Here's what happens after a high PSA result
Dear Doctor Roach: I'm a 91-year-old male who has had excellent health all of my life. I'm very active for my age, as I play golf twice a week, workout at the local gym once or twice a week and walk about 1/2 mile once to twice a week, including a rather steep grade.
At my recent annual physical exam, my blood test showed everything was normal except my PSA (prostate specific antigen), which had jumped to 15.8. I was told I could probably live another five to 15 years. Of course, 15 years is a stretch. My question is, What's realistic? What am I to expect at my age considering I have no other problems? Also, I understand there is a rather slow cancer and a more aggressive cancer. How do I find out which one I have? -- D.H.
Answer: The prostate specific antigen test is a blood test that identifies an enzyme made by the prostate, which is secreted into semen but also normally found in small amounts in the blood. High amounts of PSA are found in the blood of most men with prostate cancer, but high PSA levels may be found as a consequence of benign conditions as well. I don't know if you have prostate cancer or not now.
A PSA level that has suddenly increased could be due to a rapidly growing prostate cancer; however, it may also be due to inflammation or infection of the prostate. These are usually, but not always, symptomatic.
It is not normally recommended to test a PSA level in a man who is 91 years old, but you aren't a normal 91-year-old. Still, you have the result, and you have to decide what to do. One approach is to ignore the result. This isn't satisfying, as you will still be left wondering what is going on.
If you decide to move forward in making a diagnosis, the first step is always a careful exam and history, followed by a picture of the prostate. MRI is the preferred way of taking pictures when available, as the MRI can give important information about potential cancer. If the MRI is suspicious for cancer, a biopsy would then be recommended. Once you have a biopsy and MRI, and probably with another PSA test to determine how fast it is rising, you will know whether this is cancer. And if so, you will have a very good idea if it is a more aggressive or more slow-growing type.
Armed with this information, you can decide whether treatment or active surveillance is more appropriate for you.
Dear Dr. Roach: If a person has a very severe reaction to a COVID booster, will they benefit from it? My cousin got very ill after her third shot. She has severe allergies. Will she be immune to COVID? -- C.W.
Answer: Severe reactions to any dose of the COVID vaccine are unusual and unfortunate, but normally the vaccine is still effective at providing protection to the COVID virus. As we have seen, vaccinated people can still get infected, but they are much less likely to get so sick that they need to be in the hospital (or worse).
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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