60 Yr Old - % free PSA 10%, free PSA 0.26, Total PSA 3.98 in March

Your PSA is not implying that you have a problem. It’s not that you’re producing no PSA your PSA seems about normal for your age and is not going up at a fast rate, Actually, not Going up at all.

A total PSA of 2.06 is generally considered low and within normal limits for most men, which is reassuring, particularly since it is not rising. A 12% free PSA is in the low-intermediate range (often < 10-18% is of concern), which, combined with a low total PSA, usually indicates a lower risk of prostate cancer and more likely a benign, non-cancerous condition.
Urological Research Foundation

A 12% free PSA can sometimes be caused by an enlarged prostate (BPH) or inflammation, not just cancer.

I really do think it’s time to wait. You’re not even at the active surveillance point With such a low PSA.

concure with Jeff- your PSA is going down and that is good..just watch closely and if you experience any unusual symptoms, great fatigue, blood in urine, pain which doesnt resolve..etc..check in with primary and maybe get referred to uroloogist..but really, I think your worries and concern is unfounded.

As I see your PSA history as follows
2025- PSA 2.06
3/2026 PSA 3.98
4/2026 PSA 2.60
It is to soon to identify any pattern but I would definitely get another PSA next month. If you knew your PSA’s prior to 2025 that would be helpful. If your next PSA is up again, I would inquire about an Epi Switch PSE blood test. Totally non invasive except for a regular blood draw. This was new technology not available to me. I had a ExoDx non invasive urine test. Improvement’s in new technology is always out to benefit patients. If your PSA is up, definitely get to a good urologist at this point because if it is up, and the PSE reflects higher risk, then you probably will want an mpMRI.
Here was my history which actually one Oncologist told me that I could not have prostate cancer because your PSA does not drop only keeps rising.
2013-2020 PSA 1.7 to 1.9
10/20 PSA 1.9
11/21 PSA 3.0
02/22 PSA 2.5
04/22 PSA 2.3
10/22 PSA 3.2
12/22 PSA 4.0
01/23 PSA 2.9 Free PSA 13
06/23 PSA 3.4 Free PSA 8
08/23 PSA 4.1 Free PSA 9
09/23 PSA 3.0 Free PSA 10
01/24 PSA 3.3

What would happen each time we were discussing doing something then my PSA would drop again. Also at my age late 68-70 then , PSA was in range. My argument was always my PSA was stable for years until this up, down, down, up, up, down, up, up, down. During this time my urologist added the Free PSA and the ExoDx (their is newer and better technology today) which came back high and we all agreed MpMri was up next and as they say the rest is history.

Without a history of rising PSA it is unlikely that your insurance will consider either the ExoDX ($300-$400) or the PSE test ($1000) as medically necessary. This compares to the PSA and Free PSA costing your insurance about $10 each. If you are worried enough to pay for one get the PSE since it is much more accurate. FYI: All of the ranges for the Free PSA were developed based on total PSA between 4.0 and 10.0 and they do not claim accuracy with lower total PSA. The .26/2.06 is 12.6% and that falls into the lower end of the Free PSA gray zone 10-25%. Prostate cancer tends to be slow growing so you have time to see what is going on. The kicker is that even if you went through the mpMRI, biopsy, etc. and cancer was found it is very unlikely to be more than a Gleason 3+3 and the urologist will recommend active surveillance (i.e., get more PSA tests on a regular basis and delay treatment until it gets worse).

@jim18
That was everyone’s feeling with mine, but on biopsy had several 6’s, several 7’s, and an 8, which was later downgraded to an unfavorable 7 after a review of the excised prostrate. I think when the psa is acting erratic you want to pay more attention. Also a good reason to see a urologist is they have better idea being a specialist that if they order something it could more likely be paid as they have access to other billing codes as a specialist that a general doctor does not.

My PSA numbers are very similar to yours. Similar age to you. I turned 61 a little over a month ago. Biopsy on April 10, 2026 had (4) cores of 3+4 and (1) core of 3+3. Biopsy in September of 2025 had 5 cores of 3+3. I do not think lesion went from 3+3 to 3+4 in 6 months. I think the 1st biopsy sampling missed the 3+4.

In 2022, my yearly bloodwork PSA went from 2.0 to 2.8 (prior year to 2022). Had two more PSA tests in 2022. One was at 1.8 and the other at 2.7.

Since it was not too high, I did not go to Urologist. 2023 and 2024, yearly PSA were at 2.5.

My 2025 PSA was 4.0. I made 1st available appointment with Urologist. 1st ever visit to a Urologist. No infection and nothing felt by DRE. With 4.0 still not being too high, I was not pushed by Urologist to submit to any further testing. I told him I wanted more tests.

I did 4K blood test (PSA portion was at 2.0) and MRI. MRI showed a Pirads(5) lesion. Biopsy a few weeks later confirmed Gleason 3+3. Active Surveillence was treatment protocol.

Went to City of Hope for 2nd opinion. 3 PSA tests at City of Hope in 2025 and early 2026 were 2.7 (few weeks after biopsy which should elevate PSA) and 2.0 twice.

Scheduled a confirmation MRI/biopsy for April 2026, because MRI was indicating a lesion likely with higher grade than 3+3. This has proven to be the case.

PSA test April 3, 2026 was at 3.6 (bloodwork prior to MRI and April 10th biopsy)

February 2026, PSA was 2.0.

You going to Urologist and having a DRE and MRI would provide information.

My lesion is along the prostate capsule. MRI indicate no visible extracapsular extension, but it is along the wall. If I had not gone to Urologist last year, I would have never known. I do not know why I have only had 2 PSA values over 3.0 and none over 4.0. If lesion extends thru capsule, treatment and spread are more difficult to manage. That is one reason to visit Urologist and get MRI. Finding cancer before it spreads or gets too high of a grade, is important.

Best case for you, you visit Urologist and have an MRI and no lesions are visible. In that case, keep tracking PSA. Maybe get PSA checked 3-4 times per year for a few years.

Best Wishes.

I'm 68, at 65 had a psa of 4.1 with a 13.5% free psa, then 2.2 retest. Year later 3.85, 3.75, then this year 5.09, re-test 4.99, doctor said large non-nodular prostate currently waiting for mri.

@wheel1
Thank you. My PSA trend:
2019 1.1
2020 1.0
2021 2.1
2022 3.1
2023 1.9
2024 2.2
2025 2.06
March 2026 3.98
April 2026 2.6 with *free PSA 0.26 & *% free PSA 10%
I have another PSA scheduled for July. I will inquire about a Urologist and send over these results. I would rather go ahead and get it checked out if possible. That free PSA concerns me.

@charlesprestridge
Thank you. My feeling is to get to a Urologist to discuss and ask for further testing. This is helpful information.

@oinc2526 You have probably been on "inactive surveillance" since 2021 if all of your previous PSA tests had been around 1 or less. BPH does not double PSA in 1 year and it has never really gone down since. You definitely want a Urologist referral since work insurance (at 60 assume that is what you have) is more likely to approve the tests / procedures ordered by a urologist. They may go straight to MRI with that history. Biopsy is required for diagnosis of prostate cancer. You still may have trouble with your insurance since PSA is below the 3.0 in their cookbook. Any denial is likely to be approved on appeal if cancer is found. I included my biopsy report in all of my appeals (to 3rd parties) and all got paid.