Question: I am 79 years old and had a recent PSA test that turned up high (4.82). Should I have my prostate removed?
Dr. Hibberd's answer:
Probably not. A simple elevation of PSA does not mean you have cancer. Even if you did have cancer, it prostate removal surgery (called prostatectomy) may not necessarily be the recommended treatment for you. The PSA (prostate specific antigen) can be elevated by inflammation within the prostate from infection or cancer, or other problems. It not a reliable indicator of cancer. Also prostate malignancy cancer can occur with normal PSA readings also.
The U.S. Preventive Services Task Force has recommended against random PSA screening for prostate cancer, since new evidence shows it can cause more harm than benefit. But the PSA test is a useful test for the surveillance of prostate cancer after a diagnosis or for surveillance of prostate cancer's response to treatment.
Not all prostate changes require aggressive intervention and treatment. It is common for men to develop slow-growing prostate cancer tumors within their prostates as they age, especially as they advance into their 80s and 90s. But they rarely cause of death or reduced life expectancy, and may be best left alone — and watched closely — rather than treated with high-risk procedures that are not going to improve their quality of life or life expectancy for older men.
The largest majority of prostate cancer cases in patients in their 80s and 90s is non-aggressive and slow-growing. A prostate biopsy can determine the aggressiveness of cancer.
The real secret here is having a good physician with experience managing you and your health. Now that you have found you have an elevated PSA, you need to sort out whether this is a transient elevation that is going to clear with time or whether a biopsy would be useful. Most often a prostate exam is done during your rectal exam, and your physician can determine whether a hard nodule (suspicious for cancer) is present or not.
In any event, the underlying cause of elevated PSA should be evident, and the management may be antibiotic, alpha blockers (to relieve obstruction), or possibly a drug such as Proscar to help reduce prostate enlargement from BPH (benign prostatic hypertrophy).
If your exam is suspicious for cancer, and a biopsy confirms it, there are other options beyond surgery, including radiation, hormonal therapy or chemotherapy. Understand that these are all issues your treating physician should be well versed in, and I encourage you to discuss these matters with your personal physician for recommendations most suitable for you.
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