Question: I'm more than 80 years old and have a PSA of about 8.0. I have no pain but a very long wait to start flow, especially at night. What can you suggest? I already take Flomax and other natural supplements.

Dr. Hibberd's Answer:

Your PSA (which stands for prostate specific antigen) test is a general blood test used to monitor prostate inflammation in men. It rises in the presence of infection and prostate stones, and is used as a marker for prostate cancer. Weak urine stream and dribbling are common symptoms of prostate enlargement which is usually painless, especially in the absence of infection.

The PSA is only a marker, and does not equate with malignancy diagnosis. There are also cases of prostate malignancy that do not elevate PSA, making surveillance more difficult. Enlargement does not necessarily equate with malignancy either.

The doubling of your PSA from 4 to 8 is highly significant, and does demand prompt evaluation for correctible causes. Given that almost all of us will have a focus of prostate malignancy if, and when, we reach our ninth decade, I would temper the aggressiveness of investigation to suit your personal level of comfort and risk.

Regardless, seek a urological consultation to guide your decision. Not all PSA elevations are due to cancer, and it would be foolish to obstruct your kidneys (possibly ending with dialysis) by ignoring a correctible prostate condition.