Blood Tests For Cancer

in uterine, illustration of fibroid types vs cancers

What does High Platelets Count Mean if I’ve uterine cancer? Can Uterine Cancer and Fibroids Affect The Platelets Count?

Uterine fibroids or what’s medically termed “Uterine myoma or leiomyomas” are kind of abnormal growth of muscles in the uterine lining but it’s benign not a cancer and yet has no known reason. Pain in pelvic area, back pain, and heavy irregular menstruation (Menorrhagia) are of early red flags. Fibroids developed in the womb have many consequences such as low hemoglobin level (Anemia), elevated platelets count (Reactive Thrombocytosis), and large blood clots during menstruation, that’s because the fibroids produce proteins that make the blood vessels bleed within the uterine (i.e. local venous drainage) while the body can’t keep the blood regularly flow, thus the localized blood clots formed.

What we are explaining below?
Causes of increased platelets count during uterine fibroids
Does platelets high count indicate uterine cancer?
When should you worry?

Can fibroids of the womb cause thrombocytosis?

Yes, fibroids usually cause high platelets count (thrombocytosis) and anemia (low hemoglobin) but it’s not necessarily for all cases with fibroids to complain from anemia and thrombocytosis, the platelets elevated due to reactive disease which is the fibroids not due to a primary disease of platelets, hence the elevated platelets level is medically named (reactive thrombocytosis due to fibroids).

Why do Womb Fibroids cause high platelets count?

Fibroid formation within the uterine leads to too much blood loss along with consumption of iron which lead to low hemoglobin level and reduction in the count of red blood cells (Anemia), therefore the bone marrow produces lesser number of normal RBCs and excessively produces platelets in absence of Iron that is needed for RBCs making, so that the early stages fibroids can result in abnormally high platelets count in CBC test.
As well as the produced RBCs during this condition is defected thus, they can’t work well, however blood can’t produce enough anticoagulants to keep pace with flow which promote abnormal blood liquefaction and lead to formation of blood clots that act as resistance for blood flow and result in increasing the size of the womb (enlargement of the uterine cavity).

You should understand: Can Iron deficiency anemia lead to elevated platelets count?

Are fibroids of uterine elevating or decreasing platelets?

In fewer cases they develop thrombocytopenia (low platelets) after prolonged uterine fibroids, the reason is obvious which is the excessive long-term consumption of platelets and other blood cells during the fibroid bleeding. i.e. in the first stages, fibroid may elevate platelets (thrombocytosis) but in the late stage the platelets are deplete leading to low platelets count in the CBC test (Thrombocytopenia).

That was how do fibroid affect platelets count?

Platelets high appear in my blood test results while my uterine has fibroids, is that bad or good? should I be worried?
Like fever when the body becomes ill, the elevated platelets count is one of symptoms and signs that may follow the growth of fibroids, which considered as one of complications as well. so that you should worry about treatment of fibroids rather than be concerned about the level of platelets.

What is the level of elevated platelets after fibroids in uterine?

Untreated Fibroids in the uterine can complicate to the degree of developing extreme count of platelets (e.g. more than 999,000), therefore, according to many scientific studies, the highest level of elevated platelets indicate the severity of fibroids formation.

How long do platelets remain elevated after removing the fibroid?

After surgical operation that remove the fibroid from the womb cavity, the platelets elevated as one of postoperative complications (e.g. thrombocytosis post-splenectomy), the elevation peaks within a weak or two after the operation and may remain high up to 2 months, then must back to the normal limit or the doctor may suspect that there’s another underlying disease that keep the platelets high in the blood count.

in uterine, illustration of fibroid types vs cancers

What is the Effect of Uterine Cancer on Platelets Level?

Below are some of frequently asked questions and their typical answers about the meaning of elevated platelets count in case of uterine cancer.
Did you know, how does a cancer detected in blood tests?
You may know what’s the effect of cancers on platelets count?

Can uterine cancer cause high platelet count?
Yes, cancer of the womb can elevate the platelets count above the normal limit in the blood count test (Thrombocytosis) because the tumor mass will lead to localized inflammation, and you may know that the inflammation starts with increasing platelets level then increasing white blood cells. Endometrial cancer is another medical name for uterine cancer.

