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How Can An Enlarged Prostate With PSA Level Of 2.6 Be Treated?
Question: Dr I emailed you last week, so you may remember me. I am going to see a Urologist next week.
But in the meantime, a follow up new question. I mentioned everything but this if you look at our prior discussion. It also said prostate enlargement with estimated volume of 48 cc with mass effect upon the bladder floor. No filling defect in the bladder is demonstrated. What does this mean? My most recent DRE a few months ago was ok and my PSA was about 2.6 with the use of Flomax and Finestride. Is this likely BPH or prostate cancer?? Best.
But in the meantime, a follow up new question. I mentioned everything but this if you look at our prior discussion. It also said prostate enlargement with estimated volume of 48 cc with mass effect upon the bladder floor. No filling defect in the bladder is demonstrated. What does this mean? My most recent DRE a few months ago was ok and my PSA was about 2.6 with the use of Flomax and Finestride. Is this likely BPH or prostate cancer?? Best.
Brief Answer:
Your prostate is definitely enlarged
Detailed Answer:
Hi again,
I am glad to know you will be meeting a urologist next week.
I did explain to you earlier that your prostate is definitely enlarged. 48 cc prostate is certainly large, but does not mean that this is causing obstruction. Even a mass effect as seen in your case does not necessarily mean there is obstruction, though chances are indeed higher. It was in this context that I advised you to get a Uroflowmetry test done which will indicate if your urine peak flow is low, which is often due to prostate enlargement, among other causes. If the flow is normal, nothing else needs to be done, though you could continue Avodart which will help reduce the progression of benign disease.
The absence of filling defect in bladder means there is no evidence of a bladder tumour or a clot, which in your case was anyway quite unlikely.
Please let me know if you need any doubts to be clarified.
Regards.
Your prostate is definitely enlarged
Detailed Answer:
Hi again,
I am glad to know you will be meeting a urologist next week.
I did explain to you earlier that your prostate is definitely enlarged. 48 cc prostate is certainly large, but does not mean that this is causing obstruction. Even a mass effect as seen in your case does not necessarily mean there is obstruction, though chances are indeed higher. It was in this context that I advised you to get a Uroflowmetry test done which will indicate if your urine peak flow is low, which is often due to prostate enlargement, among other causes. If the flow is normal, nothing else needs to be done, though you could continue Avodart which will help reduce the progression of benign disease.
The absence of filling defect in bladder means there is no evidence of a bladder tumour or a clot, which in your case was anyway quite unlikely.
Please let me know if you need any doubts to be clarified.
Regards.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Final question Doc, I promise. So is it likely just BPH and not cancer??
Secondly, I understand that your PSA could be 1.5 for every 10 cc of volume and that would be normal?? Is this correct? Because if my volume is 48cc it would suggest my PSA would be ok at 7.2???
I believe we determined that because of the Finisteride that my PSA which is 2.5 in more like 4-5?
Thanks for the clarification and help.
Secondly, I understand that your PSA could be 1.5 for every 10 cc of volume and that would be normal?? Is this correct? Because if my volume is 48cc it would suggest my PSA would be ok at 7.2???
I believe we determined that because of the Finisteride that my PSA which is 2.5 in more like 4-5?
Thanks for the clarification and help.
Brief Answer:
Most likely to be benign enlargement of prostate
Detailed Answer:
Hi,
You are welcome to get clarifications of your apprehension. PSA levels are likely to be approximately 1.0ng/ml for every 10 gm enlargement. Thus, a patient with 48 gm prostate could have a PSA level of around 4.8. The issue gets complicated in patients who are on drugs like Finasteride which might cause lowering by half of PSA values. This is only a guideline, and you could have PSA upwards of 7 or 8 in an obstructive 50 gm gland and it could still be benign. Conversely, as I explained earlier, PSA level could be well below normal and patient could still harbour foci of malignant cells. The question is how relevant are these foci of cancer - would they grow big enough to kill? Or are we causing more harm by treating such indolent tumours? This is one of the main reasons why PSA screening has been given up.
And that's why I was happy to know you will be meeting a Urologist. because he is likely to be performing a digital rectal examination, and may indicate to you that the prostate feels benign. My gut feeling, without the benefit of this digital rectal examination on your person, says you have a benign enlargement of prostate.
All the very best.
Most likely to be benign enlargement of prostate
Detailed Answer:
Hi,
You are welcome to get clarifications of your apprehension. PSA levels are likely to be approximately 1.0ng/ml for every 10 gm enlargement. Thus, a patient with 48 gm prostate could have a PSA level of around 4.8. The issue gets complicated in patients who are on drugs like Finasteride which might cause lowering by half of PSA values. This is only a guideline, and you could have PSA upwards of 7 or 8 in an obstructive 50 gm gland and it could still be benign. Conversely, as I explained earlier, PSA level could be well below normal and patient could still harbour foci of malignant cells. The question is how relevant are these foci of cancer - would they grow big enough to kill? Or are we causing more harm by treating such indolent tumours? This is one of the main reasons why PSA screening has been given up.
And that's why I was happy to know you will be meeting a Urologist. because he is likely to be performing a digital rectal examination, and may indicate to you that the prostate feels benign. My gut feeling, without the benefit of this digital rectal examination on your person, says you have a benign enlargement of prostate.
All the very best.
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Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
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