Dear Dr. Greenstein:
My friend ,who is in his early 50s, just got the results of his annual PSA test - it was between 4-5. The results of his previous 6 annual tests were in the 1-2 range every year, until now. His brother recently had his prostate removed due to cancer.
He now has to see a specialist. We are both very concerned, but should we be that worried?
First, I never tell people to worry before we have all the answers. In this situation, it is crucial to know if this man has any new voiding problems such as burning, slow stream or the sensation he is not emptying his bladder. These symptoms can indicate prostate inflammation, which can falsely elevate the PSA value. In those cases, a course of antibiotics are warranted and the PSA can be repeated after finishing the antibiotics.
If the PSA normalizes then this man can continue to have his prostate examined every 6 - 12 months. The physical exam is also very important. The discovery o...
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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