What Is a Normal PSA for a Man Without Prostate Cancer? | Ask a Prostate Expert, Mark Scholz, MD

PCRI's Alex, asks medical oncologist, Mark Scholz, MD, about the benefits and limitations of PSA testing and what men need to know to get the most out of this powerful albeit flawed method of screening for prostate cancer.
0:05 What are the origins of PSA?
2:07 Why is PSA testing controversial?
3:15 What should a normal PSA be for a man without prostate cancer?
4:00 What if your PSA is less than 1?
5:02 What is the significance of "PSA density," or the ratio of the PSA to the size of the prostate gland.
6:08 What steps should a patient take if he has a high PSA and a large prostate?
Don’t know your stage? Take the quiz: Visit www.prostatecancerstaging.org
To learn more about prostate cancer visit www.pcri.org
Who we are:
The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website or call our free helpline at 1 [phone] with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
The information on the Prostate Cancer Research Institute's KZbin channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.
#ProstateCancer #Prostate #MarkScholzMD

[@presleyrules]

My VA doctor had been checking my prostate for years. He once said "I know it's uncomfortable but a time may come when I find something wrong". That time came in Feb. 2013 when he felt 2 small bumps. In Mar. 2013, I was sent to Urology where the pathologist said "Something is wrong". A biopsy was done in late-April and the results came back in early-May; positive for stage T2C adenocarcinoma (which means it was in both lobes of the prostate). In Jun. 2013, an oncologist told me it had reached stage T3A (it was outside the prostate). He told me that, at the rate it was moving, I would have maybe 5-6 years to live without treatment. I opted for radiation treatment; had that done in Sept.-Nov. 2013. Since that time, my PSA has been at 0.1 or lower; I'm checked every year by the VA. For the previous 6 years prior to my doctor finding those bumps, my PSA had been between 1.01 and 1.67. The day he found those bumps in 2013, my PSA was 2.07; which is still very low. I was 59 at the time I went thru this. Today, I'm 68 and thank God every day I'm still here!

[@mikeedward3161]

I thank you for speaking out about the history of your prostate because I am worried for my son, whom has been constantly going to bathroom through the night and not getting enough sleep, this was spoken about with his GP who did a urine test and found blood in it but doctor said it was too small to be concerned with and would do further test in 6 months but because I raised my concern over this another test for same was done and still seeing the results being the same and giving my son tablets to help stop the night visits to the bathroom being so frquented the GP recommended my son to see an oncologist and results from this was that they would see my son again in 3 months time and left without saying anything more, but have now bought this forward to be seen earlier in March. I searched on the internet and read that university research has found that people with certain disabilities do not get treatment for cancer, which is very concerning because my son has the same disability that does not get included for cancer treatment. SO I was just wondering if this HAPPENS RIGHT ACROSS THE WORLD?

[@davidtrindle6473]

@@mikeedward3161i was getting up to pee 4-5 times a night, and getting worse. Doc put me on proscar and after a couple months was sleeping thru the night and peeing like a teenager during the day. That was 15 years ago, I’m still on proscar and still sleeping thru the night.

[@davidtrindle6473]

Thanks For telling your story.

[@blackspades0000]

I have been going to the VA for years and never had a prostate check. Even after finding is high, it was written off as nothing.

[@thomaswood7495]

Interesting. Thanks for that update. Mine was 4.2, three months ago, now it's 1.6. But I haven't had a DRE in about 1y8m. Guess I should have them check that next week.

[@eddyjimenez-scorpio]

Man o man, this is all my uro needed to tell me. In 5 mins of this clip, i learned more about my psa and prostate than i did in 4 yrs with my doctors.

[@wcneathery3100]

Unfortunately most corporate Doctors can't be bothered actually talking to their patients. Their goal is to check off the boxes and move onto the next of 70 to 90 patients per day. The art of medicine died with profit based medical care.

[@Momab]

What was your result. I did for my father recently and worried

[@reytibayan8563]

@@wcneathery3100 9i.*

[@Vga-kv8pj]

@@wcneathery3100 amen to that most dr don’t talk at all

[@TC-eo5eb]

I am 63 years old and had a PSA blood draw performed and it was 5.5. Neither my primary provider or my Urologist told me that ejaculating 24 hours prior to a PSA blood test would cause my PSA to be falsely elevated. I discovered this fact while doing my own research. I did ejaculate the day before my blood draw. I waited 3 months and had my PSA rechecked and made sure I did not ejaculate for a week before my blood draw. My recheck was 5.1. I believe providers need to do better job educating patients on this.