What is elevated level of platelets during cancers in uterine, ovaries, and cervical cancers?
Some studies report that even the platelets result near the maximum end of normal (400,000) can indicate early onset of cancer. while platelets level up to 650,000 may be a marker of metastasis (i.e. spreading the cancerous cells outside the starter site).

How to tell if your elevated platelets count is due to uterine cancer?
If you have some or all of below symptoms, then you must get diagnosis if your uterine develop cancerous growth:

  1. Pelvic pressure or pain in the abdominal area.
  2. Frequent urination and difficulty emptying the bladder.
  3. Constipation.
  4. Backache or pain in legs.
  5. Menstrual periods lasting more than a week with Heavy menstrual bleeding.
    That was the best answer for what are the symptoms of a tumor in your uterus?

How does uterine cancer cause thrombocytosis?
Platelets elevated during the growth of uterine cancer due to:

  • Estrogen and/or Progesterone receptors on the surfaces of most endometrial cancer cells is a reputable marker that predict womb cancers.
  • Obesity is a risk factor of womb cancer but do not necessarily cause cancers.
  • Hormone imbalance can lead to uterine cancers if remain long-time without proper treatment, however, blood tests for female’s hormones may appear normal in the lab results even though the woman have hormonal imbalance.
  • untreated chronic infections.

When should I worry about increasing platelets if I’ve uterine fibroids or uterine cancer?

Some of health risks may include:

  • If the platelets level exceeds the critical limits (999,000) which need urgent surgical intervention.
  • If the womb become larger and the bleeding become heavier.
  • If the platelets count still elevated more than 2 months after the date of operation and no response to healing process.
  • A pap smear can’t detect uterine cancer.
  • The best test to diagnose endometrial cancer is CBC test which can detect anemia (low hemoglobin) and thrombocytosis (high platelets) which both with other symptoms can help diagnosis of uterine cancer.
  • Sed rate test may be elevated to indicate the condition is going chronic.

How to read lab results?
Understand the meaning of lab flags and signs
Understand the letter “H” next to your platelets results

We guarantee full professional interpretation for your lab results, just don’t hesitate to message us.

doctors frustrated of the repeated question about if the elevated platelets is a cancer or not

Does High Platelets Count Mean Cancer? Understand Effect of Common Cancers on Platelets Count

Elevated platelets count is common in lab results of patients with advanced stage cancers and if their lab results show the flag “platelets high”, it’s probably a marker of progression of the cancer especially if the platelets level increasing too much with the time, but take care, some cancers suppress platelets and some other cancers increase them, also, some diseases elevate platelets count without cancer, please read carefully to understand which cancer can affect platelets count and which cancers can’t affect platelets?

What we are explaining here?
What Cancers can increase platelets count?
Causes with real case studies
Example 1: Chronic lymphocytic leukemia
Example 2: Essential Thrombocytosis
Example 3: Polycythemia Vera (PV)
Example 4: Lung cancers
Example 5: Colon cancer and rectum cancer
Does Platelets count increase or decrease during cancers?
Signs and Symptoms
What’s the level of platelets in CBC test of a patient with cancer?
Definitions of cancer

Please note that there’re two main categories of thrombocytosis (elevated blood platelets): reactive thrombocytosis, which occurs as a side effect of reactive disease such as infections, anemia, and some cancers), and essential thrombocytosis or thrombocythemia (ET) which is a rare blood platelets cancer, the common reason is genetic mutations (belongs to a disease category called myeloproliferative neoplasms or myeloproliferative disorders), if ET prolonged, it can develop a cancer called acute myeloid leukemia (AML).

doctors frustrated of the repeated question about if the elevated platelets is a cancer or not

Additional Resources:
How Can Bacterial Infections Cause Elevated Platelets Count?
Can Viral Infections Cause Platelets High Count?

What type of cancer causes high platelet count?
If you were asking which cancers cause raised platelets?

