Question Title: PSA

Posted by Bill Cline on July 16, 1999 at 09:53:08

I'm a 69 year old white male. I have an enlarged prostate. I have had three negative biopsy's. The last PSA Number was 5.2 which is down a little. My diagnos is Benign Prostatic Hypertrophy. I'm currently on no medication for this condition. Is there any medicine's or vitimans which will help lower my PSA level or help shrink my prostate? Is just keeping a close watch on this my only option?

Thank You
Bill

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Posted by HFHS M.D.-JS on July 19, 1999 at 10:33:41

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Dear Bill Cline,
As men get older the prostate enlarges, often at a slow rate. This in and of itself is not a medical problem. When it interferes with voiding or develops into a malignancy is when a physician should be involved. All men over fifty need to be screened with an annual physical exam and serum PSA. Black men and men with a family history are screened beginning at an early age(40). As the prostate enlarges the cells produce a greater total amount of PSA( an enzyme which is specific for the prostate which has a role is breaking down protein in the ejaculate) To help diagnosis malignant change in the prostatic cells the value of serum PSA has been identified to be “elevated”. The PSA value accepted as normal is <4 ng/ml. But there are circumstances and clinical scenarios in which the PSA can be elevated for other reasons than malignancy, i.e. prostatitis, foley catheter in the bladder, recent prostate biopsy, benign prostatic hypertrophy. Studies have been performed in men of different ages which have shown as men age the PSA serum level increases without necessarily indicating cancer. The cut off values traditionally for men between 60-70 yr is 4.5, men over 70 is 6.5 PSA. It is important to perform a physical exam of the prostate to identify any palpable abnormalities. If either one of these two screening exams are abnormal a transrectal ultrasound guided biopsy of the prostate is performed.

I am glad to see you have been so closely followed for the PSA elevation. The negative biopsies are a good indicator that the value of PSA is related to the size of the gland and probably not related to cancer. If you have no family history of prostate cancer and are otherwise healthy I recommend you continue to be followed conservatively on an annual basis with physical exam/PSA. If you do not have symptoms of prostatism i.e. nocturne, weak stream, inability to completely empty the bladder, urgency, frequency or straining there is no need for medical therapy. To take a medicine to lower the PSA just for the sake of lowering the number has no medical relevance.

This information is provided for general medical education only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its urban campuses by calling 1 800-6536568.

Sincerely,
HFHS-M.D JS
*Keyword:age related PSA

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