chart arrow

under 2.5
but more
.75 ng/ml
last year's

chart arrow


Related news / update

PSA Velocity May be Irrelevant in Detection of Prostate Cancer

September 2009

"Although there is a statistical association between prostate-specific antigen (PSA) velocity and prostate cancer, PSA velocity does not help detect prostate cancer once PSA and age are taken into consideration" -- Peter Scardino M.D. and team. Read more ....

Find Life-Threatening Prostate Cancer by Measuring PSA Velocity During "Window of Curability" Nov 1, 2006

General Disclaimer: PSA Rising is designed for informational purposes only and is not engaged in rendering medical advice or professional services. News and information provided through PSA Rising should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your healthcare provider.

This page and chart made by J. Strax. Last updated September 21 2009

Hon Code Seal
We comply with the HONcode standard for health trustworthy information:
verify here

© 1997-2009 PSA RisingWear blue Prostate Cancer Awareness ribbon!