My husband is 62. His father had prostate cancer at age 67.

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My husband is 62. His father had prostate cancer at age 67.

My husband is 62....

My husband is 62. His father had prostate cancer at age 67. My husband's
psa was .6 in 2008 and 2009, .7 in 2010, 1.0 in 2011 and 1.8/2.0 in 2012.
He just had a free psa test and it was 55.5. He has no symptoms at all,
no history of urinary tract infections, getting up at night, etc. With the
free psa that high, is it more likely to be BPH or asymptomatic prostatitis
instead of cancer? He is visiting a urologist next week. I wouldn't think
they would begin with a biopsy this early?

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Customer reply replied 8 years ago

Would an MRI be useful? Or, perhaps a PCA3 test (I don't know how widely used this is yet in the U.S.)? Shouldn't his internist have seen a red flag when it went from .7 to 1.0 in a year? He has had two free psa tests one was the 55.5 and the other was just told to us as greater than 50%.

Customer reply replied 8 years ago

Final question and comments:

Yes, rectal exams perfectly normal - nothing suspicious and internist says that prostate size is age appropriate.

If it is BPH, do antibiotics work or would they probably try something like avodart to try to reduce the size?

Thanks!

Customer reply replied 8 years ago

So, as far as blood and urine tests go, the only ones really used for psa testing are total psa, free psa, complex psa and (Pro psa?)? There aren't any others commonly used right now? I just want to make sure he has proper questions for his urologist. After this answer, I am good to go!

Urologist: Dr. Tharun, Urologist replied 8 years ago

Hi

These tests are more than enough for such low level PSA .There are lot of other tests but still in research phase.So no need to worry about them.

Regards

Dr.Tharun

Dr. Tharun, Urologist

Category: Urology

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Urologist: Dr. Tharun, Urologist replied 8 years ago · Answer 1

HI

The usual cut off is 4 after which biopsy is recommended.Since he has only 2 as the max value ,it may not be cancerous after all.

The worrying part is that PSA raised by more than 0.75 in a year and that is considered significant.(in your husband's case the rise is 0.8/1)

But equally good factor is free PSA which is quite high to suggest a non cancerous pathology.

Sometimes PSA can raise due to just plain BPH or infection.

The usual protocol in such cases is to give an antibiotic for 2-4 weeks and repeat the PSA after 6 weeks.If it was due to infection then it will correct it self.But if it is still raised in similar range then further step would be urologist preference.Some urologists would go for biopsy as he has a positive family history.Others may prefer to wait and watch for another 6 months to see if the PSA is stable or rising or dropping & proceed accordingly.

I hope this gives the required info.

Regards

Dr.Tharun

Urologist: Dr. Tharun, Urologist replied 8 years ago · Answer 2

HI

MRI would be useful in case high PSA with a negative biopsy.As such MRI is not recommended for diagnostic purposes except in some studies.

PCA 3 is again not that useful and is on its way out of urology practice.

0.7 to 1.0 is not alarming and will not raise a doubt.It is in such cases where the PSA is low where free PSA is useful to decide whether a biopsy is needed or not.

Usually less 25 % free PSA is suggestive of cancerous pathology.So a value above 50 is really good.

Some centers do doppler ultrasound of the prostate to see increased blood flow to certain parts of the prostate suggesting cancer spots.But again it is early to comment on this method.

Your urologist would do a rectal exam to feel for the prostate and he can combine that results and come out with a plan of action.

I hope this clears your doubt.

Regards

Dr.Tharun

Urologist: Dr. Tharun, Urologist replied 8 years ago · Answer 3

HI

One more factor in his favor .

Avodart has to be started only after ruling out cancer because it artificially decreases the PSA and hence cause false dip in PSA and cancer can go undiagnosed in future.

Sometimes there could be mild inflammation of the prostate with out any symptoms.Antibiotics are given to cover this part only and not for BPH.

If the cancer is ruled out there is no harm in starting avodart for BPH.

Regards

Dr.Tharun

My husband is 62. His father had prostate cancer at age 67.

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