Questions to My Urologist About My 5.5 P.S.A. & His Answers

Hello, everybody.
I sent four questions to my uro yesterday about my psa and recommending others tests vs. going straight to the biopsy. If you don't mind, I would love to share what was said between him and I. Here are my questions and his answers. I would love to know your thoughts.


1. My lab result says my PSA is 5.5. I’m 40 years old. How many cases have you seen in your experience, where a patient who’s 40 years old, with a PSA level of 5.5 diagnosed with prostate cancer? See about 2 patients a year in their 40's who have prostate cancer - any patient with high PSA has 30-35% chance of having prostate cancer.


2. I understand that my PSA is 5.5 and that is pretty high. Why didn’t you rule out other causes of an elevated PSA prior to rushing into a biopsy? Such as testing for an infection, a course of antibiotics? No evidence for infection on urine sample and prostate exam. No longer recommended to give antibiotics for elevated PSA without clinical infection, as more resistant bacteria and problems with post-biopsy infections.

3. Why didn’t you offer a test for free PSA? From my understanding many doctors recommend biopsies for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. No value to free-PSA in men who have not had prior biopsy, as only 20% of time is free in "safe" range, most of the time in indeterminate range.

4. How soon after the biopsy must I take the second dose of Ciprofloxacin? That evening.

5. Is there a relationship between low vitamin D and prostate cancer? Indirect evidence - those living closer to equator have lower incidence of prostate cancer. Sunlight exposure = higher vit D from skin. Vit D at high doses however, may increase prostate cancer risk.

John T said...
The questions you didn't ask:

Well, John, I'm not as much of an expert in these type situations as you are. So, I didn't know what I was missing out on. Thank you for your input. Maybe next time, I'll ask him those questions.

bluebird,

I agree with you. % free PSA is indicated before a first biopsy. Still better is the new PHI test that includes PSA, % free PSA and -2ProPSA. It is somewhat less ambiguous than % free PSA.

PCA3, on the other hand, is only indicated after a first negative biopsy. Insurance won't cover it before a first biopsy.

More importantly, other causes of PSA increase, especially BPH and prostatitis, should be eliminated before rushing into a biopsy. This is especially true with a negative DRE.

- Allen

I agree with JohnT, re the mpMRI. I wish I had done that rather than the saturation biopsy. If I "really" have Gleason 6, 1mm cancer, there's no reason for me to know it. I'll see what else they find next week when I have the mpMRI.