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Patient's Query
Hi doctor,
I am a 62-year-old male and have had IgA (immunoglobulin A) nephropathy and hypertension for the past 11 years, which is being treated with Cardace 10 mg, Stamlo 5 mg, Lipitor 10 mg, and fish oil capsules. In addition, I have thyroid nodules (no medication). BP is around 130/80. I have had an enlarged prostate (grade 2) for six years. The prostrate size was 38.19 mL 4 months back, and I started Urimax 0.40 mg 6 months back. No symptoms of BPH. My Total PSA and Free PSA test results for the past three years are, currently: Total PSA 1.93 ng/mL, free PSA 0.47 ng/mL, free PSA ratio 24.35 %. Eight months back: Total PSA 1.39 ng/mL, free PSA 0.43 ng/mL, free PSA ratio 30.94 %. Last year: Total PSA 1.32, free PSA 0.475, free PSA ratio 35.98 %. Two years back: Total PSA 1.25, free PSA 0.38, free PSA ratio 30.40 %.
Prostrate size: This year: 38.19 mL, last year: 45.66 mL, two years back: 42.37 mL. Urimax 0.40 mg was prescribed six months back as a precaution. No BPH symptoms. I attached my latest ultrasound report of the prostrate, which was done just four months back. My queries are as follows: 1. Is the rise in Total PSA by 0.54 ng/mL from 1.39 to 1.93 a cause for concern? Could this be partly due to taking Urimax 0.40 mg? 2. Is there a possibility of prostate cancer with the above PSA result? 3. Please provide your advice on the next steps to be taken.
Hi,
Welcome to icliniq.com.
I understand your concern.
There is no relationship between Urimax and PSA (prostate-specific antigen) level. There are fluctuations in the PSA in this range which is normal, and any PSA above 1.4 should be repeated twice yearly. If we notice two consecutive rises in PSA, then we will suggest an MRI (magnetic resonance imaging) scan of the pelvis with PIRADS (prostate imaging reporting and data system) scoring. If the score is 1 or 2, then no need for a biopsy, but if the score is 4 or 5, we will suggest doing a targeted biopsy for the lesions in the prostate. If the score is 3, we can observe for another reading. If it is still rising, then biopsy; otherwise, none. In your case risk of having prostate cancer is low as the safe PSA is below 2.5.
Patient's Query
Hi doctor,
Thank you very much for your prompt and informative response.
If Urimax is not partially responsible for the rise of 0.54 ng/mL in the total PSA, in your experience, what could be the reason for the increase? Is it the BPH? Previous increases in my total PSA were quite small. I am 62 years old - I thought that the safe level for total PSA was up to 4.0 ng/mL. Even if my Total PSA goes up to 4.0 ng/mL, but my free PSA ratio is greater than 15 %, is there still a risk of prostate cancer? What signs of prostate cancer should I be aware of?
Thanks.
Hi,
Welcome back to icliniq.com.
I understand your concern.
Reason for fluctuating can be different factors; anything that happens to the prostate can increase PSA within range, like examination of the prostate or ejaculation or cycling many causes, but we look at the trend, not a single reading. Yes upper limit is four ng/dL true, but with four, according to guidelines, 25 % of patients will have prostate cancer for 62 years as long as the reading is 2.5 and below no risk. Same as per number 2. Early prostate cancer has no signs.
Kind regards.
Patient's Query
Hi doctor,
Thank you for the reply. What is the normal increase in Total PSA per annum after 60 years?
Hi,
Welcome back to icliniq.com.
I understand your query.
There is no normal increase. It fluctuates within a range, and we see the trend on follow-up, and we make the suggestion to do MRI or biopsy.
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