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Grade 1 prostate enlargement with raised psa level. Family history of prostate cancer. Concerned

Jul 2016
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Practicing since : 1971
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Hello. I am a 59 year old Caucasian male with grade 1 prostate enlargement (measured last Friday with Doppler echo, 37x33x37 mm diameter, volume 24). I had a psa of 4.67 in September 2012, and the previous number in 2009 was 2.02, which is why the doctor ordered the echo. On Friday December 21, I got the results of another psa test I took a few days before and it was 5.04, with free psa at .89 and free psa/psa total at 17.66%. Complex psa was 4.15. I have no symptoms or problems, perhaps a sensation of weaker flow or it might be my imagination, but I do have a family history, my father had prostate cancer in his 60´s, survived it well, and died at age 90. I see the doctor again on Dec. 26, I presume he will send me to a urologist for an ultra and biopsy. How concerned should I be? Can a biopsy completely rule out cancer? I am not really very knowledgeable about this disease and the more I read the more scared I get, and right now I feel terrified. So if you have an general advice based on what I have written, realizing you are not my doctor and have not examined me....thanks
Posted Sun, 13 Jan 2013 in Urinary and Bladder Problems
Answered by Dr. P. T. Patil 8 hours later
Thanks for writing to us.
Given the rising trend of serum PSA levels seen on your exams, the following protocol is recommended.
1) First of all Digital Rectal Examination (DRE) is a must to assess the size of the prostate ,and to rule out presence of a hard nodule which indicates possibility of malignancy.
2)Abdominal Ultrasound Scanning and Scanning with Trans Rectal Ultra sound Probe is done to see any hypo echoic lesion in peripheral zone of the prostate.( Which suggests Malignancy)
If findings of above tests are positive then one has to go for C.T scan and MRI and Trans Rectal CT guided multi score Biopsy.
If these tests are negative, then we continue to monitor.
Hope that helps.
Feel free to write if you have any more questions.
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