Prostate Health (cont.)

MEMBER QUESTION:
How likely is it to have prostate cancer with three PSAs (prostate-specific antigen) at zero to less than one within the last nine months, and a negative bacterial culture on semen after a regimen of Cipro? Semen was blood tinged prior to culture but now is bloody.

MARKS:
First of all, blood in the semen, which is called hematospermia, is not a warning of anything. It may be infection, it may be cancer, but by itself it usually is meaningless. Men develop blood in the semen at varying points throughout their lives and unless it is prolonged and heavy we usually just ignore it. That in itself could be something to be concerned about only if it's a real problem but by itself is usually not a concern.

When the PSA is extremely low, as is described in this question, and consistently low, it's very, very unlikely that there will be a significant prostate cancer developing not only in the next few years but even in that person's life span. If the PSA were higher, one or two or three, and the person was young, then you would start to worry a little bit. Not only is the number itself important, but the trend of that PSA number over time. So if his PSA as he described is less than one on three separate occasions within a nine-month period, then prostate cancer is probably not going to be something he has to deal with.

The question that comes to mind is, if his PSA is so extremely low, why is it being checked so often? One of the biggest problems that we see in urology is that people give too much power to the PSA test, don't understand it and check it too often. The PSA normally fluctuates from person to person, day to day, and even lab to lab, so it is essential that you give enough time. So even in a patient with prostate cancer, I usually will check no more often than every three or four months. If I have a patient that does not have prostate cancer and that I'm not suspicious about, then I'm usually happy to check it just once a year and if there's reasons to be concerned, maybe twice a year if there's a family history.

This particular person -- probably cancer is not going to be a problem. But again, that doesn't eliminate that they can have other problems such as prostate enlargement, infection and so on.

MODERATOR:
What role does genetics play in prostate cancer?

MARKS:
Prostate cancer has a definite genetic influence for a significant percent of men. We know that men who have a strong family history of prostate cancer with their fathers, grandfathers, brothers, uncles -- they are at increased risk.

There's also concern that men who have cancers in their mothers and grandmothers such as ovarian and breast cancer -- these are also hormone-related cancers -- can also be at risk.

If anybody has any of these hormone-related cancers in their family, whether breast or ovarian on the mother's side or prostate cancer on the father's side, or actually even if the mother's father had prostate cancer -- any of those diseases on either side is reason enough to start checking early and regularly both in the exam and the PSA.

MODERATOR:
How early is earlier? At what age would you begin?

MARKS:
In general, we would start checking at age 40. But, let's say the family history is a close relative who developed prostate cancer at age 42. Then I would probably move that patient's checking up to age 30 or 35.

But in general, for most people, since most prostate cancers occur later in life, I think age 40 is a reasonable place to start checking the PSA and exam. If there is no family history, then probably age 50.

MEMBER QUESTION:
My husband has metastatic prostate cancer. Our son, who is 44, has BPH (benign prostate hyperplasia) and a PSA of 2.9 from last October's test. In June, my husband and I attended a prostate cancer conference in Washington, D.C. and believe our son, who is at risk, needs to be tested again by a reliable urologist rather than by his internist. He lives in a small Arkansas town. How should he go about finding an outstanding urologist in the town where he resides? Should he go to the state's medical school?

MARKS:
This is a very common question and I think the fact that the writers of this question have gone and done their research tells us that they probably already know many of the answers.

First of all, a PSA in the high twos for a young man is a serious concern to me. We used to call 4.0 the cutoff of concern and for many experts now that's dropped down to 2.5. A young man in his 40s should have a PSA probably below one. So the fact that his PSA is 2.9 is of concern, and I do agree he needs a recheck of the PSA and evaluation by a urologist, most likely with prostate biopsies with transrectal ultrasound.

If there is not a urologist in the community that they feel comfortable with, then they should travel to the next significant city because there will be many urologists there. If they do have questions, then a good excellent resource is always the local medical school university training programs. They always have cutting-edge technology and usually well-read physicians who are able to provide state-of-the art medicine. But, just because the doctor is not at a medical school or medical center doesn't mean that he is bad.

I think the first thing would be just to talk to the local doctors and say, we need a referral and is there somebody in the nearest city who he can see and be evaluated?

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