Urology/high psa

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QUESTION: I read that psa can be influced by enlarged prostate.if you have enlarged prostate hyperplasia can it raise your psa to 17.if you have high psa but normal digital rectal is that a good sign.i am 81 tookfree psa test and the doctor said I have a 33%chance of getting cancer.most reports say men of 80 diagnosed with prostate cancer the vast majority will die from another desease then prostate cancer

ANSWER: Howard:

Well, you are mostly right.  Enlarged prostate can certainly cause a very high PSA.  A normal digital exam is a good sign but not a guarantee.  If you are in good health, you might want to consider a biopsy.  In general, biopsies are positive for cancer about 1/3 of the time.  But most cancers are not dangerous; only a small percentage will cause harm or death.  Of all men with prostate cancer, only about 1/6 will die from it.  That's why we generally find that above 75 years of age, most people will do better without a biopsy and just leaving things alone.

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QUESTION: appreciate your response,too bad most of the urologists are not likeyouand are book doctors/not  positive thinkers like you.by the way is 1/6 that die from prostate cancer around 15%i am a idiot with math.god bless you

ANSWER: Howard:

It's actually 16.66%.  You don't have to be a math genius.  Just use Google on the internet.  type in 100/6 and hit [enter] and you'll get the answer.

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QUESTION: Kaiser permemte did a study of 4,144 men who had microscopic blood in their urine.of the 4,144 men who had microscopic blood in urine only 2.3%had cancer.the study said c-scans and the whole barrage of tests are not necessary.the lead urologist who led the study said most reliable sign of cancer is gross visible blood in urine.if a 80 year old man with enlarged prostate has microc-scopic not viseable blood in urine would you put him thru c-scan ans all other teasts,if his last cyscospt taken 6 months ago was normal.here in Atlanta ga doctors go ape with blood in urine and immediately jump to ct-scan.meanwhile microscopic blood in urine only causes 5%of cancer.what say you

Answer
Howard:

I'm in an academic center so we tend to be a little more overly cautious.  The generally accepted number of urological malignancies from microscopic hematuria is generally around 5%.  In another study, the risk was abouit 20%! (See Below).

The current recommendations for unexplained hematuria is still a CT scan and a cystoscopy.  These are reasonable ways to check for stones, malignancies and other potentially dangerous pathology which an 80 year old is less likely to tolerate than a 50 year old.


World J Urol. 2012 Dec;30(6):847-52. doi: 10.1007/s00345-012-0979-x. Epub 2012 Nov 5.
Accurate risk assessment of patients with asymptomatic hematuria for the presence of bladder cancer.
Cha EK1, Tirsar LA, Schwentner C, Hennenlotter J, Christos PJ, Stenzl A, Mian C, Martini T, Pycha A, Shariat SF, Schmitz-Dräger BJ.
Author information 1Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th St, Starr 900, New York, NY 10065, USA.
Abstract
PURPOSE: Bladder cancer is frequently diagnosed during a workup for hematuria. However, most patients with microscopic hematuria and many with gross hematuria are not appropriately referred to urologists. We hypothesized that in patients presenting with asymptomatic hematuria the risk of having bladder cancer can be predicted with high accuracy. Toward this end, we analyzed risk factors in patients with asymptomatic hematuria and developed a nomogram for the prediction of bladder cancer presence.

METHODS: Data from 1,182 consecutive subjects without a history of bladder cancer undergoing initial evaluation for asymptomatic hematuria were collected at three centers. Clinical risk factors including age, gender, smoking status, and degree of hematuria were recorded. All subjects underwent standard workup including voided cytology, upper tract imaging, and cystourethroscopy. Factors associated with the presence of bladder cancer were evaluated by univariable and multivariable logistic regression analyses. The multivariable analysis was used to construct a nomogram. Internal validation was performed using 200 bootstrap samples.

RESULTS: Of the 1,182 subjects who presented with asymptomatic hematuria, 245 (20.7 %) had bladder cancer. Increasing age (OR = 1.03, p < 0.0001), smoking history (OR = 3.72, p < 0.0001), gross hematuria (OR = 1.71, p = 0.002), and positive cytology (OR = 14.71, p < 0.0001) were independent predictors of bladder cancer presence. The multivariable model achieved 83.1 % accuracy for predicting the presence of bladder cancer.

CONCLUSIONS: Bladder cancer presence can be predicted with high accuracy in patients who present with asymptomatic hematuria. We developed a nomogram to help optimize referral patterns (i.e., timing and prioritization) of patients with asymptomatic hematuria.

PMID:23124847[PubMed - indexed for MEDLINE] PMCID:PMC4004026Free PMC Article

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Stephen W. Leslie, MD

Expertise

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

Experience

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.

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

Publications
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.

Education/Credentials
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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