I am a 65 year old with no family history of prostate cancer. In late 2008, my PSA went from 3.11 to 4.56 and my internist recommended going to a urologist. He did a biopsy which came back negative, and the post biopsy PSA went up to 7.7. Not too long after this, I read the National Cancer Institute report that PSA testing and biopsies were being overdone and creating a lot of anguish and pain, which certainly described what I went through. I felt that the biopsy was a waste of time. I decided not to go back to the urologist for any follow-up visits. For the past three years, my PSA's were all around 4.5, but this year, it came in at 6.3, and my internist recommended going back to the urologist. So, I went to a new urologist, a few weeks after, and he runs a PSA test that came in at 5.1 with a free to total ratio of 14%. He's urging me to go through a biopsy and tells me that not catching cancer early can lead to a "late prostate cancer that is incurable and would lead to a very painful demise." He sent this to me in a certified letter. I talked to him over the phone and told him of my concerns over having another biopsy and discussed the NCI survey, which he completely discredited. Is a 5.1 PSA an open and shut indicator to have a biopsy, or do I have other alternatives, like having another test or directly going to treating BPH, which I feel has been causing all the elevated PSAs.View Thread
Thanks for taking the time to reply to my post and providing the useful links to help me make a decision. I think the key is #5 of your breakdown of the problem, and the fact that there is no test to tell which PC will turn agressive. If I choose to have a biopsy, it's to answer whether or not I have an agressive cancer, and not just for determining the presence or absence of cancer. As I understand the argument, there is no statistical evidence of benefit gain from early detection and cure of PC, because of the high numbers of overtreatment required to catch the one cancer that would turn agressive and kill the patient. I didn't seem to see any statistical evidence that elevated PSA is an indicator of an increased chance one would have an aggressive cancer. Is this thinking correct, based on what is currently known?View Thread
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