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Should I get a biopsy done if I have potential benign prostatic hyperplasia ?

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General & Family Physician
Practicing since : 2008
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Hi, I'm a 62 year-old male who at age 52 (2002) had a spike in psa up to 4.5 (my first psa); a month later it had returned to 3.5 (no discernible DRE issues). My most two recent PSA's (8/2009--4.4; 4/2011 4.6), depending on which metric you use either places me .6 above the 4.0 cutoff or in the midrange of an age-related PSA scoring inventory (upperlimit of normal 5.9 for men between ages 60-69. Curiously, if you accept the established annual age-related increase in PSA of .03 and calculate that increase since 2002, you arrive at my current PSA level within a few hundredths of a point.

I've no family history, work as a pilot flying long-haul international routes (8+ hours for each leg), some indicators of BPH, and frequent (almost nightly long-term use of 50 mg of Benydryl to sleep in order to somewhat reestablish circadian cycles.)
My guess is my Uro guy may want another PSA test in 8-12 weeks including a free PSA number. My question is, given lifestyle factors, possible BPH, benedryl use, etc; what is the best indice upon which to make a decision? (A friend who is a doc calculatd my PSAv at an adjusted .12). A real consideration I have is that one of our pilots with a similar profile yielded to a biopsy and contracted a vicious infection that he was told could have been life-threatening. The guys at XXXXXXX Kettering have admitted sepsis subsequent to biposies is getting to be a major concern. My job (fomerly as an F16 pilot) often required me to crunch a lot of numbers quickly to make very important decisions but this has me stumped. Do you go for the biopsy given my individual circumstances are lean to a very conservative "watch and wait" given the statement buy the authors of the most-recent Guttenburg study that you have to screen almost 300 men (297) and treat 12 to save one. I'm fairly comfortable with ambiguity but would never in the air choose an option that seemed to have about a 1:300 chance of saving my passengers (let's say a ditching) when I had an alternative option (a forced landing on a short runway) that suggested probabilities of about 16% of making the landing with relatively no danger to my passengers, an 8% probability that there would be some serious injuries, but only a .03% probaility that lives would be lost.

I apologize for being longwinded but I thought the more info you had the greater the likelihood I might get a slant from you that I could add to the suggestions I have now received from two friends who are docs who literally told me to "sit on it".

Posted Sun, 6 May 2012 in Kidney Conditions
Answered by Dr. Raju A.T 3 hours later
Hi ,

Thanks for your query.

I do really admire your way of assessing things and arriving at a solution.It does make you choose between options in a quick and confident manner.

But I am afraid to say such calculation do not hold good in the filed of medicine as there will be many known and many more unknown factors influencing the numbers.Its always evidence based here.

Yes, there is slight amount of deviation existing in my above mentioned fact in the case of prostate.PSA velocity is one such partly accepted indicator.The PSA velocity in you is very insignificant and do not push me into consider any prediction.As I too arrive at a PSAv value around .12.

The benadryl use may not be influential here, hence do not consider the same.

A DRE for now would be advisable, if it turns to be normal then the second step should be getting a test to determine ratio of free PSA to total PSA which can be a leaf of help here.

Yes, Biopsy do have such complications to be expected, but in better caring hospitals this can be a rare chance.

Its always a rule to make decisions on diagnosis or treatment when the numbers and clinical evaluation are clubbed.Either of both cannot be trusted alone.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.
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