On New Year's Eve, Norm wrote, instead of celebrating:

(snip)

I'm not an expert, and neither is anyone else on this group, regardless
of pretenses.

There is not enough information in Norm's post to understand what, if
any, problem he may have.

BPH is just that: benign. The formula, per the benighted (according to a
few) Dr. Strum, for computing benign-related PSA is this: GV x
0.066=benign PSA, where GV=gland volume. Anything in excess of the
result of the computation is suspicious and requires further investigation.

Frex: given a 30-gram gland, 30x0.066=1.98 ng/mL benign PSA.

So: First determine the facts of the case, then consider what to do --
if anything.

Regards,

Steve J

"Digressions, objections, delight in mockery, carefree mistrust are
signs of health; everything unconditional belongs in pathology."
--Friedrich Nietzsche

From: NOSPAM@yahoo.invalid (Norm)

I'm 63 years old with BPH (large).
Over the last 3 years my PSA numbers have ranged (no trend) from 2.8 to
3.4 with the last at 2.9 in July of this year until now.
The recent December 2007 reading was 4.4.
Curious how any "experts" would view this situation and action
alternatives. I haven't had a chance to talk to my PCP who is traveling
at this time of year. Didn't know how concerned I should be and how
proactive I should be.
Thank you for any input.  

==> hi norm - here's the facts....

a normal healthy prostate that has no problems, usually has a psa level
under 1.0

the average age that a male had been dx'ed in the past is around the age
of 65.

a psa of 4.4 is just over the 'alarm level' as set forth by the medical
people.   and the age of 63 is open to discussion too, not to mention
the large prostate.

it will be a close call and i'm sure that you will get all kinds of
input, both positive and negative.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

Sorry, Norm.  But, I think you're not going to get much expertise here.
We're dealing with cancer and don't know a lot about other prostate
conditions.

Just concerned and proactive enough to find out why your PSA is
climbing. Many things, including bicycle seats, sex, infection, BPH,
and, oh, yeah ... cancer ... can elevate PSA. You doctor can sort it all
out, but if he isn't certain and can't proved his findings to your
satisfaction, I'd recommend consulting a urologist. The odds are against
cancer, but identifying the cause is too easy (and not identifying it is
too risky) not to do it.

I.P.

Norm,

As others have said, none of us are experts and I certainly am
not.  I'm not a doctor.  My knowledge, if that is what it is, is
based solely on lay reading and experience.

Now having said that, here are my thoughts about your request for
input.

Your current PSA is a little above average.  This could be caused
by benign prostate hyperplasia (giving an enlarged prostate), by
temporary stress on the prostate, for example by having had sex
or a digital rectal exam less than 48 hours before the blood
draw, by a prostate infection, by irritation of the prostate
caused by calcium or other deposits or, in the worst case, by the
beginnings of prostate cancer.

Of those causes, only cancer is usually thought to be a serious
concern - though some of the others can be a pain in the butt.

There is no way to tell from the PSA alone what the cause might
be.

It is usually suggested that when a man's PSA goes a little above
normal as yours has, that a visit to a specialist, i.e., a
urologist, is in order.  The urologist will almost certainly do a
digital rectal exam, and may suggest other tests such as a repeat
PSA and possibly other blood tests, or a biopsy.  In the biopsy,
an instrument is inserted in the rectum that provides an
ultrasound image of the prostate, and a needle comes out of the
instrument to snip out small samples of prostate tissue to be
sent to a pathologist for examination under a microscope.  If you
have cancer, the pathologist should find it.  If he doesn't, then
either you don't have cancer, or it was small enough not to show
up in the samples, in which case even if it exists, it is
probably not an immediate threat.

Steve Jordan has given you a formula for computing PSA based on
prostate gland volume.  If you have information about the volume
that may tell you whether your PSA is high or not.  If you don't
have information about the volume, that too is something that a
urologist can estimate for you - and get a good estimation if you
have an ultrasound exam - with or without a biopsy.

If you have a primary care physician who agrees that you should
see a specialist (some may not agree, and I defer to their
expertise), ask him which one he would go to.  Over the course of
time I've visited several urologists, and one was a guy that I
wouldn't go to again.  He did a sloppy job in my opinion.  As
with anything else related to medicine (or home repair, or darned
near anything else), you want someone good if you can get him.

Finally, if my understanding of the statistics is right, the odds
are pretty good that you don't have detectable cancer.
(Undetectable cancer is another story.  It's thought that most
men have at least microscopic amounts of prostate cancer when
they get old.)  But a specialist could tell you a lot more.

Best of luck.

   Alan