A common question?

I am a relatively healthy 66 yr old male. Although I don't think it's related, I'm mention that i've been overweight most of my life. Since Januraly, I'm on low carb diet, losing about 50 lbs to date, with another 50 to go. about 12 yrs ago, i lost 100 lbs and kept it off for 5-6 yrs. In January, i was about the same weight as when i begun in January. I note this not to discuss diets but in case there is any connection. Now, regarding my prostate:

My PSA levels have always been in the 2.5 to 3 levels. 2 yrs ago it was 4.1. We repeated the test 6 month later and it was back down to 3. This February, it was 6.0 and doc referred me to a urologist. We discussed the possibilities and decided to redo the test 3-4 months later and last week it was down to 5.1. This is still not down to my previous 3 level but I wonder if the biopsy, etc are necessary?

Some related info. Over the past 8-10 years, my pee has gotten weaker which is normal. There has been no starting and stopping, no getting up at night to go, and no big urgency. Over the years, the doc has noted my prostate was normally getting bigger but not dramatic. He did ask about waking up to go or urgency and I told him no. However, since that time, I am noticing the need to go more frequently, an urgency and not feeling completely empty. There is still no significant waking up at night to go pee unless something else wakes me up like a thunderstorm, etc. Once awake, I end up thinking about having to pee and get up to go.

I started taking Saw Palmetto a month ago and it seems to diminish the frequency sometimes. At times it feels like the garden hose is being pinched and other times like it's flowing full throttle.

My questions:

With my PSA level, is a biopsy warranted? Along with that, should I find a doctor who has a color doppler sonogram equipment or does it make a difference? I've read a number of articles about the biopsy and none give me confidence that it's worth the time and possible issues.

Next, should i ask my regular doc for something like "Flowmax' or other similar Rx? Are there any side affects to this?

I would get a PCA3 and a free psa test and get a biopsy only if these were abnormal. Your doctor should also estimate the size of your prostate from a DRE (you said it was enlarged). If the resulting psa density is <1 then don't get a biopsy. For example a 40cc prostate should yield a psa of about 4. If you do have an enlarged prostate, Proscar or Adovart would be good.
JohnT

Hi:

Allow me to offer a quote for your consideration:

"A study from Johns Hopkins and the National Institute on Aging found that an increase in PSA level of more than 0.75 ng/mL per year was an early predictor of prostate cancer in men with PSA levels between 4 ng/mL and 10 ng/mL. PSA velocity is especially helpful in detecting early cancer in men with mildly elevated PSA levels and a normal digital rectal exam." Johns Hopkins Medicine Prostate Disorders, by Dr. H. Ballentine Carter (2011)

The Study referred to was published in November, 2006 in the Journal of the National Cancer Institute, Volume 98, No. 21.

Unfortunately, many Docs are not familiar with this Study. Had my Doc known about it, or had I done my own due diligence research, my PC would have been caught early and I would have had a chance for a cure. As it is, my treatment now for Advanced Cancer is only to prolong life.

The mistake has cost me 10 to 20 years of life!

I don't understand the reluctance to get a biopsy. Sure, there can be false negatives, but hey, it CAN catch PC early enough for a chance to cure it! It is an outpatient procedure that takes 15 minutes with less than 1% complications.

Houseboy

I agree with Medved, I would drop off using the saw palmetto. Based on what you posted, I would be inclined to have a prostate biopsy at this point. They are no fun, but most of us got through them fine, and it may give you peace of mind if it comes back cancer free, and if it does come back positive, then the early warning would be a good thing, before it ever has a chance to get out of hand. It's certainly between you and your doctor to decide.

David in SC

I would get a biopsy