Question: I am an 84-year-old man who recently had a PSA test with a reading of 10. What is the best route to go from here? I don’t want a painful biopsy if it will do no good.
Dr. Hibberd’s answer:
PSA readings are not a reason for cancer phobia. While an elevated reading over five may be suspicious, a reading of 10 does not necessarily mean you have cancer. If you take testosterone or anabolic steroid supplements, stop them. Have your PSA repeated for confirmation, and be sure to use the same lab, as measurements may vary by lab.
I have seen readings of over 20 and up to 100 in men who had prostate inflammation from prostate stones, infection (prostatitis), and no cancer. The first thing to do is to go to your primary care physician, and request a rectal examination. Hard nodules are suspicious for cancer. Ask for a urinalysis and ask if a trial on antibiotic — such as 14 days of twice daily 500 miligrams of Cipro — would be appropriate, with a repeat PSA test in two to four weeks.
A prostatic ultrasound would be wise to confirm gland size and character. Nodular areas and suspicious areas on ultrasound should be biopsied under ultrasound guidance. You may wait on the biopsy until your repeat PSA. If your PSA isn’t improved with treatment, I would advise you to consider a biopsy, so a definitive diagnosis can be made.
While Lupron (an anti-testosterone) chemotherapy can be started without a biopsy, it would be a good idea to have tissue checked to confirm whether you have BPH, prostatitis, or a malignancy, especially after a failed treatment for acute prostatitis.
Above all, do not panic. Too many men rush to aggressive and sometimes unnecessary treatment out of fear. Take your time (four to 12 weeks), but set up a plan of attack with your doctor that is appropriate. As you age toward 90, prostate cancer becomes quite common, but it is not usually very aggressive. In most cases, it is a localized, slow-growing, and confined disease. If cancer is confirmed, there are many options besides surgery that are available to the large majority of patients.
So do not panic. Set up a plan and let me know how you do.
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