Q: I am a 57-year-old male. I am a non-smoker although I did smoke until age 30. I seem to be in good health but a recent routine test at the doctor’s office revealed a raised PSA level for the prostate. It was 5.7. Repeat blood test showed 4.7. The doctor does not seem concerned. Should I have more tests?
A: The PSA, which stands for prostate specific antigen, is a controversial test because there can be false positive results that could unnecessarily alarm people.
The PSA looks for a protein in the blood that is produced by prostate cells. It is normal in older men to have small amounts of this protein released into the bloodstream. This would account for a reading up to four nanograms per millilitre. However, as you are only 57, and both tests showed levels above four, I think you should have more testing done. I do not want you to be too alarmed because readings above 10 are generally required before prostatic cancer is suspected
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It is more likely that you have something known as benign prostatic hyperplasia, a non-cancerous enlargement of the gland. It may still need to be removed because it can sometimes lead to partial or complete obstruction of the urethra, the tube through which you urinate. Then a catheter must be inserted to release urine. Even if it does not come to this, you may have a tendency to get urinary tract infections due to a slower stream and incomplete emptying of the bladder.
Another less serious possibility is an infection of the prostate known as prostatitis. However, this would probably cause you pain or discomfort. It is usually easily treated with antibiotics.
If your doctor has not already done so, he should perform a digital rectal examination of the prostate. He will be able to feel if there are any abnormal bumps or some enlargement of the gland. If it feels normal, I expect that he will ask you to repeat the blood test from time to time to see if there is any change before there is a need to proceed with a biopsy.
Remember that even men who are diagnosed with prostate
cancer will live an average of 15 years from the time of diagnosis even without any treatment.
Canadian doctors recommend that men get both a PSA and a digital rectal test performed every two years after the age of 50. Men who have a family history of the disease should be tested every year from age 40.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
