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Is There A Possibility Of Prostrate Cancer With The Above PSA Result ?

Posted on Thu, 29 Aug 2024

Question: I am 62 years male and have IGA nephropathy and hypertension for the past 11 years which is being treated with Cardace 10 mg, Stamlo 5 mg, Lipitor 10 mg, and fish oil capsules. In addition I have thyroid nodules (no medication). BP is around 130/80.

I have a enlarged prostrate (Grade 2) since July 2016- prostrate size was 38.19 ml in August 2022 and I started Urimax 0.40 mg since May 2022. No symptoms of BPH.

My Total PSA and Free PSA test results for the past 3 years are as follows :

•     Dec 2022: Total PSA 1.93 ng/ml, Free PSA 0.47 ng/ml, Free PSA ratio 24.35%

•     April 2022: Total PSA 1.39 ng/ml, Free PSA 0.43 ng/ml, Free PSA ratio 30.94%

•     July 2021: Total PSA 1.32, Free PSA 0.475, Free PSA ratio 35.98%

•     Nov 2019: Total PSA 1.25 , Free PSA 0.38, Free PSA ratio 30.40%

Prostrate Size : Aug 22 : 38.19 ml, July 21: 45.66 ml, July 19: 42.37 ml. All ultrasound reports stated normal echoes.

Urimax 0.40 mg prescribed since May 2022. .

My queries are as follows:

1.     Is the rise in Total PSA by 0.54 ng/ml from 1.39 to 1.93 between April 22 & Dec 22 a cause for concern ? Could this be partially due to taking Urimax 0.40 mg since May 22 ?

2.     Is there a possibility of Prostrate cancer with the above PSA result ?

3.     For a 62 year old, what level of Total PSA is considered normal with a low risk of Prostrate cancer ?

4.     Are Free PSA/Total PSA ratios and PSA density good indicators of prostrate cancer risk?

5.     Please provide your advice on next steps to be taken.

Thank you

Answered by Dr. Dr. P. T. Patil (28 hours later)

Brief Answer:
Please read answers to your queries as detailed below

Detailed Answer:
Hello thank for your query.
1) Variation in your PSA levels are it to be worried.There is no possibility of developing cancer as long as PSA is below 4 .0 Bg

2) No

3) 4.0 ng is considered to be normal .

4) No

5) Continue taking Urimax as prescribed by your Dr. Repeat PSA every 6 months.

Thanks and Regards
Dr Patil

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr. P. T. Patil (3 hours later)

Thank you for your prompt response.

1. I did not understand your first statement "Variation in your PSA levels are it to be worried" . Did you mean "not to be worried" or "are to be worried" ?

2. With the above PSA scores since Nov 2019 do you consider it necessary as part of an annual check up to also have a DRE ? So far I have only being doing an annual abdomen ultrasound(which includes prostrate) and six monthly PSA tests.

3. If the Total PSA crosses 4 ng/ml, how does a person know if the increase in the PSA is caused by BPH or prostrate cancer?

Thank you.

Answered by Dr. Dr. P. T. Patil (33 minutes later)

Brief Answer:
PSA levels below 4 are not to be worried at all.

Detailed Answer:
Hello
Thanks for follow up A variation in PSA levels are very common and depend upon the sexual activity or mild infection of Prostate.One has not to be worried as long as it is below 4.

It is not necessary to do DRE every six months but it is advisable to do PSA test for a individual above the 60 years of age.

Single high PSA level could be due to infection of Prostate. HoweverPersistent rising levels of PSA above the level of 4 done at monthly interval for 3 months is a screening test and is supposed to be due cancer of Prostate unless proved otherwise by doing Biopsy of Prostate.

Thanks and Regards
Dr Patil

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Above answer was peer-reviewed by : Dr. Kampana