[@minerdave]

Suggest seeing someone for further examination. I have prostate cancer and haven’t yet seen a PSA as high as yours. PSA is only an indicator measurement. I’d suggest seeing an urologist and at least having a check.

[@1999backetballboy]

I had two ejaculations within 12 hours of my psa test not knowing it could give false reading at age 59. Test came back at 3.1 resulting in my doctor recommending a specialist consult ( I didn’t make an appointment) The following year I refrained from an ejackulation for 2 or 3 days before the next test and it was 1.5. Doctor never told my an ejackulation before the test could give a false positive.

[@mikephillips8810]

Also vigorous exercise can increase the PSA. No-one told me that either. I did 2 hours of hard tennis the night before the test and had PSA of 9.33. One month later with no exercise I had a PSA of 5.67.

[@christopherkerwick8054]

@@mikephillips8810 0

[@paulmaxwell8851]

@@minerdave A PSA of 5.5 or even 5.5 is not unusual at all in older men. It might mean trouble but usually means BPH, an enlarged but cancer-free prostate.

[@yiotisdemetriou]

If you have enlarged prostate DO not ejaculate before psa test for at least 5 days, six days even better. Do not measure psa if you have constipation. My psa was day 1 after ejaculation 7.4, 3 days after 6.7, 4 days after 6.4, 5 days after 6.1, 6 days after 5.7. Prostate size 52cc age 58. Take lycopene supplement 25mg every day, it will also drop psa. Hope that helps. 🙏

[@budbud2509]

@yiotisdemetriou Many thanks for putting up that message as I have always suffered from a very high PSA for the last 10 years or so. My annual exam comes around end of Jan and as a cyclist Im usually in training for the summer months or a special event in the early season . I'm much older than u and I suspect my prostrate is larger , although I do not know its Vol. About a year ago I got a reading of 7.5 , which got them a bit panicked and I got called back in and told I needed another test, well I knew it was going to be a bad one because they wanted me to test there that instance , and I had been riding in the morning + ejeculated the night before .. = PSA 9 and then on to a complete exam + MRI. . After all that I got another test and results were better . The small Asian Dr explained to me it would be impossible for me to get my PSA down to 3 ( as my Dr wanted ) because of my size ( 6 foot and about 90 kgs ) + and enlarged prostrate , he said he could being only 5 ft and 50 kgs , me not a chance. his advice was as follows No sex for 2 weeks No riding a bike for 2 weeks before the test and maybe I would be able to get down to a PSA of about 6 Anyway , hope this helps someone.

[@schmingusss]

I have not ejaculated in over a year and got a psa score of 9.6. Does abstinence contribute to high psa?

[@bodymind195]

Excellent sir...when a common non medical man can't get informed even after visiting drs.. urologist.. your evidence based information is great great help to people all over the world...thx to whole team for their constant effort to upinform the people...

[@CALVINLNIKONT]

I was 75 and I hadn't had a prostate test ever. I fell out of bed and my back started to ache, so I went to the hospital for an X-ray. The X-ray showed a need for a CAT scan and while I was at the hospital, in spite of the fact that I had been feeling great, they took some blood tests. The blood test showed that I was in perfect health except for the fact that my PSA was 61...not 6.1! I was scheduled for a needle biopsy and cancer was inside both sides of my prostate. They took a whole-body CAT scan and found that the cancer was still just in my prostate. To be extra sure, they gave me an MRI of my entire pelvic region and the cancer was still only in my prostate. I decided to go for radiation therapy. First, they put me in some stirrups as if I were having a baby and injected about 20 rods between my legs, and gave me internal radiation with a new treatment that doesn't leave any radiation inside of your body. Next, they gave me the first of 4 shots in my rear end the effect of which lasts for 6 months that kills the testosterone that the cancer uses as food. Then I had 10 minutes of external radiation every day for 25 days. After my last of four shots to kill the testosterone, we waited 6 months for the last shot to wear off and then waited another 4 months to check my PSA and testosterone. The PSA is ZERO!!! and my testosterone is raising. I will have another blood test in 3 months and another blood test 3 months after that to make sure that the PSA stays at zero and the testosterone continues to rise. The Lord has been very good to me!

[@uzmasadat664]

And urine problem is solved or catheter is used after radiation when ur PSA is zero

[@uzmasadat664]

My dad also suffering from this

[@katrinamclaughlin9322]

Great practitioner. Great video. Thank you for your knowledge in this field. It has helped so many men with this cancer.

[@gavinfoster9118]

Dr Scholz is really reassuring and informative. Also the young lady who does the interviewing does an excellent job as well

[@Rob-157]

Agreed

[@StuStevens-rn7rb]

Doesn't she though. Wonder if she's a nurse or someone in his office or from somewhere else in the medical community?🤔

[@stephenhicks826]

A really good, clear explanation. Thanks

[@rolandoaponte214]

This guy really knows what he is talking about. Objective, knowledgeable and well balanced information, congratulations!

[@kathymercer9259]

My 69 y.o. husband PSA has been steadily increasing from 5, 6 and now 7 over 6 month periods. What test should he get next or an MRI or ultrasound?

[@raymondvenezia334]

Just had the biopsy done. Cancer free. This video explains a lot.

[@javierrodriguez6779]

Absolutely marvelous explanation. Answered questions that I had.

[@mr.ronaldlawrence1231]

Awesome and relevant video. I am over 50 years old and my PSA peaked from 4 to 6 then lowered to 4.5. I have no symptoms and everything else, blood pressure, blood sugar, weight, etc are measured as normal. I am consulting with an urology surgeon, oncologist, research scientist and local cancer patients to explore my options. The oncologist described my condition as an intermediate cancer risk compared to individuals that are low risk and high risk. Thankfully, the body scan and bone scan did not detect any evidence of cancer. However, the biopsy detected a small malignant tissue in one of my prostates. My urologist has recommended aggressive surveillance to continually monitor the situation. As I stated earlier, I am exploring my options.

[@williamdenton6317]

Make sure you read The Great Prostate Hoax by the scientist who discovered PSA. You really need to know the other side of the story.

[@DM-hd4xm]

Very informative, thank you both.

[@kamugishajude2646]

It has helped shade more light on some of the questions I had about the PSA test and prostate cancer. Thanks alot

[@slellison3]

I like watching really smart people discussing this topic. Inspiring. Thanks!

[@YourThermalWorld]

That young lady is a wonderful interviewer! I’ve just been referred to a Urologist as my PSA doubled from last year so I’m doing my initial research. These interviews and presentaions are very helpful in alleviating my anxiety.

[@charlesblumenstock9160]

Yes I agree elevation is a question

[@danielvahnke3369]

I'da lika C 'er sit onna hizza face axtuualley..

[@ell745]

Wow, thank you for such an informative video! The interviewer asked all the right questions and the doctor gave all the right information in a way we can understand it. Really appreciate it!

[@tonylawrence9157]

How do you know she "asked all the right questions", and the dr gave "all the right answers"?

[@MLife1972]

@@tonylawrence9157 the 'Dr' in his title.

[@charleschristian8132]

Thanks I have PSA 3.4 73, last year it was 2. 5 I go back in 6 months. But thank you for the information,

[@ChildofGod3712]

Was diagnosed with advanced high risk prostate cancer couple months ago…I was put on hormone therapy treatment not long after…when I started the treatment my PSA level was 37 it has now dropped down to 0.35

[@georgeconway4360]

My story. D.O.B. 1947, Retired age 65 2012 . 2017 PSA 2.1 had creeped up over previous years an increase of 1.1 in 24 months. Primary care physician scheduled tests every 24 months but in hindsight realized he had some concern because he palpated my prostate because that was a first for him. 24 months later just before age 72 I had my P.S.A.. which was 9.0. Had a second test 30 days later it was 8.4. Scheduled an appointment with a urologist and the P.A checked my prostate and said I should get a biopsy. That Internet said I still had only a 50% chance of cancer at that PSA. Had the biopsy, not a big deal, just a little uncomfortable but in hindsight found it should have been done on 2017. The doctor called to tell me is was positive. My first question was “What was the Gleason Score?” It was 9. The only good news was it was not 10. At an office visit I discussed it with the Doctor and he recorded it as Stage 1B. Went through additional work ups CATScans and such, met with a Radiologist and discussed various options. Approximately 8 weeks after the biopsy I met with the Doctor and advised I would like surgery which was scheduled about a month later. During that wait the Doctor said he would like me to meet with another surgeon about a problem discovered wiry my gallbladder. It was decided I would get two surgeries the same day, one to remove my prostate and the second to remove my gallbladder. After surgery I would wait 6 months to get 7 weeks, 34 Radiation treatments. Everything turned out well and now I take Ultra Sensitive PSA tests every 3 months. My PSA is now less than .01 which is considered undetectable which means I’m cancer free. After Surgery my pathology report said I had Stage 3b Cancer. If I had my biopsy in 2017 or my doctor had ordered another PSA 12 months later rather than 24 months it would have been much better in my opinion.

[@panavila]

Valuable information indeed. It was reassuring above all. Thank you sir

[@najamarifeen8823]

A professional n important talk by the doc. Appreciated.

