Your Good Health: Urologist demands that patient does a biopsy for his prostate

Dear Dr. Roach: A friend in his late 50s has to make a decision whether to agree with his urologist’s decision to do a biopsy of his prostate. It seems the only thing prompting this decision is a recent prostate-specific antigen reading of 4 ng/mL, which has fluctuated a bit between 2-4 ng/mL over two years. His doctor says that at his age, it should be under 3 ng/mL.

We both recently read a review of the literature on prostate cancer by the National Library of Medicine. It stated that the recommendations for screening for prostate cancer using a PSA test are unclear! They also seem to say that early detection and resultant post-screening treatments can lead to overdiagnosing, unnecessary biopsies , and the overtreatment of patients.You are quite right that the optimal strategy for screening for prostate cancer is unclear.

There are many men who get a slow-growing, almost indolent form of prostate cancer. This kind of cancer is destined to never bother most men who get it, and most will die of something else before they ever know they had it . Treatment of this type of prostate cancer is unnecessary since it will never cause problems.

The fact that his PSA level has been stable for two years argues against an aggressive cancer, but it isn’t definitive. Men can have prostate cancer with a PSA of 2 or have benign prostate disease with a PSA of 10, but usually, the higher the PSA, the greater the likelihood of cancer. However, your friend’s risk with a stable PSA level under 4 is small.

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