Copyright The Oregonian
DEAR DR. ROACH: I am a 68-year old male in good health who exercises regularly, doesn’t take any medications, and doesn’t have a family history of prostate cancer. During my most recent yearly physical exam with my physician, my PSA score was 3.5 ng/mL from the blood draw and analysis, while my physical exam was deemed normal. One year ago, my PSA score was 1.5 ng/mL. My physician is going to repeat the blood draw and analysis, then advise what the next steps are. Although my PSA score is within the normal range (less than 4.0 ng/mL), should I be concerned? Is this a “false positive,” and what would you suggest for next steps? -- C.M.B. ANSWER: The prostate specific antigen (PSA) test is a way to screen for prostate cancer. It is not perfect, but when used properly, it can save lives by identifying men who have early prostate cancer so that the cancer can be removed before it is too late to do so. The PSA level at which we should be concerned enough to look more carefully for prostate cancer is most commonly 4 ng/mL, but both higher and lower numbers have been considered. With a strict cutoff of 4 ng/mL and a lower cutoff such as 2.5 ng/mL, there will be more false positives (people with abnormal test results but without cancer) and fewer false negatives (people with cancer but a normal test result). However, with a cutoff of 10 ng/mL, there will be fewer false positives and more false negatives. An increase of more than 0.75 ng/mL has also been considered as a cutoff to begin a more thorough workup. However, the PSA level normally goes up and down over time, and a single elevated measurement or an increase by a point or two does not always mean cancer. I completely agree with your physician’s plan to repeat the blood test. There are other refinements to the PSA test, including free PSA, bound PSA, complexed PSA, and [-2]proPSA, as well as combinations of these that add small amounts of sensitivity and/or specificity to the PSA test. But none of them are so good that they can replace the common PSA test. A repeatedly abnormal PSA test doesn’t necessarily mean that a biopsy is needed. Advanced imaging studies (MRI) and genetic studies can often keep men from needing a biopsy. More advice Miss Manners: Offer to bring pie to holiday meal results in a $150 shopping spree Dear Abby: It’s that time of year again! If you’re not sending thank you notes, you may see fewer gifts Asking Eric: In-law’s unsightly nose hair is ruining my Thanksgiving DEAR DR. ROACH: My daughter is in her 50s and was always an athlete growing up. She did swimming, diving, softball and some gymnastics. She has been in constant pain for 20 years. One doctor has suggested Ehlers-Danlos syndrome. What do you know about it? -- M.H. ANSWER: Ehlers-Danlos syndrome is a group of uncommon and rare connective tissue disorders. There are 13 types of EDS, and they are divided into hypermobile types, classical types, vascular types, and a handful of rare types. People with the hypermobility type of EDS often have persistent pain, so her doctor might be correct, especially if she has a history of being extremely flexible (sometimes incorrectly called double-jointed) or a history of easy dislocations of joints. Easy bruising and skin fragility are other common features of EDS. The diagnosis of EDS should be done by an expert and in conjunction with a genetic counselor. I was able to find experts near you and a lot more information about EDS on the Ehlers-Danlos Society website at Ehlers-Danlos.com. 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. (c) 2022 North America Syndicate Inc.
