Dear Dr Roach: I am a 72-year-old male in good general health. I have been monitored for my prostate enlargement for a few months. Last week, my family doctor did regular labs. Yesterday I went to my urologist. He took my PSA, since he had not received the results from my doctor. Here is the problem: My PSA reading from the urologist鈥檚 test was 10.7, so we set up a biopsy. Today, the results from the doctor came back, and the result was 6.4. Six months ago, it was 5.4. The urologist has no explanation for the discrepancy but suggested that I consider postponing my biopsy. He also suggested repeating the PSA in three to four months. How can I be sure the next PSA will be accurate, and why isn鈥檛 anyone concerned about this? E.S.
Prostate specific antigen is a protein made by both the normal prostate and by prostate cancer. Higher levels indicate a higher likelihood of cancer. PSA is not a perfect test, and it is possible to have cancer with a normal PSA, and high levels can happen in conditions other than cancer, especially with infection or inflammation of the prostate.
All laboratory values go up and down during the course of a day or a week, but this degree of change is much greater than one would expect. I wonder if the doctor used the same laboratory as the urologist, since there are variations in the way the test is done, and so it is best to have the same lab doing the test each time.
No matter which level you look at, the 6.4 or the 10.7, your PSA level has been rising and is now in a higher-risk range. It still is hotly debated whether early diagnosis and treatment of prostate cancer leads to better outcomes (even though it seems common sense that it should). The older a man is, the more likely that prostate cancer, if found, will be a more slow-growing type, and because the treatments, including surgery, radiation and chemotherapy, all have significant side effects, many men choose not to treat. Our ability to determine which cancers are likely to be aggressive and which are destined to never cause trouble isn鈥檛 nearly as good as听we want it to be, even with a biopsy.
If you decide to have a biopsy, remember the decision to proceed with any kind of treatment is your choice and ought to be discussed with your family doctor and urologist, and it depends on your overall medical condition and preferences.
听
Dear Dr Roach: You have written many times about chickenpox, shingles and the shingles vaccine. My question concerns the age at which one should get the vaccine. Most doctors and other sources recommend 60 and above; however, I am concerned about more and more younger people getting shingles, in their 50s and, in one instance I know of, a woman in her 30s. Are these isolated cases? I am a 48-year-old female, and I did have chickenpox as a child. My husband鈥檚 insurance will pay for the vaccine at 50, and I intend to get it then. What are听your thoughts on the matter? L.A.B.
The vaccine is indicated by the Food and Drug Administration for those ages 50 and up, but advisory groups have recommended the vaccine to people over age 60, since the complication of post-herpetic neuralgia is more likely, lasts longer and can be more severe the older you get. It is reasonable to get the vaccine at 50 if you want, but it鈥檚 important to get it at age 60 or over if you haven鈥檛 already had it.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
