WHAT TO DO IF YOU HAVE BPH: TESTING DURING WATCHFUL WAITING

One objective during the watchful waiting period is early detection of prostate cancer, should it develop. Early detection can lead to early treatment, making the likelihood of complete recovery relatively high. To this end, your doctor will probably order a PSA test and do a DRE exam on a regular schedule.
If you suddenly have a much higher PSA level, do not panic. When taking the PSA test, as many as one-third of all males over the age of fifty will score higher than 4.0 ng/ml, which is considered by many urologists to be within the suspect zone indicating cancer cells may be present.
But within this group, only about one-third will have detectable prostate cancer. According to one recent survey, when 148 males with elevated PSA levels were examined, researchers found not cancer but enlarged and inflamed prostate tissue as well as a fair number of harmless lumps. Others had high PSA levels because of bicycling (probably due to the pressure the seat puts on the prostate gland). Recent ejaculation was also considered a reason for some high PSA levels. A larger prostate and older age, as we have discussed, will also affect the level.
If the PSA test result shows a much higher level and differs radically from that found in prior years, you may want to ask your doctor if the blood sample was tested by the Ciba Corning method or by the Hybritech's Tandem PSA. The Hybritech's Tandem PSA is currently the only test that is formally approved. If your doctor uses a different type of screening, it can suddenly change the level, causing needless alarm.
It is also possible for a patient to receive someone else's test result. This may sound farfetched, but it happened to me. I received a panic call from my urologist to inform me that my PSA level had soared from the 4 ng/ml level to over 20 ng/ml. Since this figure indicates that malignant cells are present, needless to say, I was very frightened. Subsequent tests taken at a different laboratory were in the 7 ng/ml to 8.8 ng/ml range—not as low as I would have preferred but consistent with the level to be expected in a middle-aged male with an enlarged prostate.
To avoid this problem, you should select a reliable laboratory. One associated with an academic medical center will probably be a good choice. You certainly should have additional tests taken if your PSA level suddenly spurts up to a higher level.
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