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The bloodstream. So what can make the PSA rise besides just having getting older and having a larger prostate. Well if you get an infection in your prostate so think about that like you got your city. You have her sewer network and there's an earthquake all all the pipes are rat a little bit and they all are extra leaky. And that's what an infection is is not a infections in the prostate or either all or none really they're not focal so the whole prostate gets more leaky in the. PSA number can go way up the other way to think about it as if you have cancer and the the analogy would be lulled. There's there's a city block that has the pipes pipes you know the sewer systems clogged. There's more backflow into the bloodstream. And that's how I pick it up. That's not really how it happens. But that's a good way for patients to think about it. So what is a normal. PSA well a normal PSA is age adjusted so normal PSA for a forty year old is around point five two point six nanograms per aml for fifty year old normal meaning. This is the median for all the population for a fifty year old. It's one and so it kind of goes up stepwise by by decade so there are eight adjustments that we do for the PSA number now what are PSA numbers that tell you you don't have a cancer there's no. PSA number that that is one hundred percent no cancer but there is a proportional rise in cancer detection with rising PSA numbers so originally the cutoff set a PSA of four. We do you know we think about things more based on the individual scenario so if you're a younger person and if your PSA more than two point five that usually considered to be abnormal and may want you may need further work. You don't need a biopsy right away these days in my opinion but you need further workup. So depends on the age of the patient and depends on how also their prostates announce how many guys will go and when they get their PSA check. There's another thing that gets checked. Checked called the free. PSA and then a number is reported. which is the percentage free which is obviously that if their? PSA is three and they're free PSA is one the percent free free is reported thirty three percent. What does that mean? These are different ways for urologist. Try to fine tune this prostate specific antigen test to make it more a cancer specific test so again. PSA goes up when you have an every man has it's not cancer specific so so percent free. PSA was the first way that urologist began to look at what. What's the chance that A? PSA of four is coming from cancer sir versus a PS four coming from just benign overgrowth. So remember there's a lot of factors in play one would be if you had a man who's prostate volume was eighty grams that big and his. PSA was four well. That's of low ratio that's something called. PSA density how much PSA's made per gram of tissue issue. So you'd say well that guy. It's very low chance that he has a cancer that guy would also have a high percent free free. PSA So percent free PSA is another way to just look at what how much of the PSA's produced from benign cells versus cancerous cells. So if two guys have A. Psa of four and one has a free of one. He's twenty five percent free and the other guy has a free of three which is seventy five percent free. What's the different physiologically in those situations?.

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