Aa
prostate
during a routine exam my psa score was 4.9 .I am 70years old and in otherwise excellent health.was sent to urologist and he said exam seemed ok.he put me on an anitbiotic and said would repeat psa test in two weeks.Told him I disliked taking antibiotics unnessaryily and he told me it was either the antibiontics or a biopsy.Isnt this a little drastic for a score of 4.9?John
Hi,
Biopsies are advised when PSAs exceed 4.
Screening for prostate cancer while commonly advised does not have a strong foundation compared with breast cancer. While it is known that treatment of early disease can lead to easier intervention, there is an issue that screening itself does not actually improve outcomes as a whole. Put another way, with currently available modalities, screening does not improve survival. I have a feeling you were not made aware of this when you had your blood tests done. In general, men should be informed of the uncertainties with screening and then make a shared decision whether to push through with it or not, and a plan that would be acceptable to the patient undergoing testing.
Since the screening itself remains a matter of debate, there really isn't a clear answer to your question.
You could also choose to monitor the PSA and observe the pattern of rise and then re-consider the biopsy. Of course, should any other symptoms arise - this plan would change. Another option is to investigate the size of the prostate (this is usually done with a rectal ultrasound - its a bit invasive, so I wonder if you would consider this as pretty much the same procedure as a biopsy) and try to correlate this with the PSA value and then re-evaluate the decision about the biopsy. Still another option is to get another blood test called free PSA to reassess likelihood of cancer. There is some evidence that these modifications on PSA may help select which patients should and should not get a biopsy, but as a whole the selectivity adds only a modest gain in the power to discern.
At the day's end, this calls for a value judgment on your part regarding with what level of risk and uncertainty you are comfortable with.
Take heart that research is always on to improve PSA testing. There is a gene based test (PCA3) which uses urine sample (obtained after a prostate massage - done by the doctor via the rectal examination), but the available data on how best to use this is still too young to make firm recommendations.
I hope this helps more than it confuses.
Biopsies are advised when PSAs exceed 4.
Screening for prostate cancer while commonly advised does not have a strong foundation compared with breast cancer. While it is known that treatment of early disease can lead to easier intervention, there is an issue that screening itself does not actually improve outcomes as a whole. Put another way, with currently available modalities, screening does not improve survival. I have a feeling you were not made aware of this when you had your blood tests done. In general, men should be informed of the uncertainties with screening and then make a shared decision whether to push through with it or not, and a plan that would be acceptable to the patient undergoing testing.
Since the screening itself remains a matter of debate, there really isn't a clear answer to your question.
You could also choose to monitor the PSA and observe the pattern of rise and then re-consider the biopsy. Of course, should any other symptoms arise - this plan would change. Another option is to investigate the size of the prostate (this is usually done with a rectal ultrasound - its a bit invasive, so I wonder if you would consider this as pretty much the same procedure as a biopsy) and try to correlate this with the PSA value and then re-evaluate the decision about the biopsy. Still another option is to get another blood test called free PSA to reassess likelihood of cancer. There is some evidence that these modifications on PSA may help select which patients should and should not get a biopsy, but as a whole the selectivity adds only a modest gain in the power to discern.
At the day's end, this calls for a value judgment on your part regarding with what level of risk and uncertainty you are comfortable with.
Take heart that research is always on to improve PSA testing. There is a gene based test (PCA3) which uses urine sample (obtained after a prostate massage - done by the doctor via the rectal examination), but the available data on how best to use this is still too young to make firm recommendations.
I hope this helps more than it confuses.
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