I'm 48. In august, 2004 my first psa test came in at 3.1. I waited several weeks and had another test in november 2004: 3.1 again. I was referred to a urologist, who performed a dre which revealed no abnormalities. He suggested biopsy. I suggested holding off on it and checking psa levels over the next few months. In late march 2005 (at a different lab) the level was 3.3. They forgot to do a psaii as the urologist had requested, and so, within two weeks I had yest another psa (same lab): 3.8 total, but a 27% free-to-total ratio.

As you can tell, I do not relish the thought of undergoing the biopsy. The free-to-total is encouraging, but I don't know what to make of the jump in total.

I have read studies, reviews of studies, and "meta-analyses" on the sensitivity of the free-to-total test. A growing consensus suggests that a f-t ratio of 25% or more yields a cancer probability at <10%. Further, the false negative rate on biopsies is said to be around 20%.

I'm half tempted to hone up on on bayesian probability calculus to figure out what my odds are! Am I simply being unreasonable in avoiding the biopsy?


Advice?