Low PSA level not a cancer-free guarantee

Dr. Keith Roach M.D.

DEAR DR. ROACH: I am a 72-year-old man with an enlarged prostate. My PSA has varied over the past several years, between 2.8 and 3.5. I take Flomax.

My primary doctor has noticed a nodule on my prostate. He recommends further evaluation by MRI with possible biopsy. What do you think? -- J.L.

ANSWER: A low prostate specific antigen test (i.e., below 4) is good news but it does not exclude prostate cancer with certainty. A palpable mass should be further evaluated so that you have more information, and can make a more informed decision. If the MRI or ultrasound shows no abnormalities on the prostate, you have a good reassurance there is nothing wrong.

If there is a nodule, then a biopsy can show not only whether it is cancer, but can give important prognostic information. A small cancer, with no evidence of spread, low PSA and especially with favorable characteristics on microscopic examination, does not need to be treated immediately. Men in this situation, which is quite common, are often followed closely, a strategy called "active surveillance." However, if you are one of the unlucky ones to have a more aggressive form of prostate cancer, early treatment, often with surgery, could potentially be life-saving.

The risk of MRI and biopsy is small, and you are likely to get important information, so I agree with your primary doctor.

DEAR DR. ROACH: I'm a 54-year-old male who works out three to four times a week with weights. I eat healthy, with a very low sugar and restricted carb diet. At my age can I still increase muscle mass, and does testosterone have any play in it. After my recent physical bloodwork, I had a 670 total testosterone score and thought maybe with that result and increased protein intake I could still add some muscle mass. -- M.C.

ANSWER: Healthy men and women can add muscle mass at any age. It is true that low testosterone levels can cause loss of muscle mass. Men who have concerns about losing muscle should be evaluated for low testosterone. Since your level is in the middle of the normal range, there is every reason to expect you can add muscle mass with strength-building exercises. Age 54 is quite young -- even those in their 80s and beyond can improve muscle mass, strength and tone with exercise.

DEAR DR. ROACH: I'm a 75-year-old man with no serious health issues. My problem is nighttime bathroom visits. I feel the need to urinate six or seven times each night. However, I have a weak stream and a soreness in my lower stomach while urinating. I don't usually have anything to drink after 6 p.m. What could be the problem? -- H.S.

ANSWER: Enlargement of the prostate is extremely common among 75-year-old men, and the weak stream you note is a strong indication that this is the problem. The urethra -- the tube coming from the bladder that urine flows through -- goes right through the prostate in men. Enlargement of the prostate compresses the tube, making urinating difficult.

The discomfort could be due to enlargement of the prostate, but it could also be a urine infection, a common complication of an enlarged prostate. A urine test and a prostate exam are likely to lead to an answer. Your regular doctor or a urologist can easily do this, and there are several effective treatments.