DEAR DR. ROACH: My question is in regard to prostate cancer diagnosis. Im a 65-year-old man.
Several years ago, I was placed on testosterone. At that time, my PSA reading was normal (2.5), but after being on the testosterone for two years, my PSA steadily started to increase to the point where my PSA reading was over 10. My doctor performed a biopsy, which proved negative.
Unfortunately, that doctor passed on, and I am now treated by another doctor. After discussions with the new physician, we elected to terminate the hormone supplement, resulting in my PSA diminishing to 3.7. It has stayed at the same level for several years, but as of March 2018 it increased to 6.4. My doctor performed the following tests: a 4K blood test that resulted in a score of 1 (5 percent chance of cancer); a PSA of 5.7; an MRI resulting in scores of 1 and 2 (less than a 10 percent chance of cancer); and a 3D Doppler, which showed a small area where blood was potentially above normal (possible cancer area). With the above test results in hand, my doctor has recommended we watch and monitor, and not perform a biopsy. Do you agree with this approach? F.S.
ANSWER: I think this doctors approach is reasonable for some people. However, its what you feel that is the real issue. The doctor has obtained a lot of information to help determine the risk of cancer, but only a positive biopsy is definitive evidence of cancer, and even a negative biopsy doesnt prove there is no cancer it is possible to miss cancer, although that is much less likely with the MRI and Doppler sonogram guiding where to biopsy.
The question to ask yourself is whether you can live with uncertainty, meaning a 5 to 10 percent chance of cancer, based on the best evidence you have. If you cant, then I think a biopsy would be reasonable.
On the other hand, its still possible, even if unlikely, that the biopsy would come back as cancer, most likely a low-risk type of cancer (since the PSA has actually gone down since the previous test). In that case, the likely recommendation would be against treatment at this time, and to instead watch and monitor. So, its probable that a biopsy would actually not change management, especially considering that a negative biopsy would also have the same outcome.
In either case, continued careful monitoring, not watching and waiting, is clearly indicated.
