Question of the Week # 71

Q71) A 65 y/o African American man is brought by his daughter to you and requests a PSA test because there is a hx of prostate ca in their family. You perform PSA and DRE. DRE does not reveal any palpable mass. The lab test reveal : PSA : 8ng/ml, Free PSA: 1.5ng/ml. You reveal the results to patient and his daughter. The daughter asks you if her father has a cancer. Your best response is :

A) The PSA level increases with age and your father’s PSA  is in the  age-appropriate range
B) PSA level is very nonspecific and your father does not have a cancer
C) The fact that the free PSA is only 1.5ng/ml as opposed to a bound of 6.5 indicates that your father most likely has a cancer etiology rather than benign cause
D) PSA will not help in diagnosing carcinoma prostate
E) I did this test only because you requested for it, I do not think this results mean anything.

3 Responses

  1. A

  2. C is the right answer. please discard my first answer

  3. I don’t like this question… you can calculate that there is about 23% free PSA. The articles I found state that in general, most physicians agree that anything about 25% means the patient doesn’t have cancer. If you look at this table from Harvard (http://www.harvardprostateknowledge.org/what-is-the-difference-between-psa-and-free-psa), between 20-25% the risk is about 16%. So I would think that answer C isn’t the best since it says that the patient “most likely” has cancer.

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