Increased PSA and Low Free-PSA: When To Worry About Prostate Cancer Risk?

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment, Dr. Mistry and Donna Lee answer a listener's question about his PSA and free-PSA levels in conjunction with testicular pain and a family history of urologic cancer. Dr. Mistry answers the implied question, "What else could people do after a spermatic cord denervation and cremasteric release?" If pain persists, Dr. Mistry suggests medication therapy with Gabapentin, Lyrica, or similar medications that treat nerve pain. In addition, the use of pelvic floor physical therapy with percutaneous electrical nerve stimulation is generally helpful. If all else fails, removal of the painful testicle may be necessary. Regarding PSA and free-PSA levels, the risk of prostate cancer is only indicated when the PSA level is at or above 4. With a PSA number of 2, this listener has a low overall risk of prostate cancer despite his family history. That being said, there are other tests that don't rely on PSA, including urine tests that look for markers of prostate cancer as well as MRI's that can identify lesions in the prostate. The most important thing to remember is that a thorough and holistic urologist will listen to your concerns and offer you all the options for testing to reassure you if genetic risk is a factor. 

If you enjoyed today’s episode, don’t forget to like, subscribe, and share us with a friend! As always, be well!

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode!

Phone: (512) 238-0762
Email: Armormenshealth@gmail.com
Website: Armormenshealth.com

Our Locations:

Round Rock Office
970 Hester’s Crossing Road
Suite 101
Round Rock, TX 78681

South Austin Office
6501 South Congress
Suite 1-103
Austin, TX 78745

Lakeline Office
12505 Hymeadow Drive
Suite 2C
Austin, TX 78750

Dripping Springs Office
170 Benney Lane 
Suite 202
Dripping Springs, TX 78620

Transcript

Speaker 1 0:09

Welcome back to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry 0:17

Hello and welcome to the Armor Men's Health Hour. I'm Dr. Mistry, your host, here as always with my cohost, Donna Lee.

Donna Lee 0:23

Hello everybody. I feel like we have a new studio space. We sound so good today.

Dr. Mistry 0:27

We do sound good today. I'm pretty proud of ourselves. I'm a board certified urologist. This is a men's health show. Thank you so much to our partners here at KLBJ news radio 590 AM. 99.7 FM.

Donna Lee 0:40

Oh, it's always a little backwards when you say it. It's"News radio KLBJ!" That's what you're supposed to say.

Dr. Mistry 0:45

Well, until, you know, I'm put on permanent staff...

Donna Lee 0:49

But you're right about the numbers: 590 AM and 99.7 FM.

Dr. Mistry 0:52

Well, if you're listening to us, then you already know where we are, and if you're listening to us on podcast or you're in another country listening to the podcast and have no idea what these numbers mean...

Donna Lee 1:00

That's right. And until you, we say[inaudible]. How do you say hello in German or Japanese? Hello!

Dr. Mistry 1:06

Anyway, this is not a foreign language show. This is a men's health show, fortunately for you. I am a board certified urologist. Our practice is NAU Urology Specialists. It has been around since 2007. We have four physician providers: myself, Dr. Christopher Yang, Dr. Stacy Ong and Dr. Lucas Jacomides. We also have five mid-level providers. We have two physical therapists that do pelvic floor physical therapy, sex therapy, and we have a real interest in the connection between obstructive sleep apnea and urologic conditions. So we do have a sleep apnea coordinator in the office. Really a focus on a more holistic approach to the way that urologic care is delivered to you.

Donna Lee 1:49

That's a lot going on in one office, don't you think? We need more space.

Dr. Mistry 1:53

Every day, it almost seems like the introduction of our practice gets longer and longer.

Donna Lee 1:57

And we have like a hundred thousand employees now.

Dr. Mistry 1:59

And if I had to think of a motto for our practice, I think"Longer and longer" is not bad.

Donna Lee 2:03

Can I get the software that does the drums, drum sounds when you make a joke?

Dr. Mistry 2:08

Or you can get a real drum set. Donna Lee, why don't you tell people where our offices are and how to get ahold of us?

Donna Lee 2:13

That's right. You can call us during the week at(512) 238-0762. You can also ask for me and give me your question anonymously, which has happened, you know. That's interesting. You can send us an email to armormenshealth@gmail.com and you can visit our website, armormenshealth.com, where you can learn all about our practice and Dr. Mistry and our other partners as well.

Dr. Mistry 2:33

So your questions when you're a patient in our clinic or your questions that you ask for our show is really what drives this show. We are so happy to answer those questions. Please make sure you email them to us. Our producers here at KLBJ tell us what it means that our listeners have such high engagement with us that they'll actually listen to the show in the car and then go home, remember the website, and send it to us. But if you have any questions and don't remember the website, if you do put my name in, it's M-I-S-T-R-Y, Dr. Mistry. Our website will come up and you can click on us for a quick question for the radio show.

Donna Lee 3:10

That's right. You can send a question through our website, our main website as well. So there's a little"contact us" page. So I'll get that as well. I get every one of them and I respond to every one of them. And guess what? They get a free podcast in response.

Dr. Mistry 3:20

Free podcast. We used to say free shirt.

Donna Lee 3:21

Whether they want it or not. But no, the podcast is free.

Dr. Mistry 3:24

And if you want a shirt, please let us know because we have thousands.

Donna Lee 3:27

Not a thousand, hundreds. Oh, we have a patient who you did answer his question. I responded to him. He said he did hear it on the radio. And then his response was,"Well, I didn't think he'd answered quite like that, but it was really interesting."

Dr. Mistry 3:42

Well, we do our best. We do our best. So do you have a question for us?

