DEAR DR. GOTT: It is a pleasure writing to you. I enjoy your work in the Journal Inquirer.
I am 61 years old. In April 2011 my PSA was 1.3 In early May of 2012 my PSA jumped to 1.9. Should I be worried? My urologist said I shouldn’t lose sleep over it. I realize 4.0 is the magic number but I want to be proactive. Any suggestions?
DEAR READER: A PSA is a laboratory value for a prostatic specific antigen, a protein produced by the cells of the prostate gland. The higher a man’s PSA level is, the greater the probability of prostate cancer – but as you pointed out, the normal upper range is 4.0 that you are far from.
As a man ages, it is normal for prostate issues and prostate cancer concerns that can include prostatitis (inflammation of the prostate) and benign prostatic hyperplasia or BPH (prostate enlargement. There is no evidence that either condition causes cancer. Further, a PSA level alone does not provide a physician with sufficient information to make a determination between prostate issues and prostate cancer.
The recommendations for the screening test vary. Recently the United States Preventive Services Taskforce developed a guideline that recommends against routine testing; however, many physicians may choose to ignore this newest guideline. Some physicians encourage yearly testing as part of a routine physical examination beginning at age 50. Men at higher risk might be tested before then and followed more closely. Advanced age is the most common risk factor for developing prostate cancer. Other issues include a family history, ethnicity, and investigation into diet is being studied. Because PSA levels are known to increase with age, the consideration of age-specific PSA reference ranges has been suggested for increasing the accuracy of PSA tests. On the flip side, these age-specific ranges could lead to the delay of detection of prostate cancer in up to 20% of all men in their 60s and up to 60% of men in their 70s. The bottom line is that you should take the word of your physician or urologist when it comes to test results. There could be reasons other than prostate cancer for your slight elevation, such as enlargement or infection. Treatment based on an annual test with the minimal elevation you experienced does not warrant in depth testing but close follow-up. According to the guidelines from the National Comprehensive Cancer Network, additional treatment may be indicated if your PSA level has doubled in less than three years, you have a greater than 0.75 ng/dL increase per year, or if a biopsy reveals evidence of cancer.
PSA screening may help detect early prostate cancer that will be easier to treat and cure if diagnosed and treated early; however, a biopsy can cause unwanted side effects, to include infection and bleeding. Not all cancer of the prostate requires treatment. They may be slow-growing or may never spread beyond the prostate gland. And, testing isn’t foolproof. False positives and false negatives can occur, causing a great deal of stress and concern. Extensive treatment such as radiation or surgery can result in incontinence and erectile dysfunction. Therefore, it is important that the risks and benefits of any treatment or procedure be considered prior to undertaking prostate cancer screening.
In the interim, review your diet. If necessary, make appropriate choices to include fresh fruits and vegetables, fish and whole grains. Exercise appropriately, either through walking, swimming, biking, golfing, or in a manner that fits your lifestyle. Get adequate sleep every night and avoid stress whenever possible. And, continue to visit your physician for that annual checkup that drew your doctor’s attention to the issue in the first place. Ask if a referral to a urologist is appropriate. If so, visit and follow his or her advice.
Readers who would like related information can order my Health Report “The Prostate Gland” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