The typical answer is that a cancer developed in the organ’s tissues can raise the count of blood platelets (thrombocytosis), e.g. lung, endometrial, gastric, esophageal, or colorectal cancers in which the platelets blood test shows elevated level of platelets or the result is just near the upper normal limit, i.e. the platelet count may appear just above the normal limit while the body contain a type of tissue cancers.
On the other hand, the blood cancers, e.g. the leukemia that doesn’t cause elevation in blood platelets but they cause a decline in the platelets count (Thrombocytopenia) in the blood test, that’s because these types of cancers exaggerate the production of white blood cells at the expense of other types of blood cells.

You should know that: Even cancer that occurs in organ’s mass may cause a slight increase in the number of platelets, but with the increased demand for platelet production as cancer progresses in the stages of development, the bone marrow may have any disruption or depletion of resources, which ultimately leads to a severe decrease in the number of Platelets, Red blood cells, and white blood cells as well.

How do cancers cause high platelets count?

There are two major paths of cancers in men and women, one is the cancer in the blood-cell-forming-tissue inside the bones marrow (e.g. spongy tissue), the second occur in the other tissues (e.g. connective tissue, epithelial tissue, and muscle tissue), each type has its own effect on other blood components, examples of tissue cancers are the womb, ovarian, breast, testis, and lung cancers; examples of blood cell cancers are leukemias and lymphoma.

The way that cancers of tissues affect blood platelets begins after the cancer’s first stages when trying to activate the near platelets to make shield around the cancerous area, the suggested reason is to isolate cancerous mass from body defense mechanisms, consequently, the activated platelets recall other blood cells which results in in unwanted inflammation (the cancer-associated inflammation) around the tumor site which has two main functions: firstly act as camouflage, disguise, or shield to protect tumor cells, accordingly the bone marrow become busy to make unneeded platelets and white cells because the cancer cells cheating or manipulating the biological systems of human body, secondly: the platelets release some biological molecules upon their activation which falsely benefit the tumor cells in their metastasis (distribution), accordingly the platelets falsely promote carcinogenesis (processes of copying more cancer cells).
That’s why the full blood count during some cancers shows elevated white blood cells (leukocytosis), elevated platelets (thrombocytosis), Low red blood cells and low hemoglobin (Anemia).

PCT and PDW represent the estimation of platelets volume and variation in size respectively, in cancers of specific tissues (e.g. lung, rectal, breast) the platelets produced in a hurry which means their sizes will be bigger with the time of cancer progression which impacts on PCT, PCV, and PDW% indices and lead to elevation of their values in CBC test result.

illustrated, how do cancers affect count of platelets in CBC test

In case of blood tumors “e.g. leukemia, lymphoma”, the spongy tissue inside marrow of bones produces and releases large numbers of abnormal cells or proliferate the normal cells in huge quantities, thus the bone marrow be unable to create other healthy cells, consequently, platelets and red cells decrease as a result of crowding the bone marrow with the production of carcinogenic white blood cells. Thus the full blood count shows low platelets (Thrombocytopenia) instead of (elevation of platelets) that shown in other tissue tumors.

For example: blood cancer of the type “Chronic lymphocytic leukemia” result by copying too much “normal lymphocytes”, one type of white blood cells, therefore the production of other cells “e.g. platelets and red cells” is blocked, thus the CBC test results show:

  • Elevated white blood cells to greater than 50.000 which indicate leukocytosis leukemia
  • Elevated lymphocyte count over 40.000, almost all of them are of the normal type not the carcinogenic.
  • Low Platelets count to 10,000 in some patients which indicate severe thrombocytopenia.
  • The High PCV, elevated PDW, the blood smear examination may reveal blast cells which is elder cells that made (and must stay) inside the bone marrow, which all of that indicate malignancy advancement.
  • RBCs count less than 2,000,000 and hemoglobin less than 6.0 which indicate severe anemia.

Therefore, in CLL leukemia, a type of blood cancers, the platelets blocked from being produced due to crowd of massive production of huge amount of lymphocytes, therefore the platelets count in leukemia blood cancers decrease not increase.

comparison, normal cells count shows normal wbc, plr, rbc vs leukemic count shows too much wbc that suppress platelets count
Comparison, normal cells count shows normal wbc, plr, rbc vs leukemic count shows too much wbc which suppress platelets count

For example 2: Essential Thrombocytosis is considered a platelets cancer of the type myeloproliferative neoplasms, other hematology books consider ET as relative benign blood tumor, in essential Thrombocytosis the platelets level exceeds 1,000,000 without reactive disease, thus why it’s called essential or primary thrombocytosis.

Example 3: Polycythemia Vera (PV) is considered a rare Red Blood Cells cancer because it causes the bone marrow to produce too many RBCs and affect platelets as a side effect, therefore, in PV the platelets count is elevated to 600,000 or even to 999,000 in some cases.

For example 3: lung cancer, starts when invades the lung cells then spreads (metastasis) to the whole respiratory system and nearby lymph nodes and even to the other parts of the body. But in lung cancer, are the blood test results show high or low platelets? initially, the lung cancer recalls too many platelets to make shield to the tumor cells which will increase platelets count (Secondary Thrombocytosis) to 450,000 or may slightly higher, but if the the cancer metastasizes (spreads) to the bone marrow, the platelets production will be negatively affected and therefore, the CBC test results show low platelets count (Thrombocytopenia).

For example 4: colorectal cancer that starts in the colon or in the rectum also leads to false inflammation effect which causes outside the range platelets count but within a limited level because another event may happen, the bleeding or hemorrhage usually occur during colorectal cancers and lead to blood loss including platelets loss which results in decrease in the platelets as well, therefore, the platelets count in the colorectal cancer may ranges from high-normal (400,000-450,000) up to slightly high level (500,000-550,000) for adult patients. Also MPV during colon and rectal cancer can be normal, and PDW% may be slightly elevated.

For example 5: Uterine cancer and fibroids can affect platelets as well, but this is upcoming post, please follow…

Do platelets count go up or down with cancer?
It does mean that not all types of cancers can elevate platelets count in the blood, if the tumor is in a specific organ’s tissue then it abuses platelets and other cells to serve it which elevate white blood cell count and platelets as well and show high platelets count in the CBC test results, but if the white blood cells is cancerous, the resultant cancer (leukemia) will lower the blood platelets count in the blood counting test. Red blood cells and Hemoglobin usually decreased in all cancers (indicate severe anemia).

What happens if platelets are high in cancer patients?
Cancers that occur in the tissues of organs usually cause elevated blood platelets count because the tumor tissue draw the platelet particles and blood cells into the formed cancerous mass which lead to producing too much platelets and other cells, thus WBC and PLTs are elevated while the RBCs is reduced.

If you were asking about what are the signs of high platelets during cancer?
This is when to tell if the platelets high count is due to cancer; Elevated platelets level (Thrombocytosis) during cancer is not the primary event but the cancer itself is, thus the body may or may not show symptoms of thrombocytosis which may include:
Skin signs: Superficial Thrombophlebitis, an inflammation of the skin along a vein including apparent redness, darkening, hardening, warmth, tenderness and worsen pain when added pressure. Skin bruising which can be seen by naked eyes.

The signs and symptoms of an elevated platelet count that are linked to blood clots and bleeding may include:

  1. Weakness and Dizziness
  2. Bleeding, Melena: Bleeding in the stomach or intestinal tract that appear on the fecal occult blood test. Bleeding from nose, mouth or gums which can be indicated in CBC test and PT test.
  3. Headache
  4. Chest Pain
  5. Tingling in the hands and feet.

How do platelets increase in cancer patients?

Early stages of tumors in organs can followed by mild elevated platelets count, but as the cancer progress it may additionally elevate platelets count, therefore the very high platelets count is indicator of metastasis (spreading the tumor cells to the other parts), but at the end stages it may cause platelets test results to drop especially if the patient received chemotherapy, the treatment of cancer with strong chemicals that kill tumor cells and stop them from producing.

