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I am 81 yrs old and have a PSA of 5.7 and a free PSA of 16.5…

Customer Question
I am 81 yrs...

I am 81 yrs old and have a PSA of 5.7 and a free PSA of 16.5 %. We have been actively watching the PSA since May of 2015 when it was 4.42. Any comments.

Doctor's Assistant: Any pain or burning sensation while urinating? What color is your urine?

No pain urine is yellow. I seem to have some pain lately where my prostate is. Not severe but nagging.

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

Chronic

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

I had a TURP maybe 20 years ago. I am taking mytriq spelling not good for urgency.

Submitted: 1 month ago.Category: Urology
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Answered in 34 minutes by:
1/3/2018
Urologist: Dr. Arun Phophalia, Urologist replied 1 month ago
Dr. Arun Phophalia
Category: Urology
Satisfied Customers: 37,268
Experience: MBBS MS (Surgery) Vast experience and routinely perform all urology procedures including endoscopy.
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Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer, or further information request.

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Urologist: Dr. Arun Phophalia, Urologist replied 1 month ago

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.

e) Bike riding

f) Constipation

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%

Now coming your individual scenario;

In your age, your total PSA of 5.7 is not considered high.

This small rise of PSA from 4.42 to 5.7 in 2 years is not worrisome.

You may get a transrectal ultrasound for evaluation. If it is uniform, nothing should be done except yearly check ups.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

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Urologist: Dr. Arun Phophalia, Urologist replied 1 month ago

Was this information helpful to you? I would be glad to answer any further questions.

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Wishing you all the very best in life.

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Happy new year 2018.

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