What are the potential treatments for raised PSA levels?

Question

Hello doctor,

I am 62 years old and writing with growing anxiety about my recent PSA test results. My PSA levels have suddenly spiked to 5.8 nanograms per milliliter from 2.1 last year. I have been experiencing increased urinary frequency especially at night and occasional discomfort with my lower back. As my father battled aggressive prostate cancer, I am terrified that I might face the same. The thought of potential treatments and their side-effects such as incontinence, erectile dysfunction is overwhelming. I am losing sleep worrying about what this could mean for my future and my relationship with my wife. How urgently should I pursue further testing? What are my options if it is cancer?

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your growing anxiety about your recent PSA ( prostate specific antigen) test results and the impact it might have on your future and relationship with your wife. Given your age, the significant increase in PSA levels from 2.1 ng/mL to 5.8 ng/mL, and your family history of aggressive prostate cancer, it is important to take this seriously and pursue further testing promptly.

It is crucial to consult with your healthcare provider as soon as possible. They may recommend the following steps:

It is better to repeat the test for PSA levels as they can fluctuate due to non-cancerous conditions like prostatitis or benign prostatic hyperplasia (BPH).
Digital rectal exam (DRE) to find abnormalities in the prostate.
An MRI or ultrasound may be used to get a detailed view of the prostate.
If your PSA levels remain elevated or the DRE is abnormal, a biopsy may be necessary to determine if cancer cells are present.

If the tests confirm cancer, there are several treatment options available, each with its own potential side effects and benefits:

For slow-growing cancers, especially in older adults, active surveillance (monitoring the cancer closely) might be an option.
Surgery (prostatectomy) is the removal of the prostate gland and can be effective, especially if the cancer is localized. However, this can have side effects like incontinence and erectile dysfunction.
Radiation therapy externally or internally (brachytherapy) targets cancer cells in the prostate. Side effects can include urinary and bowel problems, as well as erectile dysfunction.
Hormone therapy.
Chemotherapy in advanced stages- can have systemic side effects, including fatigue, nausea, and increased risk of infections.

Newer treatments that target specific aspects of cancer cells or boost the body's immune response against cancer. These are generally used in more advanced cases or when other treatments have not been effective.

Managing anxiety and relationship concerns:

Consider seeking counseling to help manage anxiety. Support groups for prostate cancer patients and their families can provide emotional support and practical advice.
Discuss your fears and concerns with your wife. Open communication can strengthen your relationship and help both of you cope with the uncertainties.
Educate yourself about prostate cancer and its treatments. Understanding your condition and the options available can help reduce anxiety.
Maintaining a healthy diet, regular exercise, and adequate sleep can improve your overall well-being and potentially support your treatment and recovery.

Next steps:

Schedule an appointment with your healthcare provider to discuss your PSA test results and symptoms.
Follow through with the recommended diagnostic tests.
Discuss all potential treatment options and their side effects with your doctor to make an informed decision.

Taking prompt action and seeking support can help manage your anxiety and ensure you receive the appropriate care.

I hope this has helped you. Please feel free to reach me again, in case of further queries.

Thank you.