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Urology/Prostate problem.


Dear Sir,

I am sorry to come back to you for some reasonably explanation on my questions,as you have already replied my previous questions.This is last time I am seeking your advice.Please help.

"Dear Doctor,

my age is 74.physician asked for PSA & free PSA:8.78/2.35.Rectal sonography indicated vol.55.7gms.
Urologist seeing reports prescribed Silodosin 8mg & Dutasteride-o.5mg,one capsule each/day, for 30days as post void vol was 118ml.It came down to 68ml.But on continuing drugs for another 45days,the same was 130ml,though the flows were normal.(14.6,14.1& 9.3ml)later F/U he asked for transrectal sonography,indicating mild swollen Seminal vesciles(5.1,6.3 size,length being 3.3/3.2cms.while prostate vol.was 66gm.
considering mild inflammation,he prescribed Doxy-100mg.twice/day contnuing above both drugs for 21days.
Kindly give your assessment based on above history within span for  just 3months.(2nd 27th.Dec-2012)
Question remains what is next.My urination frequency has reduced from 4/5times to 2/3times at night with same water intake.
PSA is checked twice as 6 & 5.95.
I have no other health problem and would like to avoid side reactions of expensive medication as I am NA glaucoma patient though after laser surgery & cataracts' surgery my IOP is 12/14mm.Hg without any drops since about 2years.(I am worried of my vision undergoing long term medicatios!!!)
I am really confused as prognosis seems endless & would like to wait when surgery for prostate is called for.At that point of time doubt of cancer can be cleared.
It gives me impression from literature on subject that it is not a life threatening issue,unless diagnosed for cancer.
Please give me your frank opinion what you would do,if you are in my situation.I am sorry,but you would appreciate my anxiety (without having any serious problem) i am under tests & frequent F/Us.Both Kidneys are normal in shape,size & echo-pattern.
Thanking you.
With warm regards in NEW Year.

and was asked on 01/11/2013


Understand that this is not an official second medical opinion and is based only on the limited information provided.

First, there is a question about prostate cancer due to the eleveated PSA levels.  In general, we do not start medications like dutasteride that lower PSA levels 50% until we are reasonably sure that the original elevated PSA is not due to cancer.  This was not done in your case so the question about prostate cancer remains.  Your followup PSA levels while on dutasteride are around 6 which translates to a real PSA level of 12 if you were not on the dutasteride.  In my opinion, the issue about prostate cancer needs to be addressed first; either with a biopsy or a conscious decision not to pursue a cancer diagnosis accepting the potential problems this may cause later.

I don't understand your feeling that the "prognosis seems endless".  You have a reasonable response to medication for symptoms.  At some future point this may change and a surgery then becomes reasonable.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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