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MY FRIEND IS 73 AND HAS A NORMAL PSA READING OF 4. HE WENT…

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MY FRIEND IS 73...

MY FRIEND IS 73 AND HAS A NORMAL PSA READING OF 4. HE WENT FOR HIS REGULAR CHECK UP 3 MONTHS AGO AND HIS PSA WAS 5.2. THE DR PUT HIM ON A MONTH OF ANTIBIOTICS AND CHECKED IT AGAIN. IT WAS STILL 5.2. THIS TIME THE DR DID NOTHING AND A MONTH LASTER HIS PSA IS 6.1. THE DR TOLD HIM A MAN HIS AGE WOULD NEVER DIE FROM PROSTATE CANCER. MATTER OF FACT HE SAID THEY SHOULDN'T EVEN BE TESTING MEN HIS AGE.WHAT SHOULD HE DO?

Doctor's Assistant: Is the condition chronic, or acute?

I'M NOT SURE IF IT IS EITHER. I DON'T THINK HE HAS EVER HAD A PSA READING OVER 4 UNTIL THIS EPISODE.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

NOT REALLY. IT'S HARD TO EXPLAIN SINCE THIS IS NOT ABOUT ME.

Submitted: 5 months ago.Category: Urology
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Answered in 5 minutes by:
11/19/2017
Urologist: Dr. Arun Phophalia, Urologist replied 5 months ago
Dr. Arun Phophalia
Category: Urology
Satisfied Customers: 37,787
Experience: MBBS MS (Surgery) Vast experience and routinely perform all urology procedures including endoscopy.
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Urologist: Dr. Arun Phophalia, Urologist replied 5 months ago

PSA alone should not be criteria for diagnosing the cancer prostate.

Following are some facts about the PSA;

1) PSA can rise because of the following;

a) Benign prostate hyperplasia

b) Prostatitis

c) Cancer prostate

d) Any stimulation of prostate like sex, instrumentation, catheterization.

2) PSA is a poor screening method for the cancer prostate so it has false positive as well as false negative results for the screening of cancer prostate. This means that there are some patients with the cancer prostate who don't have raised PSA and there are patient who have raised PSA, with no cancer.

3) The suspicion of cancer prostate is clinically determined by the four main factors;

a) digital rectal examination (DRE)

b) transrectal ultrasound (TRU)

c) PSA estimation

d) Free PSA

Combination of all the four above, is more indicative of a biopsy.

4) A ratio of free PSA to total PSA is more indicative or suspicious of the cancer than the PSA alone and with the DRE and TRU finding. So you may ask your doctor to get a trans rectal ultrasound, and free PSA if not yet done. A trial of antibiotics, to eliminate the possibility of prostatitis raising the PSA can also be done, meanwhile. Once all these results come, you may have better insight whether you need a prostate biopsy or not. Here is a reference about free PSA (fPSA);

Chan DW, Kelley CA, Ratliff TL, D'Agostino D, Ritchey J, Lamb DJ. Analytical and clinical performance characteristics of Hybritech's Tandem-R free PSA assay during a large multicenter clinical trial to determine the clinical utility of percentage of free prostate-specific antigen. Clin Chem. Oct 1999;45(10):1863-5. [Medline].

The results of the above trial demonstrated the following:

Of patients with a free PSA (fPSA) value of 0-10%, cancer was found on biopsy in around 55%.

Of patients with a fPSA value of 10-15%, cancer was found on biopsy in around 25%

Of patients with a fPSA value of 15-20%, cancer was found on biopsy in around 15%

Of patients with a fPSA value of 20-25%, cancer was found on biopsy in less than 10%

Of patients with a fPSA value higher than 25%, cancer was found on biopsy in less than 5%

So a lower free PSA would be indicative of biopsy. But simultaneously an ultrasound should also be detected.

I also agree with the doctor that cancer prostate does not cause death and people with it have normal life span.

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Urologist: Dr. Arun Phophalia, Urologist replied 5 months ago

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Customer reply replied 5 months ago
Thank you so much for your response. I guess my questions is, if you have a psa result that is higher than normal, should the doctor get to the bottom of what is causing the elevation and then give the patient some sort of answer that he can understand. I know that you won't die from prostate cancer, but if you have it and do nothing can it spread to other areas? The doctor left it all up to the patient to decide what to do. He did do a rectal exam and said it was normal. No ultra sound though.
Urologist: Dr. Arun Phophalia, Urologist replied 5 months ago

Yes, with a high PSA patient should get an ultrasound and a digital rectal exam and also a free PSA.

Evaluation gives the right perspective.

There is more than 95% chance that it is not cancer.

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Urologist: Dr. Arun Phophalia, Urologist replied 4 months ago

If you were satisfied with the interaction; a positive rating would be appreciated.

Happy Thanksgiving Holidays!

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