Hi, Steven,

Larger prostates create more PSA than do smaller ones.  Another Steve --  
Jordan -- or one of the Rons will probably jump on within the next 24 hours
with the formula.  But, suffice to say, you could very well have a benign
prostate problem.

On September 25, Steven L. wrote:

"Benign" PSA is calculated as follows: gland volume x 0.066 = benign
PSA. So Steve's figure would be 67 x 0.066 =
4.422 ng/mL. It would appear, therefore, that the recorded PSA of 4.4
ng/mL is quite normal.

See
http://www.prostate-cancer.org/education/riskases/Strum_StrategyOfSuccess2.html
or
http://tinyurl.com/39x68e

On that same authoritative website is a section entitled, "Undiagnosed"
which should prove informative.

NB: An elevated PSA is *not* diagnostic of prostate cancer (PCa). Only a
skillfully interpreted biopsy can do that.

There are several causes of elevated PSA, and the *least* likely is PCa.
One of the common causes is BPH (benign prostatic hyperplasia); it "just
grew." Others are prostatitis, infection and, occurring less than 48
hours before a PSA blood draw, DRE (digital rectal examination),
ejaculation, and anything that stresses the gland including even bicycle
riding.

There are tests for other markers such as free PSA, UPM3, and so on.

I suspect that the biopsy is unnecessary, but I suppose that it can't hurt.

Regarding "hurt" I recommend that anesthesia be required. Some men claim
little or no pain during a biopsy, others say that it was agonizing. I
say why gamble? What's to be gained by playing macho? Besides, if the
patient is relatively relaxed, the procedure is easier for him *and* for
the medic.

Lastly, if the local pathologist reports PCa, I cannot recommend too
strongly that the specimens and paraffin tissue block be sent to a
specialist lab for verification. It's a "second opinion" and should be
covered by insurance. Some labs resist, but in enlightened
jurisdictions, those specimens are the property of the patient, not the
lab and not the medic. Firm insistence will have good results.

Here is a list of expert labs:

Bostwick Laboratories [800] 214-6628
Dianon Laboratories [800] 328-2666 (select 5 for client services)
Jon Epstein (Hopkins) [410] 955-5043 or [410] 955-2162
David Grignon (Michigan) [313] 745-2520
Jon Oppenheimer (Tennessee)  [888] 868-7522
UroCor, Inc. [800] 411-1839

Why the second opinion? Because everything that is done is ultimately
dependent upon the accuracy of the biopsy and it is simply prudent to be
certain that the results are dependable.

Lastly, this place is becoming infested with Steves. Steve L, Steve J,
Steve K and Steve T. If this goes on, we'll be able to take over......

Heh heh.

Regards,

Steve J

Steven L. wrote:

Just a shade over the "worry mark" of 4.0 that many/most doctors use for a
referrence.

Be sure you have an anesthesia for that biopsy - IF you go that route.
You should first seek a second opinion/test/exam by another doctor totally
unrelated to the first one, i.e. different medical group.

That's entirely possibly.

Also bike riding, a DRE, sex, and perhaps a couple other activities within
48 hours of the blood draw for the PSA test.

No one in the group can say.  Even your doctor doesn't know.  That's why he
wants a biopsy (but first get a second PSA test).

There are too many "IF's" this early.   Take a deep breath, exhale slowly,
think positive.   Don't panic - now or ever.

Remember a saying that's repeated year after year: more men die WITH
prostate than FROM it.  Only after autopsies following a heart attack,
traffic accident, shooting, or other sudden or violent death is PCa
discovered.  It had no effect on any of those men.  They lived years and
years without knowing they had PCa and led happy, productive lives (in most
cases).