Understanding PSA spike and what questions to ask

You should be aware, but not yet concerned. A PSA jump that much in a short span of time is usually a red flag that something is going on and that something doesn't always mean prostate cancer, it could be your BPH.

The PSA test is often referred to as your "check engine light", to investigate further. You may want to request a PSE test, which is extremely accurate in detecting prostate cancer (also a blood test), and if that is positive then MRI would likely be next and then a biopsy.

Also, PSA under 4 are generally not considered concerning, but the jump could indicate that 4 is coming up fast.

In other words, you have a ways to go before "concerned" should be in your vocabulary regarding your prostate.

@rcroane56
We do not want to welcome you to group. Hopefully, you are just having some prostate irritation and BPH issues.

Survivor5280 gave good information for you. Many many things can cause a rise in PSA and not be cancer. So hopefully that is your case, and we don't welcome you to our group. You stated you have been diagnosed with BPH so that is already a known irritation.

MCC is not to give medical advice but share our experiences. Per my urologist and PCP (since you are new PCP is primary care physician) normal PSA is under four (4). It does not mean above four (4) is cancer just means is higher than normal levels. However, can you have prostate cancer and have a PSA below 4, Yes!

I had a PSA of 3.75 but had rising numbers year after year. I did not have a BPH diagnosis or symptoms. PCP changed my PSA testing to every 3 months and showed continued rise. My PCP referred me to urologist who did MRI, and then biopsies. Yes had prostate cancer but all urologist, PCP, R/O all stated caught very early.

Be optimistic millions and millions of men have rising in PSA levels and no cancer. You have already been diagnosed with BPH which per medical doctors can affect your PSA levels. You are a long way from being overly concerned.
Good luck!

Thank you for the replies. I'm still wondering where the free PSA fits into this and the free/total ratio? Other reading I've done suggests that the spike in the total PSA, accompanied by a total/free ratio of .27, is most likely due to something other than cancer. In my case, I'm hoping it's just my BPH acting up. A couple things I didn't mention in my original post....my father had prostate cancer and I had a biopsy many years ago that was negative.

Your familial history certainly puts you at a higher risk, but again it's not a sure thing. Also the ratio is just statistics, and are only markers for whether or not you need to explore further.

Here's a good writeup on how those numbers work, but try not to self diagnose or let a forum full of non medical professionals guide your decision, we can only share our own experiences and knowledge gained from going through this crap situation.
https://healthmatters.io/understand-blood-test-results/psa-free

Just wanted to add that recent COVID vaccination or COVID infection can rise somewhat PSA level for some individuals and PSA can stay somewhat elevated for couple of months. I am talking about one point elevation or so. For some reason virus has affinity to attach to prostate and probably causes some inflammation. This was what our failed urologist told us when my husband got 7.5 PSA result back. I did some reading after that and there are some studies done (Google it, as a new member I can not post links). To be honest, the fact that COVID effects prostate and attaches to it is very worrisome IMHO and should be really better investigated.

Chemo can cause PSA Flare ( google that ) 30% as can some ADT's like even Xtandi Check it out

There is a PSE test which looks for biomarkers for cancer. It is touted as being 94% accurate.
You could do this before you move onto the next steps in diagnosis which are more invasive.

@rcroane56 I agree with @heavyphil and @survivor5280, the PSE test is a highly accurate indicator of prostate cancer. Its test results basically say, highly likely or not highly likely to have prostate cancer. Its worth it before you get a biopsy.

I'll mention my current situation and would welcome comments. Active surveillance for several years, Gleason 6, group 1, low intermediate Decipher, annual MRI, 6 month PSA tests. About a year ago I had mild symptoms of a UTI infection--went away after day or so. About a month later I had a PSA test and it rose from a stable 4.2 to 8. Scared hell out of me. I mentioned to my primary care the symptoms and he thought maybe prostatitis--gave me a two week dose of antibiotic, waited 2 weeks, retested and back down to 4.4. About 3 months ago same thing happened with symptoms, different antibiotic, went away easily, PSA checked about a week or so after antibiotic and up to 5. I've been doing as much research as possible, and seems types of prostatitis can exist even while urinalysis and cultures come back clean. And can affect PSA. So, not sure where this goes, but just another bump on this road we don't want to be on.

Sorry, that sounds like a nightmare to deal with. There are all kinds of things that can cause PSA false positives - I chased them down too. After my first PSA I asked for a second to verify, giving myself six weeks of total abstinence from all things that impact the PSA. The doctor told me "unlikely it will change anything but go for it". The second time it was the same and when I did that they also did the PSE so I knew, I just didn't want to admit it. I hope you can get to the bottom of it.