[@dbvnyc]

I do wish all our Doctors were like Dr. Scholz. Perfect bedside manner. Other physicians can take a leaf out of his book!

[@RaysDad]

When my PSA rose to almost 9.0 I got a biopsy. The pathology lab couldn't make a decision, so a second lab was used and they decided I had Gleason 3 3 malignancy. A surgeon recommended a radical prostatectomy, but the side-effects sounded awful so I got a second opinion, meaning an MRI. The MRI showed almost no chance of clinically significant cancer. For three years afterwards I got annual follow-up MRIs that likewise found very little cancer risk. But my PSA was up to almost 11.0. My doctor felt the high PSA might be due to my highly-enlarged prostate, so he prescribed Finasteride. My last PSA was about 6.0. So that drug seems to work to bring down my PSA. I'm not going to get any more MRIs for awhile -- my only treatment is the Finasteride.

[@sanbrimo4547]

Please be informed your PSA while taking Finasteride is multiplied by 2 which is about 12. Ask your doctor. I'm in a similar situation. Stay healthy and vigilant.

[@wallacegeller2111]

Good for you Ray's Dad. Hang in there.

[@deeptime5581]

I had a PSA of 13. It was BPH. Don’t let the urologist scare you into biopsy. Get an MRI.

[@RaysDad]

@@deeptime5581 My radiologist said my prostate volume was 3x normal, so it made sense that my PSA was 3x normal.

[@tonylawrence9157]

Thank you for this very useful information.

[@stultuses]

The interviewer knows how to let the interviewer talk the topic out without interruption, excellent Her skin complexion is lovely too

[@Kismainspires]

These conversations are so reassuring for me as the wife of a prostate cancer survivor

[@paulmaxwell8851]

Thank you! A very illuminating discussion. I like this doctor: he's a casual, easy-going, down to earth guy who speaks in plain language. Far too many men are being subjected to painful, invasive biopsies so I'm pleased he promotes imaging over random needle biopsy.

[@RaxOldies]

So glad I found these folks and this channel!! Have learned so much in such a short while!

[@JerryRains]

Both my father and my maternal grandfather had prostate cancer, so I started having PSA tests at 40. For years they ran between 2.1 and 2.4 and the general consensus was that since i was under 4.0 I had no worry. However, in 2007, at age 60, it jumped to 3.0 and that concerned me. I found a doctor who would do a digital exam and he found a lump. A needle biopsy found 2 cancers. I had a radical prostectomy by a traditional surgeon (my only mistake. I should have had robotic surgery) and have been cancer free ever since.

[@bobwright3438]

I have watched urologist and oncologist have PC; so what is the link between these medical practitioners with knowledge and us the unknowing, I would say the "Western Diet" the meats are raised in very poor conditions, with feed that is not "Proper" for the animals and the chemicals dumped into them; watched how "Farmed Raised" chickens are raised, you never touch another chicken.

[@nishtarabdul7079]

Iam from Sri Lanka I tried so many times to get an explanation from my doctors about psa.but failed.when we ask for explanation the doctors lower their spectecels and stairs 😅at you the message they give you is don't waste my time.Therefor a very big thank you for both of you.

[@jcolumbiap]

Sorry for your experience. I think doctors are using a procedure that is only interested in profits, not science!

[@zandro20]

This has been extremely useful information. It puts my mind at ease in some ways. Especially when the doctor was speaking about the 10:1 ratio of prostate size and PSA values.

[@hildahibbert2732]

This doctor's explanation gives easy understanding of prostate issues and also gives hope for patients. Excellent! Thank you sir.

[@jerryai6448]

Great and very informative. I never heard of the blood test or urine test that can shed some insight. Have to wonder why these were never mentioned by my Urologist prior to my MRI that showed nothing. Even after the MRI the Urologist was "almost" suggesting a TRUS. My PSA was only 4.1 and my volume from the MRI was 39, which in the video is even within the normal range. I think any man going to a Urologist should watch this video and take very careful notes and ask very specific questions of their Urologist if he is even remotely considering recommending a TRUS. TRUS, according to the internet, is the most over prescribed invasive surgical procedure done in America. Seems like since it is an outpatient procedure Urologist are overzealous in recommending and performing.

[@bw1841]

Trans rectal ultra sound. Not surgical, not really what I would call invasive. Not harmful, not going to cause infection. Now the needle biopsy sounds surgical and invasive and can cause infection.

[@johnmcdonald1810]

Im assuming you are referring to TRUS guided biopsy?

[@williammurray7264]

Very knowledgable and professional interview.

[@nicoc6387]

What an intelligent and informative video! A very valuable resource. Thank you.

