Dear Dr. Roach: I am a 72-year-old male in good general health. I have been monitored for my prostate enlargement for a few months. Last week, my PCP did regular labs. Yesterday I went to my urologist. He took my PSA, since he had not received the results from my PCP. Here is the problem: My PSA reading from the urologist’s test was 10.7, so we set up a biopsy. Today, the results from the PCP came back, and the result was 6.4. Six months ago, it was 5.4. The urologist has no explanation for the discrepancy but suggested that I consider postponing my biopsy. He also suggested repeating the PSA in three to four months. How can I be sure the next PSA is accurate, and why isn’t anyone concerned about this?
Dear E.S.: Prostate specific antigen is a protein made by both the normal prostate and by prostate cancer. Higher levels indicate a higher likelihood of cancer. PSA is not a perfect test, and it is possible to have cancer with a normal PSA, and high levels can happen in conditions other than cancer, especially with infection or inflammation of the prostate.
All laboratory values go up and down in the course of a day or a week, but this degree of change is greater than one would expect. I wonder if the PCP used the same laboratory as the urologist, since there are variations in the way the test is done, and so it is best to have the same lab doing the test each time.
No matter which level you look at, the 6.4 or the 10.7, your PSA level has been rising and is now in a higher-risk range. It still is hotly debated whether early diagnosis and treatment of prostate cancer leads to better outcomes. The older a man is, the more likely that prostate cancer, if found, will be a more slow-growing type, and because the treatments, including surgery, radiation and chemotherapy, all have significant side effects, many men choose not to treat. Our ability to determine which cancers are likely to be aggressive and which are destined to never cause trouble isn’t nearly as good as we want it to be, even with a biopsy.
If you decide to have a biopsy, remember the decision to proceed with treatment is your choice and ought to be discussed with your PCP and urologist.
Dear Dr. Roach: When someone with hemochromatosis has blood drawn to bring down his or her iron content, what is done with the blood?
Dear D.D.: I’ve talked several times about hemochromatosis, a hereditary condition of excess iron absorption.
There is nothing at all wrong with the blood, and it can be lifesaving for a person with acute, severe anemia. However, each blood bank has its own policy as to whether to use the blood or not, as long as the donor meets all other criteria for being a blood donor.
Email questions to ToYourGoodHealth@med.cornell.edu.