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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18461
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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In 2011 my psa was .2, in 2012 it was .3, and in March 2013

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In 2011 my psa was .2, in 2012 it was .3, and in March 2013 it dropped to .1. My digital exam was normal and I was retested last week again normal. The doc told me it felt smaller than he would have expected at my age.

Question...I have noticed that when I have to pee in the middle of the night or very first thing in the morning the force isn't the same and it sometimes breaks stream. This only happens in the above situations. I believe everything is normal during the day. concerning?
Not really. This is a sign that you are developing early benign enlargement of the prostate affecting the central portion of the prostate.

The urethra (the tube that drains the bladder) passes through the center of the prostate. Benign prostatic hypertrophy (or BPH) can affect the central portion of the prostate, so that the man may notice some symptoms of compression on the prostate even though the prostate is not enlarged on exam. Examination feels the back of the prostate, so is not sensitive at detecting any enlargement that is localized to the central zone of the prostate.

As it turns out, prostate cancer tends to occur peripherally in the prostate, which is really why we perform prostate exams. Since you have a normal exam and a low PSA, there is no reason to be concerned about prostate cancer.

Whether anything should be done for BPH symptoms that is due to the BPH affecting the central portion of the prostate would be determined by the severity of symptoms. From your description, it does not sound to be at a level that would warrant treatment, which is why I say that it is not really concerning. If the symptoms worsen over time, it may get to a point that would warrant treatment, but it is not at that level currently.

Let me know if there are any further questions.

Customer: replied 3 years ago.
I heard one doctor say that my psa could be too there such a thing as too low of a PSA?

But this only happens in the middle of the night or first thing in the morning when I am half asleep....wouldn't it be more often throughout the day? Does activity impact the prostrate?

This isn't a smythom of cancer at all?

Again, thank you for your help. I am getting professional help for my anxiety issues.
There is no concern about a low PSA in this situation. There is some concern that in a man that presents with a large prostate tumor, a low PSA could be a sign that it is a poorly differentiated cancer, as larger tumors (benign or cancerous) would typically have a larger PSA. But since you do not have such a tumor, there is no concern about a low PSA.

Prostate symptoms are frequently more bothersome when first awakened. It isn't an issue with activity levels as it is that you were asleep. Later in the day, simply sitting and being inactive does not typically have the same effect as being asleep and just waking up.

With time, men with BPH will start having symptoms throughout the day, but at this stage, there is no reason to be concerned because you only have symptoms when awakening.

Customer: replied 3 years ago.
If there was a cancer it would be felt during the exam? And with cancer this would be constant and with more smythoms?

I don't know how long this has been going on...I just happened to give it some attention the other day, and thus I am now trying to solve the puzzle.
exam is not perfect at detecting cancer, which is why there is PSA screening, but with a normal exam and a low PSA, there is no reason to be concerned about cancer.

Cancer usually does not cause symptoms, primarily because they typically start peripheral in the prostate and do not compress the urethra until they are very large.

It does not matter how long it has been going on since it is not worrisome for any length of time.

Customer: replied 3 years ago.
Thank you for you time this evening. I wanted your opinion to make sure nothing is being missed overlooked.

Would cancer present over the entire outer edge...I know you can only feel 1/3 of the total?
It depends upon how far along is the cancer when detected. Usually, it is detected as a lump that is not involving the entire outer edge, but if not detected earlier, it could involve the entire outer edge when detected.

Dr. D. Love and 2 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
Thank you. As you can tell I am extremely worried about cancer. Dates back to why I don't have a right colon and some small bowel. The doctor screwed up big time.
You're welcome. I'm glad that I could be of assistance.

Dr. D. Love and 2 other Medical Specialists are ready to help you