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I Am 50 Years Old. I Was Referred To A

Posted on Sun, 5 Jul 2020

Question: I am 50 years old. I was referred to a Urologist in 2014 and have had annual PSA and DRE. PSA was 0.6 each year from 2014 through 2018, and normal DRE. Started Proscar for enlarged prostate in Nov. 2018. In November, 2019, PSA of 0.7 after being on Proscar for one year. I would have expected PSA to decline or stay the same (have read that PSA levels drop on average 50% on Proscar). Urologist wanted to retest in 6 months. He did say, "I'm not worried about it" but wanted to see more data. DRE was normal.
Since then I have had PSA checked several times:
--December 2019--0.4
--January 2020--0.5
--February 2020--0.4

Saw different urologist in March who was not concerned about PSA at that time but ultrasound showed 190cc post void residual and I started 2mg/day Cardura. Still taking Proscar.

Yesterday, I had my PSA tested and it was 0.9. I was reassured with the lower PSA levels through February, but am concerned with the jump from 0.4 in February to 0.9 in XXXXXXX Cardura may be helping slightly but I still often feel I cannot empty my bladder completely. I read somewhere that "any" "confirmed increase" in PSA while on Proscar "could" suggest cancer. Should I be worried about the doubling in PSA in 4 months and continuing LUTS even when on Proscar and Cardura? Thanks.

Answered by Dr. Dr. P. T. Patil (9 hours later)

Brief Answer:
Not to be worried about PSA at all

Detailed Answer:
Hello
Thanks for query ,
Based on the facts that you have posted you have been regularly monitoring your PSA levels since 2014 and it has been reported to be in a range of 0.6 to 0.9 ng .

PSA is an enzyme secreted by prostate which helps to liquefy semen and normal value of a PSA in a normal individual is 0.4 to 4 ng.So one has not to be worried as long as PSA is within this normal range .

PSA is a guiding tool to screen and do further tests like MRI or Prostate biopsy if it shows rising trend when PSA tests are done at every 15 days interval consecutively for period of 3 months and DRE detects hard palpable nodule on posterior surface of Prostate .

In a given situation like normal PSA and DRE you need not have to be suspicious about having prostate cancer .

The high post void residual urine (PVR) detected on Ultrasound Scanning could be due to Bladder Outlet(Neck) Obstruction (BNO) .Discuss with your Urologist to explore need for doing endoscopic examination of bladder (Cystoscopy) to rule out the same .

Do not raise your anxiety levels by thinking about having prostate cancer.

Hope I have answered your query ,please feel free to ask if you have more questions,I shall be happy to help you
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (8 hours later)

Thanks for the detailed reply. Even though PSA is under 4, I have read that the finasteride (Proscar) I am taking should reduce PSA levels by 50% and that any increase while on finasteride can be a concern. I read the following in a book by Dr XXXXXXX Walsh on prostate cancer: "once you are on finasteride, your PSA should continue to decline slowly and never increase. If it begins to increase while you are taking the drug, this is a strong indication that you have cancer, and it may be a very aggressive form." I read somewhere else that an increase in PSA levels while on finasteride is associated with about a 25% risk of having cancer. My baseline PSA from 2014 was 0.6, and, while taking finasteride, it went up to 0.7 in November last year and 0.9 this month. My PSA was also measured at 0.4 or 0.5 on different occasions between November and now. So it has been fluctuating up and down, but there have been 2 times that PSA is higher than baseline even though I'm taking finasteride. Could you please let me know your thoughts on the increase in PSA while on finasteride? Thanks again.

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
Fenasteride decreases PSA which is higher than normal (More than 4 )

Detailed Answer:
Hello
Thanks for follow up .

Fenasteride decreases PSA which is abnormally raised more than normal value of 4 it does not decrease the normal PSA.

The value of a PSA are different even on day to day basis and depends upon sexual activities and condition of prostate .It may get higher if there is slight UTI or infection of prostate.

I think you are unnecessarily giving too much importance to your PSA values which are absolutely within normal range .I would add a word of cautious that Fenasteride taken over a longer duration in some individuals may lead to cancer of Prostate .

Thanks and Regards.
Dr Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar