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 of a nodule during the digital rectal exam raises the concern for an early developing prostate cancer. If this man has no symptoms, if the PSA does not normalize after antibiotics or if a nodule is felt, then it is clear his PSA is remaining high and prostate cancer must be ruled out.
PSA velocity calculates the rise of 3 consecutive PSA values over time. A PSA velocity of 0.75 ng/ml in one year raises the risk that a man is developing prostate cancer. Of concern is men with a rise of 2.0 ng/ml within one year. These men have an increase risk of aggressive prostate cancer that tries to metastasize early to other organs such as the lymph nodes and bones. The role of PSA velocity is controversial, but it is one of the best indicators that a cancer could be developing in the prostate gland.
The prostate biopsy is the only way to know if this man is developing prostate cancer. He is a higher risk for developing cancer because his brother had prostate cancer requiring surgery, and his PSA velocity of over 0.75 ng/ml/year. Cancers of the prostate tend to be familial. Prostate biopsies are easy to perform with low risk.
It’s hard to tell people not to worry. I would rather they be concerned, stay optimistic, continue to follow-up with their physician and listen to what he or she has to say. Good luck.