Donna Lee 3:47

I do have a question. So a patient sent in the subject line is"Increased PSA and low free PSA." He started with a sweet comment:"Thanks for your show and what y'all do. A couple of questions concerning PSA numbers. My regular PSA has been on the increase over my last two physicals. It's gone from 0.25 to now 0.93, and now I have a new item from my PSA blood test: a free PSA of 0.09. I've had several issues with BPH, enlarged prostate. I've had a varicocelectomy"--did I say that correctly?

Dr. Mistry 4:17

That's right.

Donna Lee 4:17

"...cremasteric release and spermatic cords denervation for chronic testicular pain and didn't resolve the pain." That was so many syllables, I'm sorry about that."I have a family history of..."

Dr. Mistry 4:30

Usually you'll say,"That's a mouthful." I don't know why I have to be the one that's joking today. Donna Lee, you're fired.

Donna Lee 4:36

..."I have a family history of prostate and testicular cancer--father and older brother. I'm interested in new additional free PSA number findings. Is it serious, and how aggressive should I be with my urologist for a serious diagnosis? As always, thanks again for what y'all do and discussing men's health issues."

Dr. Mistry 4:52

Well, I love it. I'll start with a question that wasn't asked, which is"What else could people do after a spermatic cord denervation and cremasteric release?" If the pain has not resolved, then what we usually do is we move on to medication therapy, such as the use of medicines like Gabapentin or Lyrica. We also will often do a pelvic floor physical therapy with percutaneous electrical nerve stimulation. And so those are some things that we would do or could do if chronic testicular pain was not resolved. And if it's severe enough, there are even some patients that choose to get their testicle removed. With that, however, the question of the PSA, fortunately for you, the answer is pretty simple. The free PSA percentage has no value if you are, have a PSA under 4. So the test that that showed that free PSA levels could suggest a higher risk of prostate cancer are only true if the PSA is over 4. We use these tests like free PSA really to help further distinguish those that are likely to benefit from a prostate biopsy or not. But if your PSA is as low as it is,2under two, then your overall risk for prostate cancer is pretty low, even with your father's family or the family history of your father having it. I would say that there are other tests available that if you're really trying to assess your risk for prostate cancer, there are tests that are non-PSA based. There are urine tests that can look for certain markers for prostate cancer, there's an MRI of the prostate that we can get you done for for about$800 if your insurance won't pay for it and that can identify lesions in the prostate. So, you know, if you're, if you think you're at risk and you're willing to take that extra step, we certainly have ways beyond the PSA to help diagnose you. So even though for this particular caller, the question of free PSA didn't really enter into their risk for prostate cancer because the PSA is too low. Just so I can be comprehensive enough for those patients out there--so if you do have a PSA over 4 and you get something called a free PSA, so PSA as it's made by your prostate circulates in the blood, and some of it gets bound to other proteins and is not, you know, is not free. It's bound. The lower your free percent is, so the more that's bound, the more dangerous it is for you in terms of your risk for prostate cancer. And although it changes a little bit by age, there is a risk of having prostate cancer based upon how low your free percent is. Generally under 15% free PSA, we think that you may have a 28% to 30% risk of cancer, and if your free PSA is over 25%, then your chances of cancer drops substantially to under 10%. And so, but these percentages are predicated on having a PSA over 4 on the first place. So...

Donna Lee 8:00

So he's looking good?

Dr. Mistry 8:01

He's looking good. I mean, I think that, you know, except for the testicular pain. And unfortunately, testicular pain, excuse me, testicular cancer, which his brother had apparently has some genetic like predisposition, but you really you'd have to be in the, you know, the correct age bracket. So if you're, if you're not, you know, under the age of 25, then I would say you probably escape this genetic risk of testicular cancer.

Donna Lee 8:30

Wow. Well, that was quite the question. I've never seen that question about free PSA.

Dr. Mistry 8:34

It was a very specific one. And I think something that really distinguishes how we approach questions and topics here on our show. You know, that's a lot of inside baseball when it comes to understanding urologic conditions. Bu if you come and see us as a patient, that's what you're going to get. You're going to get kind of our very frank opinion on medical condition and avoidance of surgery and avoidance of procedures if and when possible, and kind of trying to look outside the box to help treat your conditions.

Donna Lee 9:05

You know, this is kind of a side note, but in the clinic I noticed the other day that we had a ton of shockwave patients--we're calling it"spark wave," but we had so many patients that day. And then I talked to one of our providers, Jason Ramsdale, and I was asking his feedback and he said the patients are loving it, and that traditionally based on studies that we've seen from Europe, it should take about 10 weeks after the series of 6 that you get for shockwave treatment for ED. But his patients are seeing big differences in just 2 or 3 or 4 treatments.

Dr. Mistry 9:36

Well, I like the idea of"big difference."

Donna Lee 9:37

Big difference! Enlongated difference.

Dr. Mistry 9:38

And so for those of you men that are...finally waking up, aren't you? For those of you out there that suffer from erectile dysfunction that's mild to moderate, maybe you're still responding to medications, those patients with chronic pelvic pain and those with painful Peyronie's disease, considering spark wave therapy or in our case, this linear acoustic therapy working on the perineum and the penis to help regenerate those tissues is something that if you're interested in learning more about, we would love to hear from you.

Donna Lee 10:11

That's right. You can call us during the week at(512) 238-0762. You can send us an email to armormenshealth@gmail.com and you can visit our website armormenshealth.com. Thanks so much Dr. Mistry.

Dr. Mistry 10:23

Thank you so much.

Speaker 2 10:25

The Armor Men's Health Hour is brought to you by Urology specialists for questions, or to schedule an appointment, please call us

Speaker 1 10:31

(512) 238-0762 or online at Armour men's health.com.