Dear Dr. Motola,
If a person has a low PSA can you attribute this to any particular factor or factors? In other words are there any medical reasons for a low PSA? A friend told me that there has to be mitigating factors for this low score.
A low PSA is usually desirable as it will be associated with a lower likelihood of prostate cancer . Prostate cancer is not always associated with an elevated PSA as tumors that are very high grade may be associated with normal PSA . This occurs because high-grade tumors are very dissimilar to normal prostate, and as a result lose their ability to secrete PSA. Most often these patients will have very abnormal digital rectal examination. Patients taking Proscar or Avodart may often have low PSA values. This group of patients needs to have careful scrutiny of the interpretation of their PSA.
A series of studies were recently published in the New England Journal of Medicine that question the efficacy of widespread PSA testing for the early detection of prostate cancer. One study, The European Randomized Study of Screening for Prostate Cancer (ERSPC Trial), involved 182,000 men in Europe. An American study from the Prostate, Lung Colorectal, and Ovarian (PLCO) Cancer Screening Trial looked at nearly 77,000 men in 10 medical centers.
For the last 20 years, urologists have been practicing in an era that advocates the early detection of prostate cancer . This has led to a decrease in the death rate from prostate cancer. With the decrease in death rates that we have been experiencing, we have to somehow explain what we as physicians are doing that is contributing to this. These studies may suggest that PSA screening may not be responsible for this.
However, several major flaws have been identified with these studies.
1. Most importantly, in the PLCO study, the PSA lev...
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...
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