A 62-year-old patient had surgery to remove his cancerous prostate gland about 6 years ago. Two years after surgery his PSA started to rise and now his PSA is 4.6 ng/ml.
I hate to say it but, it is clear that this patient has failed surgery and has "biochemical failure." In other words, his prostate was removed but there is something in his body making his PSA go up and probably more cancerous cells in his body. Even though he feels fine, this rise in PSA is the only sign that his prostate cancer is trying to return. There are two places were cancer can return: 1) in the pelvis where the prostate used to be located, or 2) elsewhere in the body, suggesting that the cancer has spread. Unfortunately, this is a fairly common problem. Up to 30% of men will not be cured by surgery alone and they will have a rise in their PSA months or years after the prostate is removed. That is why it is crucial for men to have their PSA checked on a regular basis after treatment.
There are f...
Dear Dr. Motola:
What is the normal PSA for a 69 year-old man? At what level does the PSA become troubling or warrant further tests?
PSA cut off levels have been debated for many years. Traditionally the cut off for a normal PSA has been 4, however more recently age-adjusted PSA values are being advocated. Utilizing age-adjusted PSA values helps to explain that the PSA of a 45-year-old should be different than that of a 70-year-old. A PSA less than 3.5 is usually considered normal for men age 55 or younger. Similarly as patients get into their mid 70s, higher values of PSA are now being accepted without the need for the patient to undergo biopsy.
Rather than utilizing the absolute PSA value, the rate of change of the PSA is a very important variable. PSAs that are rising at a very rapid rate are more like to be associated with prostate cancer . A PSA increase of more than 0.75 per year may also be indicative of underlying prostate cancer. Furthermore,...
Dear Dr. Motola,
Four years ago I had surgery for a left inguinal
hernia, which unfortunately resulted in uncorrected internal post-op bleeding
causing ischemia and subsequent atrophy to the left testicle. Until
recently, I've never had my testosterone level checked against the reference
range. I am 83 years old and in very good health. I am told the normal
reference range is 200 to 900, hence my question ... is 259 good or bad
and is it dependent upon both testes functioning? My PSA level averages
3.5 and DRE tests are always normal. I have BPH . I am sexually active but not
as frequently as in the past.
start to fall after age 40. Symptoms
associated with decreased levels include memory loss, mood changes, depression ,
increased fat mass, loss of muscle mass, and a decrease in sexual function. These
symptoms are also associated with the aging process. Many times patients may
experience some of these symptoms, h...
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