Written by admin on 2009-03-30T07:54:17+0000">March 30, 2009 – 7:54 am
If the PSA is greater than 10, all of these men are likely to have significant cancer remaining, and all should have definitive therapy before it’s too late.
What about the patients in the middle, with PSA levels between 1.o and 10—the range for about half the men with T1 disease? Currently, there’s just no way to predict exactly how much cancer remains in the prostate—and, therefore, who will need treatment and who won’t. Some doctors have advised these men to undergo a repeat TUR, but there’s no real evidence to suggest that this will provide any helpful information—it’s hard on the patient, to boot. Also, a repeat TUR may make it more difficult for a surgeon to perform a subsequent radical prostatectomy.
Other investigators are enthusiastic about the use of ultrasound and random needle biopsies as follow-up measures for these men, but the long-term success rate for these procedures has yet to be determined; cancer could still slip outside the prostate and not be caught in time. The safest guideline here may be the patient’s age: If he’s younger than 60, aggressive, curative therapy should be strongly considered.
Another group who could have insignificant cancer are men with stage T1c disease (found by needle biopsy, after an elevated PSA score). Ten percent of these men with a PSA greater than 4 have insignificant cancer. PSA density, plus the findings of the needle biopsy can be helpful in predicting which of these men can afford to wait.
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