Elevated PSA --- what now?

[Random User]

My patient had a PSA of 4.6 exactly 7 months ago.
Today rechecked and.....
Total PSA - 7.7
Free PSA - 1.52
% Free - 20%

Though the total shows he's in the "gray zone", the higher free PSA indicates lower risk for PCA.
Also this seems pretty high for the PSA velocity.
Only 2 PSA's have been measured.
I do know that if its >10, a TRUS guided biopsy is necessary.

Question is, what should I do next?
-Monitor PSA in 6 months (to get 3 separate measurements)?
-Send to Urology now for eval?

Thanx

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[cabinbuilder]

I am not a patient person when it come to people's lives and cancer. I would send to urology.

 

[Random User]

awesome thanx

 

[Bacchus]

Yeah... I had a moderately elevated, but still normal PSA in a younger guy who wanted screening given family history. He was s/p 6 weeks for UTI/prostatitis. I gave him another 6 weeks, repeated it. 1 of 2 scenarios: its back to normal (do nothing) or its abnormal (send to urology). It can be followed, sure, due to the slow-growth potential of prostate ca. in general, but rather be safe then sorry.

 

[deleted87716]

Hell, yes...send to urology. Sitting on stuff like that is a good way to end up getting sued for delayed diagnosis.