Posted by: johan | 2007/03/26

enlarged prostate gland


During August 2006 I had a routine 12 monthly CT scan (had cancer of the small intenstine nearly six years ago, operated on sucessfully) it was established that I have an enlarged prostate gland, but am clear otherwise (AGAIN) from any sighns of tumours.

I subsequently saw a Uroligist and he done a PSA=1.31, Free PSA=0.41 and PSA ratio=0.31, as well as a internal check up. He stated that although the gland is larger, it felt smooth and not rough at all.

Subsequently I had another CT scan on 6 March '07 (on my own request) as well as another PSA. The CT scan again showed no sighn of any tumours, but again an enlarged prostate gland. My latest PSA= I.07.

Although my Uroligist, Surgeon and GP is comfortable with the results, my Uncologist feels that some times the PSA could be OK, but the Prostate can still be cancerous and I should have a biopsy done of the gland. I can only see my Uroligist in 3 weeks time. Hence, what is your view on my prostate gland? Do I realy need a biopsy?

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Our expert says:
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Hallo Johan
Normal PSA, with normal physical exam is a fair indication that all is well. ( 90% sensitive)
An additional way to exclude prostate cancer will be with sonar guided biopsy. One PSA alone has little value - but serial PSA does give one an idea whether anything is growing - in other words if the PSA is HIGHER every time you test it, it needs further exam. Normal can be 0-4ng/ml.
If you don't want to go for the biopsy, follow up on the PSA's every 6 months and get a physical exam at least yearly. As one gets older the prostate enlarges anyway - 50% of men at 50 years old have enlarged glands, 60% at 60 years and 70% at 70 years. Doing a CTscan of the prostate is expensive way of monitoring it - rather do prostate sonar, serial PSA's and regular physical examination ( rectal examination - I know it is unpleasant but still very important).
Having the biopsy will give you peace of mind though...? In that way I agree with your oncologist as it is important for your general immunity that you do not stress over unneccesary things.

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