Thus, the chemotherapy kills platelets as well as the cancers cells and lead to low platelets count in the blood test (Thrombocytopenia), therefore, the doctors may stop the treatment doses to let the bone marrow produce enough platelets before they give the patients another dose (letting the PLT be high in CBC test firstly), or may continue the treatment but give them urgent a platelet transfusion to raise the count of platelets.
Based on that, chemotherapy (the cancer treatment) doesn’t elevate the platelets count but is commonly cause very low platelets levels in CBC test along with the apparent symptoms of thrombocytopenia.

What is the platelet count of cancer patients?
Usually, Cancers of organs (e.g. colorectal, lung, ovarian, or uterine) in many cases show their platelets count at the borderline or near the highest normal limit (300,000-400,000), but that in the mild to moderate stages, consequently, these cancers can cause mild elevated platelets count (400,000-450,000), or highly elevated count of platelets if the cancer advanced to the metastasis phase.
Blood cancers usually lower the platelets count below (15,000 – 50,000) which is the minimum platelet count for chemotherapy too.

Some information about cancers you may want to know

Doctors classify cancer using the site where the cancer began or the type of tissue in which the cancer arose
The major types of cancer are carcinoma, sarcoma, melanoma, lymphoma, and leukemia.

  1. Carcinoma, solid tumors that start in the skin or covering tissues of the internal organs, e.g. prostate cancer, breast cancer, lung cancer, and colorectal cancer.
  2. Sarcoma, a cancer that begins in bones and soft tissues such as muscles and fats, e.g. Osteosarcoma. LDH and ALP blood tests can help rule out such cancers.
  3. Melanoma, a type of cancers that begins at the areas of the body with pigmented tissues (have the melanocytes that give the skin its brown color) such as Skin and Eyes.
  4. Lymphoma is a cancer of the lymphatic system (lymph glands, spleen, thymus gland and bone marrow. CBC test can detect abnormally elevated lymphocytes count.
  5. Leukemia is a medical term for cancers of blood-producing tissues (e.g. bone marrow and lymphatic system)
  6. Blastoma: caused by malignancies in precursor cells or thought is a tumor may be arising in embryonic tissue.
    Worldwide deadly cancers that killed the most people in past years are lung cancer, colorectal cancer, and liver

Thus, we can conclude that not all cancers can cause elevated platelets level, and the increasing level of platelets isn’t the only indicator of cancer because their are other non-cancerous reasons that elevate platelets count such as infections and Iron deficiency anemia.

It’s possible that your case isn’t discussed here, so that we urge you to messaging us for your results interpretation.

Can I have False PSA Results and No Cancer in My Prostate?

What are the reasons cause false PSA high levels and false low PSA results, which means you have no cancer in your prostate at all and your PSA level was relatively incorrect, come to know and tell your doctor you’re a cancer Free.
A matter of concern for whom deal with PSA False Resultsprostate cancer testing with PSA blood test as an early cancer marker, you must be aware of things can alter your PSA interpretation, however the professional lab tech must ask you about them before taking a blood sample for prostate specific antigen test.
If you don’t understand the PSA just read> what is the PSA blood test meaning?
What do cause False positive PSA results?
PSA false results mean that’s unlikely you have a prostate cancer and may come from:

  • Lab errors: wrong sample, improper handling, storage, inadequate sample as wells as the invalid QC values. To avoid that just take your test in a qualified laboratory.
  • Advanced age: cause high normal PSA levels, increasing levels over the time may be interpreted as cancer.
  • Prostate biopsy or resection: Prostate biopsy “can lead to a dramatic increase of PSA in serum and keep the PSA value high in one week.” After biopsy, it takes a month or more for PSA to return to baseline. Do PSA test before surgery or must wait for six weeks after surgery to avoid false PSA elevations.
  • Indwelling Catheter cause high elevation in PSA results, so that PSA is not useful blood test for prostate cancer when a man has a catheter.
  • Injury to pelvic region or prostate
  • Prostatitis cause mild elevation but with no clinical significance until it gets worth.
  • Riding a bicycle: Physical activities such as riding bicycle, exercise biking, spinning, etc., can cause temporary increase PSA level.
  • Sexual intercourse within 24 hours: After ejaculation must wait 24- 48 hours to do the PSA test, ejaculation can produce temporary elevation.
  • Testing PSA after prostatic massage for DRE cause false increase in PSA level.
  • Drugs of prostatic enlargement: Drugs known as 5-alpha reductase blockers (finasteride or dutasteride), which can be used to treat an enlarged prostate, will lower PSA levels.
  • Supplements that effect testosterone: cause high PSA and inverse effect on testosterone results which impacts on seminogram and shows low sperm counts.
  • Urinary tract infection cause mild PSA elevation.
  • Ultrasensitive PSA blood test (USPSA test) has high sensitivity to detect trace PSA for prediction of the persistence or return of cancer, but can produce false positive PSA results as well.

Don’t miss interpretation of high PSA at: What does elevated PSA mean?
Understanding False Low PSA Results
In general, a low PSA is a good result. However, there are several reasons a PSA test level may be artificially low including:

  • Taking statins to lower cholesterol, anti-inflammatory drugs and obesity: that’s because body fat decreases the amount of PSA circulating in the blood stream.
  • Over doses of some chemotherapeutic drugs, for instance; cyclophosphamide and methotrexate, can cause false PSA increase or false PSA levels decrease.

What to do when your results show false PSA results?

  • Don’t forget to mention what drugs and supplements do you have to your doctor.
  • Repeat strange PSA results on another trustful lab.
  • When follow up multiple PSA testing, it’s preferred to do blood work with one laboratory, because minimum increase in PSA values can be a clinically significant.
  • PSA is a screening test useful as early tumor marker but confirmation is done through DRE and Biopsy.

Other blood tests for cancer detection can help make decision:

  1. Free PSA/total PSA ratio: the high values are correlated with prostate cancers.
  2. The percentage of [-2] proPSA test: is relative to the total PSA level as free PSA is used.
  3. PCA3 test in urine: increasing are produced by 95% of prostate cancer cells,
  4. Urine test for TMPRSS2-ERG gene fusion: over expressed in 50% of prostate cancers.
  5. Biopsy from prostate is the best indicator to confirm prostate cancer is present or not, as the most tests used to decide if the biopsy is needed or not.

In this topic you understand the appropriate interpretation for your blood test results.
PSA Chart by age:
PSA Levels are explained well in other topics but here are fast notes on PSA Chart by age and in general.
General PSA level guidelines
• 0 to 2.5 ng/mL is considered safe
• 2.6 to 4 ng/mL is safe in most men but talk with your doctor about other risk factors
• 4.0 to 10.0 ng/mL is suspicious and suggest the possibility of prostate cancer
• 10.0 ng/mL and above is dangerous and should be discussed with your doctor immediately
Age-specific PSA ranges
These reference ranges refer to using different PSA levels to help the physician make a recommendation for a biopsy. The age ranges are as follows:
• 40-49: 2.5
• 50-59: 3.5
• 60-69: 4.5
• 70 and up: 6.5
Understand what’s is the level should PSA be at: What is the normal PSA levels?
Some people say caffeine affects PSA and others ask if physical activities which rubbing prostate elevates PSA. Recent studies showed that there is no connection has been found to caffeine and tests of strenuous bike riding (13 hours on a mountain bike) showed no PSA rise at all. Although a person has to mention to his doctor all his suspicious matters before doing tests, if doctor and lab tech. say it’s OK, then It’s Ok.
Another thing to know is that PSA test has a normal standard deviation and that may show some slight changes in your results from time to time and from lab to lab. So that slight increase over time should be handled carefully and not to get interpretation but from a special lab consultant or from your specialist doctor.
Do my PSA results mean I have a cancer?

Don’t hesitate to send us your results and we promise a fast response.

What Does PSA Results Mean? Ask for explanation

I have got PSA lab results, what Does PSA Results Mean, what is a normal PSA reading?, what should psa level be?
Does a regular blood test PSA mean a Prostate cancer?
PSA is the specific prostate agent used as an early cancer marker in the prostate gland, not for direct diagnosis but for better prognosis and instead of hurrying up to taking biopsy, PSA is done with no surgery, only a blood sample from your arm.
Normal PSA results have explained.
Elevated PSA means:
An enlarged prostate can be a result of prostatitis, advancing age, or Prostate cancer.
Studies have shown that about 75% of men with an elevated PSA do not have prostate cancer.
High PSA results explained here.