[@stevegonzales3612]

My PSA was between 4 and 12 for a whole yr...in Sept 2020, a cancer cell was found. It was determined it was an aggressive cell, so in Oct 2020, my prostate was removed. As of Aug 2021, ALL is back to normal (PSA), with all functions working 100% again...!! 👊

[@ORWELL_USA]

You should have had stereotactic radiosurgery.

[@PhilMelbourne]

I wouldn't call having your prostate removed "back to normal"

[@herbertlong3981]

@@PhilMelbourne Maybe normal before included the inability to get a chubber! Who knows?

[@davidecasassa8679]

Normal PSA after a prostatectomy is zero. If non-zero, there are cells elsewhere in the body making PSA, which is not normal.

[@stevegonzales3612]

@@davidecasassa8679 when I said normal I meant my reading have been at (Zero), since it was removed.

[@WritewheelUK]

Hi. Thanks for the video. It came a bit late for me as my PSA came in at 15.1, then 6 months later had increased significantly, the concern being the speed. Had MRIs which showed an anomaly. One a year later showed it more clearly and I went for a biopsy. That was uncomfortable, but no more than that. They found cancer on one side, and I have just finished radiotherapy. My post-treatment PSA is 0.02. Anyone putting off going for test or treatment should be aware it is no great test. The only side effect from the radiotherapy that I found difficult to cope with was lethargy. It was all-pervading. Never felt so tired over a period before. Even two weeks after treatment, I was suffering. I lost hair on my thighs. This appears, now 6 weeks later, to be permanent. No bother. However, there's a parting, about half-and-inch wide in my pubic hair. As I came out of the shower once, my wife looked at my bits and started laughing. No man wants that of course. She said it looked like a face of a man with big eyes, a large nose (honest. She said that.) and a lop-sided grin. Not sure how that last bit works. All in all, no problem. One of the most easily treatable potentially fatal cancers. I met a chap while waiting for my turn for radiotherapy who left it too late and the cancer spread into his bones and organs. He had weeks to live. The only reason he was having radiotherapy was to ease the pain in his side. His wife came with him, not wanting to waste a moment of their time left together. The last thing every one of us, including you, will do on this earth is hurt those who love you, and hurt the ones who love you the most the most. Put it off as long as possible. Go for a PSA test.

[@peterbiesbroek]

Oh man with that big nose...almost fell on the floor laughing!!😂😂

[@yugnauj]

To whoever can benefit from my own personal case. My PSA has always been high but I did not know it as a young man. The very first time I heard about PSA was from a routine work test in 1995 (I was 50 years old). He really scared me to death when he said my PSA was so high above the 10 or 12 that most men had when they have cancer. So I was the willing sheep and went through my first biopsy. Big mistake. After the biopsy I began to leak pee - little, but it never went away and this leaking condition was not there before the first biopsy. The biopsy came negative and I forgot all about it until one day at a bar with friends I realized that I could not pee at all. That was around 2009, fourteen years after the first biopsy. Confused because it never happened before, I went home and spent the whole night trying to pee; nothing; big pain as the bladder got bigger full of liquid and began pressing all my organs; I asked god to please kill me cause I did not know what to do and the pain was maddening. I called a friend; explained that I could not drive and my friend took me to the hospital. At the hospital (UCLA at Torrance, California) they put a catheter in my ureter (first time ever) and all my pain went away immediately. From that day on I learned to put catheters my self and I always keep a supply in my car, at work, and in my home; it is inconvenient to insert a catheter but not a big deal and the relief is immediate and I prefer to do it myself because I take my time whereas in the hospital they simply push it through no matter what. Another thing that I learned was that drinking was a big factor for my prostate health so I stopped drinking. In my car and at work (when I worked, retired now) I use to keep gloves and hand sanitizer to disinfect the gloves and the catheter. After that first catheter experience, in 2009 my PSA was 16. I went through my second biopsy at Harbor UCLA Medical Center in California. Negative. I promised myself I will never get another biopsy just because my PSA is elevated, the risk of infections is very high. And I have not and will not go through another biopsy. So fast forward to 9/16/2019 my PSA according to Quest Diagnostic was 19.2. Dr. Neyssan Tebyani in Orange County, one of the best urologists in California was worried about me. I told him that I am already used to high PSA and I will not be going through any surgery or shaving of my prostate or another biopsy - rectal exam okay once a year. You can call Dr. Tebyani and ask if he has a patient with almost 20 PSA to confirm. I take Flomax every day and I urinate the same as I have urinated in the last decade. I am 74 now. My case may be unique or not. I do not recommend anyone to do what I did. I am just saying that Urology needs to conducts a meta-study to certify the percentage of men who have elevated PSA and live a normal life cancer free. I guess the resulting info from such meta-study would not be good for the field because it is good money to do the biopsies and good practice for graduating doctors in teaching hospitals who are in need of cases to practice. l researched the average PSA level for cancer patients and it is around 10. In 2021 I will ask my urologist to give me the medicine that reduces the size of the prostate. I am aware of the reduction of libido with that medicine and for that reason alone I have been refusing it but at my age I am ready for it in order to pee better and avoid frequent trips to the bathroom. Again, my case is only for those readers who have high PSA levels for decades and live cancer free. I hope this help them.

