Do I need further tests if my PSA level is 5.12 at age 78?

Question

Hello doctor,

I am 78 years old. Mild hypertension was diagnosed. Also, take Rosuvastatin 10 mg daily. Routine annual blood test shows a PSA level of 5.12.

Is further investigation recommended?

Kindly advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Let me start by explaining PSA (prostate-specific antigen): As you know, PSA is a marker for prostate cancer; however, it can be elevated for a variety of other reasons:

Advancing age.
Prostatitis.
Enlarged prostate (without cancer).
Cancer.

As per the guidelines, PSA testing is not recommended for individuals over the age of 75. However, in practice, this is a shared decision-making between urologists and patients. Your free PSA is 29, which makes it even less likely that you have cancer. If I fed your information into a risk calculator, this is what I would get:

66 percent chance of not having cancer.
21 percent chance of having low-risk cancer.
12 percent chance of having high-risk cancer.

The other thing about prostate cancer is that it is very slow-growing and not like other cancers, which can spread quickly. Even if this PSA did turn out to be because of cancer, it is very likely going to be a low-risk disease and is not going to alter your lifespan.

So I would suggest that you make this decision based on the information I have provided and based on your personal preference as well. Please also help me with a few other details:

Have you recently had a UTI?
Do you have any trouble passing urine, such as urgency, increased frequency, straining to pass urine, or a feeling of incomplete bladder emptying?
Have you had any surgeries in the past?
Is there a history of prostate cancer in your family?
Have you ever had any blood in your urine?

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Thank you for your response.

The reduction in flow rate may be due to an enlarged prostate, which is common in your 70s. What I would suggest is that you get an appointment to check your flow speed with a test called uroflowmetry. If the flow is found to be suboptimal, you will require alpha blockers to improve it. It would also be helpful to get the size of the prostate assessed by an ultrasound.

Please let me know if there are any more questions.

I hope this helps.

Thank you.