Interpretation of PSA Results Chart for men age 40-49

Low Total PSA with Low Free PSA
Means that total PSA reading is between 0.0 – 3.5 and the Free PSA percentage is below 10% of the total.
A case results: Total PSA level of 2.5, free PSA reading of 0.12, Free PSA percent is 5%
Interpretation: if no pain and no symptoms, then your prostate is good and nothing to worry about., the low results in both test can show if you’re on a treatment course.
Cancer recurrence due to biochemical reason is when PSA levels rise to a certain threshold after prostate cancer treatment, it means that some cancer cells have survived and are producing complexed PSA. Recommended for further tests and exams to confirm recurrence.
Don’t prompt a biopsy.
Real Cases reported their results is under 4.0 and diagnosed as BPH or Cancer, read carefully to understand What Does PSA Results Mean?
1. Male 70 diagnosed for BPH
My total PSA has been around 1.9- 2.5 for several years
PSA % Free= 28%
PSA Free: 0.39 (ng/ml)
Gleason 6
Onotype DX test and it came back at a good and low 15.
2. 58 years old, and my blood test revealed the following:
Total PSA = 0.76 ng/ml
Free PSA = 0.42 ng/ml
Free/Total Ratio = 0.55
Results suggest BPH, Free-Total PSA ratio > 25%.
3. I am 72 years old, diagnosed with adenocarcinoma in one lobe of the prostate, size of the tumor is 1.3mm, Gleason score of 6, enlarged prostate make frequent urine flow, my PSA done and the total PSA is 2.55 with free PSA at 1.30 and a percentage of free PSA at 49.9%.
My testosterone Lab result is 0.20, I am on the Lucrin hormone therapy, I have a biopsy scheduled in 2 weeks.
Normal Total PSA with Normal Free PSA
Means that total PSA level is between 4.0 and 9.0, Free PSA Percentage is about 10% of the total PSA value. Some textbooks may label the results in this PSA range as “grey zone” or “watchful period”.
And as the free PSA is in the normal percentage, if there is increase in levels might be due to increased complexed PSA which is from inflammation by bacterial infection, from the advanced age, other non-pathological reasons as explained in “False positive” section.
Finger exam to the lower rectum spot is normal and no pain
Require repeating the PSA blood test for 2 weeks or so, to watch the PSA results are going to be higher or reduced or still around the first result.
Doesn’t prompt a biopsy until the repeated results become higher.
A case have Normal results of both PSA forms:
Total PSA of 5.1, and a free PSA of 0.49, and a Percent Free PSA of 10%
Interpretation: the PSA result is on its way to increase, need watching repeated results and DRE to confirm, the mild prostatitis or physiological reasons are more suspected unless the PSA start to be higher and higher with time.What Does PSA Results Mean?
Borderline Total PSA and High Free PSA
When free unbound PSA is high it means the prostate abnormally produce large amounts of PSA, and the increase in the total amount of prostate specific antigen is due to the increase in free PSA level, thus the clinical reasons are:
Benign prostate hyperplasia: a common non-neoplastic hormone induced hyperplasia, prostate massage during DRE test can support the prognosis of BPH, which is soft or hard enlargement, etc.

  1. When PSA total reading show slight increasing over 10 and free PSA value is over 25% the BPH is more suspected especially for those men over 70 years old,
    Rare before age of 40
    75% among men aged from 70 – 80 years.
    Over 80% of men 80 years.
    Benign tumor found in central and periurethra zones, morphological characteristics after DRE are nodular hyperplasia, firm, smooth median grove. Note that the nodular hyperplasia is not a precursor to carcinoma. BPH can cause stones and promote infections but not cancers
    Acid phosphate test shows normal results.
    Making a biopsy is unnecessary.
    BPH is clinically suspected if free PSA is higher than 25% with the specific sign and symptoms whether the PSA total is in the grey zone or above 10.
  2. When Total PSA result is slightly greater than 10.0 with less than 25% free PSA, then there is inflammation due to UTI or STI. Remember that physiological reasons shouldn’t show PSA over 10.

