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Enlarged Prostate with a nodule
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Enlarged Prostate with a nodule

I am a 52 year old retired Navy veteran and I currently have a 50% service related disability (migraines, knee and back issues). My health care is provided for by the Veteran's Admin (VA). I routinely get exams and blood work. My PSA score/number has been 1 and at my last test it went up to 3. It is a low number but with the other factors seemed to cause some concern with the VA, and in follow up with me. I was recently schedule for a sigmodoscopy but due to issues I ended up having to have a colonoscopy, which came back clean. Now I am having reduced urine flow, same amount of urine just take about twice as long to empty my bladder. I am currently taking DOXAZOSIN MESYLATE 8mg daily. I went to my follow up exam with the urologist and I was completely thrown for a loop... I came away from that meeting with two thoughts... (1) if you have to have cancer then this is the kind to have. (2) we will do a biopsy to confirm that I have cancer. I have talked to a couple of other folks and they said that I haven't really had enough tests to confirm cancer (that I am happy about, doesn't mean that I don't have it but I haven't done enough to confirm it). I guess that I am worried about the 2 months between my urology exam and the date that they are scheduling my biopsy. Should I be concerned with the delay, if the worst case scenario is that I have cancer what are some of the questions I should ask about treatment since it seems I came away ill informed from my first visit.
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Thank you for your question and sorry for the delayed response. Even though your PSA has risen to 3ng/ml, most doctors consider a PSA level below 4.0 ng/mL as normal. In one large study, however, prostate cancer was diagnosed in 15.2 percent of men with a PSA level at or below 4.0 ng/mL. In another study, 25 to 35 percent of men who had a PSA level between 4.1 and 9.9 ng/mL and who underwent a prostate biopsy were found to have prostate cancer, meaning that 65 to 75 percent of the remaining men did not have prostate cancer. The average PSA level increases with age, so some values below 4.0 ng/ml for younger men (below age 60) should warrant a more thorough
evaluation. In addition, various factors, such as inflammation (e.g., prostatitis), BPH can cause a man's PSA level to fluctuate.

Statistics are on your side but it is still in your best interest to get the prostate biopsy to rule out prostate cancer or to detect it in very early stage if at all it is present. You should not be concerned with the delay in getting biopsy. This is normal.

If in case the biopsy results are positive for cancer, I will suggest you to go over the biopsy results thoroughly with your urologist, so that you can get an idea about the risk grading of the prostate cancer and urgency for the treatment. You should discuss with him Active Surveillance if the cancer is very low risk. You should also discuss all the treatment options available and the treatment that will be best for you taking into consideration the cost, side effects and functional outcomes of each.

Please let me know your biopsy results when it becomes available. My best wishes to you for the New year.

Sincerely,

Ashutosh (Ash) K. Tewari, MD
www.cornellroboticprostate.org

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