High PSA Levels: Should You Consider Surgery or Seek a Second Opinion?

Elevated PSA levels?

My father is 78 years old.
His PSA levels have been consistently around 1.7 every six months, but this month it suddenly spiked to 32.5.
The doctor immediately conducted a urinary tract examination and an ultrasound, but did not suggest further blood tests, monitoring, or a biopsy.
Instead, he recommended laser surgery.
In this situation, is surgery the only option, or should we seek a second opinion or consider other methods? Thank you.

Ms. Li, 40~49 year old female. Ask Date: 2022/08/24

Dr. Cai Zhuorong reply Urology

"An increase in PSA is not an indication for laser surgery.
It may be beneficial to further discuss with your physician the reasons for recommending surgery and any other considerations.
If a second opinion is needed, you are welcome to bring your father to our urology outpatient clinic."

Reply Date: 2022/08/24

More Info

When faced with a sudden spike in PSA levels, particularly from a stable 1.7 to an alarming 32.5, it is crucial to approach the situation with caution and thoroughness. The prostate-specific antigen (PSA) test is a blood test used primarily to screen for prostate cancer, but elevated levels can also indicate benign conditions such as benign prostatic hyperplasia (BPH) or prostatitis. Given your father's age of 78 and the significant increase in PSA, it is understandable to feel concerned and seek clarity on the appropriate next steps.

First and foremost, it is essential to understand that a high PSA level does not automatically necessitate surgery. The recommendation for laser surgery, in this case, seems premature without further diagnostic evaluations. Typically, when PSA levels are elevated, a series of follow-up tests are warranted, including a prostate biopsy, which can definitively determine the presence of cancerous cells. The fact that the physician suggested immediate surgery without further investigation raises questions about the thoroughness of the diagnostic process.

Seeking a second opinion is not only advisable but also a prudent step in this scenario. A second opinion can provide additional insights and options that may not have been considered. It is essential to consult with a urologist who specializes in prostate health and cancer. They may recommend further testing, such as a prostate biopsy, MRI, or additional blood tests, to assess the situation more comprehensively. These tests can help differentiate between benign and malignant conditions and guide treatment decisions.

Moreover, it is important to consider the potential risks and benefits of surgery, especially given your father's age and overall health. Surgical interventions, such as laser surgery, can have significant side effects, including urinary incontinence and sexual dysfunction. Therefore, a thorough discussion with a healthcare provider about the risks, benefits, and alternatives to surgery is crucial.

In addition to surgery, there are other treatment options available for elevated PSA levels, depending on the underlying cause. If the elevated PSA is due to BPH, medications such as alpha-blockers or 5-alpha-reductase inhibitors may be effective in managing symptoms. If prostatitis is the cause, antibiotics or anti-inflammatory medications may be prescribed. In cases where cancer is confirmed, treatment options may include active surveillance, radiation therapy, hormone therapy, or surgery, depending on the stage and aggressiveness of the cancer.

In summary, while a significant increase in PSA levels is concerning and warrants further investigation, immediate surgery is not the only option. It is crucial to seek a second opinion, undergo appropriate diagnostic tests, and discuss all available treatment options with a qualified urologist. This approach will ensure that your father receives the most appropriate and effective care tailored to his specific condition.

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