Real Patients have PSA results as have explained:

  1. A man 55 years old, Total PSA is 3.532ng/ml, low
    Free PSA is 0.918 ng/ml, higher than 10% of total.
    PSA ratio is 0.26, while the PSA is still under 4.0 the BPH is suspected due to high ratio, recommended for DRE and Ultrasound imaging to confirm.
  2. PSA 9,1 and PSA free 3,6 ng/ml, PSA ratio is 0.39. Interpretation: BPH or bacterial prostatitis are suggested as the free PSA and its percentage go high with borderline total value.
  3. I am a 63 years old man.
    Total PSA: 5.4 ng/ml and Free PSA:1.13 ng/ml. ratio is 0,20, U/S prostate followed by Trus Guided Prostate Biopsy were performed within two weeks from PSA test. U/S showed enlarged Prostate gland measurement 6.1×3.4×4.1 cm (TDxAPxCC). There was mainly hypertrophy of the central zone, suggesting benign prostatic hyperplasia. No focal lesion is seen in the peripheral zone. The contour of the prostate gland appears smooth.
    I am 57 years old. I have a TPSA of 4.18, FPSA of 14.0. Interpretation: the PSA result must be repeated because it is doutable. Total PSA must be higher in all values than Free values as the free value is a part of the total.

Borderline Total PSA with Normal Free PSA
Men with a total PSA in the same range and a free PSA below 10% need to have a biopsy. More likely than not, they have prostate cancer
Prostatitis is more suspected because the free PSA which comes from benign cells are normal or below 10% of the total level. However, the BPH/cancer is still not excluded. DRE may come with a clue.
Further causes:
Inflammation, Edema, rectal pain, urinary obstruction.
Acute suppurative prostatitis due to E-coli or rarely due to Staph or N. gonorrhoeae.
Chronic non-specific prostatitis.
Granulomatous prostatitis due to BPH, infarction, post TURRP (transurethral resection of prostate which is the removal of prostate by resectoscope), idiopathic, TB, or Allergic (eosinophilic).
High Total PSA High Free PSA
What Does PSA Results Mean when Both are high?
The higher levels of total PSA correspond to an increased risk of prostate cancer, however high Free PSA than 25 % with heigh PSA over 25 is a clue for BPH.
While high PSA total over 25 with free percentage below 25% is a clue for prostate cancer.
A previous discussion about what PSA level considers a prostate cancer?
High Total PSA and Low or normal Free PSA
Higher total PSA in levels around 100 with free PSA under 10%, is a very strong prostate cancer marker, may be at advanced stage.
Adenocarcinoma is the most common cancer in elderly males, rare before 50, 70% seen after 70, second common cause of death due to cancer in males (the first is lung cancer), caused by unknown etiologies, hormones, genes and environment most likely, prostate Adenocarcinoma is not BPH.
PSA blood test for Occult cancers: Adenocarcinoma may consist of small cancers (incidental ca) and still in situ or latent for long period and thus no blood test or exam can early detect such small cancers which called in medical terms “clinically insignificant”.
DRE exam show hard, gritty, fixed tumor, loss of fixed grove.
Biopsy by TURP: pathologist report can reveal if there is malignancy or not and nodular or not, PSA test can’t determine malignancy or nodularity alone, but PSA score (Gleason score or grading) can categorize prostate neoplasms differentiation (well or poorly differentiated).
Real Case Follow up show PSA results as explained:
A man of 67 yrs old
T-PSA Result is 73.90, high
F-PSA Result is 5.9
Free PSA Percentage is 7% of the total count.
Now it’s clear What Does PSA Results Mean?
Low Total PSA High Free PSA
Means PSA total count is around 4.0 and free PSA ratio is higher than 0.1 (10%).
BPH is the common reason in such levels, DRE is to confirm.

  • Not to worry about expecting cancer from the first PSA test results as it can be tricky.
  • It’s correct to repeat abnormal lab results to be reassured.

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