[@jeffhogueison1656]

I have high PSA too but had the biopsy luckily absolutely no side effect from it. The found no cancer. Advanced blood test still negative and scans. So this shows absolutely not everyone that has high PSA has prostrate cancer. I have no other problems.

[@indiararandeny8999]

Thankyou Dr. Very valuable discussion. 👍

[@chicagomike]

Very wonderful wonderful site. Thanks.

[@fbcpraise]

This was helpful, thank you.

[@louissatt8497]

Hi in 2016 It was found that I had a very high psa reading of 150+ I was 76 years old at the time and a reasonable athlete in my age group. Following 6 months of chemo therapy and on going hormone prostap injections my psa came down gradually to 0.358 at last count I am now 81 and quite fit and still running And I train regularly. I think I have been very lucky. A big thanks to all the doctors etc: who research this disease.

[@briangriffith2394]

Thank you doctor for all your help

[@rjlewis3932]

The problem is every urologist wants to immediately do a MRI guided biopsy if the PSA is outside the reference range despite the patients age or other factors which may cause a high PSA. The MRI guided biopsy has its own problems with relatively high morbidity.

[@macstanley925]

thank you both of you, you guys helped a lot!

[@fantascy49]

THANK YOU

[@hermanirish6794]

Yes, enjoyed this video just had recent Biopsy in England which revealed Prostate Cancer but a little amount; will be monitored very closely over the next 3 months by GP and Consultant. Will keep you up dated.

[@chicagomike]

This is terrific thank you.

[@judithlee4314]

Thank you so much for sharing

[@GogsGagnon]

Well said, Dr. Scholz. I love the analogy to help explain the PSA controversy.

[@melnovit2775]

I authored a Chicago Tribune article on this same subject 20 years ago..

[@Saw11468]

I’m 57 and recently my PSA came out 5.0 doctor gave flomax to take for 3 months is been less than a month taking this medicine and my urine flow got better. Looking forward to bringing to normal level.

[@rugbydazz2264]

Videos like this are ABSOLUTELY VITAL. They do a community service that is imeasuarable, Thank you.

[@zapszapper9105]

I wish my doctor told me this stuff. PSA density and trends over time.

[@baranjan4172]

Very helpful, thank you!

[@sedoff1948]

Good information. I wish he were my urologist. Thank you kindly.

[@gerrydonnelly9882]

What a great guy! Informative,practical, and not scaring the life out of people , like some gps I know. Well done doc.!

[@diegoos5202]

Thanks for the video. Can you do a vídeo about PSA after radioterapy or surgery? Thanks.

[@marcgottlieb9579]

Mine is up to 197....Cancer was detected 20 years ago when the 1st PSA test was taken it was 24...I never did a thing except keep on taking PSA tests since the biopsy came back as 7 large tumors with cancer in 2001..

[@fiorelvlogs7398]

@@marcgottlieb9579 you didn't have treatment at all?

[@marcgottlieb9579]

@@fiorelvlogs7398 21 years at Leavenworth.. My burial plot is 10 yards from a guy named Lansky....

[@charlesdesmondnitrile8208]

In 2013 my PSA was 1.6. In 2014 I had a bladder infection and my PSA went up to 18. Over the next few months it went back down to around 6. Since then it has hovered around 4.7. I am 65 years old. My last PSA was 4.0. I just had an MRI and the urologist said I have a large prostate. Now I have to go in for a biopsy next week. Wish me luck.

[@Giovan_Nino]

How did it go?

[@mariowestcott9889]

Get An MRI With Contrast To Be Certain!!!

[@john_carb]

@@mariowestcott9889 hi Mario, did you have the MRI before the biopsy? Or did they go straight for the biopsy. As the biopsy isn’t conclusive.

[@jaymo7161]

@@john_carb the urologist for me want to go straight to the biopsy. Guest i better ask about the MRI W Contrast. My question with doctors is which procedures pay them the most.

