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Prostate Cancer

Diagnostic Value of TRUS - Prostate

06/12/2009

Question:

Good Day. I will be 76 shortly. I have been undergoing PSA testing biennially since 2004. My total PSA value has remained constant at about 0.6microgram/ml. This value is statistically significant and supported by assay from two different laboratories. At this level of total PSA observed, the estimation of free PSA does not appear to be meaningful. I have been scheduled for TRUS - PROSTATE without biopsy. May I know what additional information this TRUS procedure will bring to light? Can the constant value of PSA over the years be still false-negative? In 2004, it was reported from DRE that there is/was slight BPH. Is BPH reversible without any medication? My diet includes cooked pumpkin seeds. Should I continue with the periodical PSA determinations? I admire the public service that your organization is rendering. Regards

Answer:

TRUS without biopsy will provide estimate volume of the prostate, may identify prostate stones (no significance unless associated with prostatitis), other areas of prostate cysts or anatomic variation that might contribute to voiding symptoms- but TRUS will not distinguish normal or benign prostate tissue from prostate cancer.

Unless you are having voiding symptoms (in which case, TRUS may guide treatment choices), I see no value in performing the TRUS. BPH is common and may cause voiding symptoms. Benign enlargement of the prostate may cause voiding symptoms, bleeding, promote urinary tract infections or kidney failure. In the absence of these signs and symptoms, the size of the prostate is irrelevant.

Reversal of prostate enlargement without medications is not possible to the best of my knowledge. The prostate volume can be reduced with several operative therapies but this is not indicated without the conditions noted above (voiding symptoms, bleeding, etc.).

PSA beyond the age of 75 is generally performed only in men who are in good general health. Treatment of prostate cancer has diminishing returns in men whose life expectancy is estimated less than ten years (e.g. men with coronary artery disease, pulmonary disease, etc). With a stable PSA of 0.6 ng/ml, no palpable prostate abnormality, no family history of prostate cancer, the benefit of continued PSA is statistically of little benefit. Hope this helps.

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati