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QUESTION: dr leslie get your catching gloves on  I am throwing you a hot potatoe.im closing in on 81 and was urinating every hour for a month.went to my internist who without my permission,which I never would have never give in snecked a psa test.my psa waS 17.WENT TO LIBRARY   andD SPENT 6 HOURE OF READING.MOST OF  theEXPERT UROLOGISTS said MEN OVER 75 SHOULD NOT HAVE PSA   TEST.de Patrick walsh of johns hompkins said his studies  showedstanleymost psa have false negetives and a man with large prostate could have elevated psa.fact my prostate gland was normal good sign.all studies the major cancer organizations   includingcancer. cancer.harvard university and dr  Stanley the inventor of the psa,said the test is useless.the experts like 23 orginixations say mem with less then 10 years to live,the psa wiii do  more harm then good.thefe is no proof that surgurical intervention in men over 80 will have better life expendcy of those who had no treatment.meanwhilw I will ifgnore the psa test and just enjoy life.what do you think

ANSWER: Howard:

There is a general consensus even among us PSA supporters, that it should not be routine done in men over age 75 since pursuit of a diagnosis and treatment of any prostate cancer often causes more harm than just doing nothing.  Also, prostate cancers in this age group tend to be less dangerous and far less aggressive than in younger men.

The elevated PSA could just be enlargement, but now that you know the PSA is elevated, you have a choice.  Consider getting a "4K" test.  This new test, which costs around $400, checks various subgroups of PSA and a few other blood proteins to provide a relative risk percentage of having dangerous prostate cancer (Gleason 7 or higher).  It is intended to be of use in situations like these where we are not sure who to diagnose or treat.  If the risk of 10% or higher, then a biopsy is usually recommended.  The test is FDA approved but not yet covered by insurance so you would have to pay yourself for the test.

You could also undergo a prostate biopsy.  This would give a good idea of the extent and character of any cancer  but does not require you to have any therapy.

Another option is to have an MRI.  This seems to be about as accurate as the biopsy, but it requires great skill among the radiologists and is not available everywhere.

Or you can choose to do nothing and take your chances for all the reasons you pointed out.

There is great controversy about PSA testing in younger age groups.  My personal feeling is that the data is not yet compelling to drop PSA testing in most men and the fear is that we could later see many men with incurable, advanced cancers that were not discovered early enough to avoid serious consequences.  For an example, just look at Sweden where they have a similar rate of prostate cancer but do not typically do screening.  Death rate from prostate cancer in Sweden is more than double the rate here in the US.

Now you have the facts and you can decide.

---------- FOLLOW-UP ----------

QUESTION: my urologist said I have hyperlasa.that could cause psa to jump to 16.also many experts say psa test not reliable in men over 80 as very small number of men in 80 get aggressive prostate cancer

Answer
Howard:

It is possible that the PSA elevation is just hyperplasia (enlargement) but without one of the tests discussed earlier it's not possible to be sure.  I would not agree that the PSA test is not reliable over 80 years of age.  The problem is that we find lots of cancers with low levels of aggressiveness, but the majority of prostate cancer deaths are in men in their 80's!

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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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