[@jaymo7161]

Thanks for all the info. I got my Dr. to admit that getting a MRI 1st was a good idea. My argument was my immune system is low I've lost 25 lbs after having a lot of dental done. Teeth removed and wisdom teeth removed. No eat just drinking juiced meals. This crushes my immune system. Now I'm just getting over shingles. The Urologist made it very clear that I could get a infection with a biopsy. With my immune system low, why should I risk it ? I'm sure I'll hear MRI cost more. Lol the money want matter. I'm gonna get that book. I'll report back after all is done.

[@jw8559]

Thanks for this video. It was very interesting.

[@kyleetie5608]

Very helpful info for us aging guys... thx for posting

[@bathman6366]

Such a fantastic explanation. I was diagnosed with a G6 lesion from needle biopsy after my PSA rose from 3 to 5 in 2014. I've been on Surveillance since with 2 further MRI showing no change, PIRADS 3 score. Over the last few years my PSA has doubled to 9. Just had results back from MRI - no change. But my prostate has doubled in size from 27 to 60cc. Diagnosis from Uro. Clinically insignificant G6 lesion present, with chronic prostatitis and BPH. I'm age 56. The MRI technology has saved me from unnecessary cancer treatment in middle-age. My uro says I may not need further intervention for maybe another decade.

[@MrWayne6363]

Thanx for sharing. I'm 58 and just got a PSA result of 9. My primary care Phys. has referred me to a urologist and I'm freaking out a little.

[@bathman6366]

@@MrWayne6363 When I was first referred it was for minor burning on urination and I had a PSA test age 48 as routine work. This opened one massive can of worms. If you have a lesion which is G8 or above then immediate treatment is necessary, but the vast majority of men have G6 or the weaker form of G7 (3+4) which can be safely monitored. If your prostate is 50cc in size that accounts for a whole 5 of your PSA score, so some men like myself have these low risk G6 cancers but their PSA goes crazy because a guys prostate grows during his 50s. G6 is considered to be almost benign as it rarely spreads. I would have an MRI before you even consider a biopsy, and if that MRI does not show significant cancer (they are programmed to ignore G6 and detect G7 and above) I'd ask to go on Surveillance which gives you plenty time to act if you ever need to. Meanwhile just enjoy life. Prostate cancer is not like other cancers. It has a 96% cure rate, and many of the tumors are so low grade that it is better for your quality of life just to monitor. Of course you may have zero cancer and just BPH. Or a mild prostate infection. Good luck and hit me up when you get some news. All the best to you.

[@bathman6366]

@@MrWayne6363 Hope you're doing OK and your evaluations were positive.

[@johnmarshall448]

I am 75 and had my prostate out ten years ago, I had a psa of 7 and biopsy showed cancer. Quite quick operation, one night in the hospital in Toronto in a ward of men recovering like me. Some had waited too long to correct the situation; it had spread, and they were into a long haul. Get a PSA test. no big deal if caught early..

[@schmingusss]

Are you still able to get an erection after the surgery? What about urinary incontinence ?

[@patrickarchbald8734]

My biggest takeaway here is that my doctor is not communicating with me as he should be. A language barrier has not helped. But this has been very helpful. Thank you.

[@drskbhagra]

Very nice information for we all menn.. esplly around 55 yrs and above..

[@songsmith31a]

I'm nearly 78 with lumbar spinal stenosis. Some years ago, my GP (since retired) referred me to the local urology clinic with a PSA (my request) reading approx. 6 as I recall which he thought required it. A rectal exam revealed an enlarged prostate but no cause for concern. Even so, a "12 pin" biopsy also followed - negative. Since then, I've had MRI scans, the latest of which I was told by the urologist was OK but was accompanied by a "written test", FOLLOWING which "on review" a spot for concern had been found on the prostate. I decided against further biopsy invasive investigation and have preferred to have PSA checks maintained. The latest have been 10 something, FOLLOWED by 9 something...a fluctuation of no great surprise to me, but nonetheless referring me back to the urologist on the "over 7.5 level" employed between urology and GP. I am now faced with booking a further appointment with the urology dept. to see what they say, with my previous hospital record to refer back to. The connection between gland size and PSA reading was informative, which, together with the likelihood of increased age bringing an increased PSA reading, helps me face the prospect of "here we go again", whatever the outcome. In the meantime, I employ a healthy diet at a bodyweight of 170lbs/188cms in height, and neither smoke nor drink. minus any family/genetic "history" of this particular disease.

[@alfredsong6841]

Thank you, PCRI for your contribution to the Prostate Cancer. I am a cancer patient and under care. I had 3 needle biopsies with no problem. They injected two antibiotic shots on my shoulders before and a pill to prevent infection. The main concern should be "missed tumors" by needles. It is really scary, isn't it? How can we avoid such a human error?

