I am 62, male, with a PSA of 8.5. What does this indicate?

Question

Hello doctor,

I am a 62-year-old man who has been experiencing urinary problems for several months. I have to get up three to four times every night to use the bathroom, and even then, it feels like I can not completely empty my bladder. My urine stream is much weaker than it used to be, and sometimes I have to strain just to get it started.

My father had prostate cancer in his 70s, which makes me nervous. My recent PSA test came back elevated at 8.5, and now my doctor wants to do a biopsy. I am terrified about what they might find and whether this could be cancer. What should I expect, and how serious could this be?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

The urinary symptoms you are experiencing, such as frequent nighttime urination (nocturia), a weak urine stream, straining to start, and a feeling of incomplete bladder emptying, are common signs of benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that often occurs with age.

However, given your elevated PSA (prostate-specific antigen) level of 8.5 ng/mL (nanograms per milliliter) and a family history of prostate cancer, it is both reasonable and important that your doctor has recommended a prostate biopsy to rule out malignancy.

A PSA (prostate-specific antigen) level above 4 ng/mL (nanograms per milliliter) can raise concern, particularly if it is consistently elevated or rising over time. That said, PSA is not specific to cancer; it can also be elevated due to BPH, prostatitis (inflammation of the prostate), recent ejaculation, or even a urinary tract infection. That is why a biopsy is often needed to confirm or rule out cancer.

The prostate biopsy is typically performed using ultrasound guidance through the rectum (transrectal ultrasound-guided biopsy). It allows doctors to take small tissue samples from various areas of the prostate to check for cancer cells. The procedure is generally quick, done on an outpatient basis, and while it may be uncomfortable, most men tolerate it well. There is a small risk of infection, bleeding, or temporary discomfort, but serious complications are rare.

It is completely normal to feel anxious, especially with a family history of prostate cancer. But it is important to remember that early detection, if cancer is present, significantly improves treatment options and outcomes. Also, keep in mind that an elevated PSA does not automatically mean cancer. It can often be due to BPH or inflammation. The biopsy is simply the most accurate way to find out what’s going on and give you clarity.

In short, do not panic; you are taking the right step by following through with your doctor’s advice. Whether it turns out to be benign or something more serious, you’ll be better positioned to take action with clear information.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.