[@Mark-Singleton]

Multi - paremetric 3d MRI scan is where it’s at.

[@frankiereinares8892]

what are the medicines for maintaining regularity of prostate enlargement.i have been prescribed atepros.?

[@bruceschwartzberg4261]

Thanks very informative.

[@calbob750]

Had a “peach size” prostate and a PSA of 6. After years of diagnosis and numerous procedures the DNA of urine and Holmium laser were the two most valuable and effective. Several TURPs just delayed the resolution by Holmium laser. In my opinion. Age 75.

[@PhilMelbourne]

don't understand which procedure did you get?

[@calbob750]

@@PhilMelbourne Holmium Laser Enucleation of the Prostate. Hollows out the core of the prostate reducing its size. You could possibly go home the same day of the procedure. See Cleveland Clinic or University Hospital Cleveland websites. Analysis of DNA in urine can determine risk for Gleason 7 or higher cancer. These procedures are relatively new. Recently approved by Medicare if your that age.

[@ebrowneiii497]

This video has been very informative. I appreciate the discussion on non invasive tests. I’m scheduled for a needle biopsy in September, 2022, but I prefer to have non invasive tests first.

[@marktweet7395]

Had P cancer and PSA caught it in time. Went from 9 to less than 1 due to timely treatments

[@sereleg07]

Excellent interview, thank you!!

[@frankjames748]

Had my PSA test done...came back at 34.5...doctor couldn't believe i was still alive...had 39 radiation treatments and 3 years of Lupron injections...going on 6 years of cancer free.

[@uberkloden]

What were the side effects?

[@carlarthur4442]

I felt a bit unwell in 2018 getting pains in my joints, I had my blood test done and it came back reading 125 , that was the beginning of my cancer journey, I had tablets to reduce my testosterone levels and then had six very strong doses of chemotherapy, that cleared my bones , but I know have to have hormone injections every three months , the treatment is working, so it's ongoing .

[@chriscusick6890]

@@carlarthur4442 my psa is 45. Are you saying the cancer spread to your bones? Are you in pain?

[@kangaroobooks7206]

I too am a victim of the discernible prostate fickle fairy of fate. I was living my life feeling good when I took the PSA , and when the results came back I was told, I was not. In my youth, I was a sailor, but then it was my doctor that gave me what I never had before, a rectal exam, a biopsy, and PSA with a very high, bell-ringing score. If I were to live my life over again, I would limit my life to cigars and whiskey, fast horses and women and gin.❤

[@saleemsiddiqi2047]

Very useful information. Thanks

[@missheidi5734]

I am very new to this and sadly know someone who is just finding out they have prostate cancer that has spread to lymph and bone. The last PSA performed by his family practice doc was in 2010.

[@Tbone.357]

I didn't even know a MRI was available for this. My doctor recommended a biopsy immediately. Turns out I had cancer and it was treatable but would have been nice to know about the options.

[@drkside53]

This happened to me and I was pissed. Was referred to an oncologist who told me prostate biopsies are like playing darts blindfolded. Had an MRI that actually uncovered more cancer in a different quadrant the biopsy missed. With today’s MRI technology there is no need to subject yourself to a biopsy.

[@TheGodpharma]

@@drkside53 MRI doesn't eliminate the need for biopsy, although it allows the biopsy to be more targeted. If MRI shows anything suspicious, even if they are 99% sure it's cancer, they will still do a biopsy because scans alone cannot tell the histology of the tumour (basically how aggressive it is), which is important in determining the best treatment.

[@mcimd8229]

@@TheGodpharma That's true

[@berty1422]

I casually mentioned a problem at the end of a doctors visit about how I had an episode where I couldnt urinate. A few Q's to rule out UTI and I had a PSA blood test. My PSA was 72. I was 56 and this was in 2016. So, Gleason 9 and underwent Chemo and radiotherapy, then hormone treatment. PSA was down at 0.1 or undetectable for 5 years. My PSA has started to creep up to 2.0 and restarted hormone treatment and the PSA dropped to 0.1 very quickly. I will be on hormone treatment for one year and hopefully all will be well. The PSA test just indicates that something is amiss. The only way to tell if there is a problem is by an MRI and biopsy. Not many cancers have such a good indication of efficacy of treatment, and routine PSA tests can indicate when problems appear.

[@fernandoyyo1]

Great video! Very interesting. Thank you

[@brianrajala7671]

Thanks for the video!

[@eddiegardner8232]

This is the first video on which I have heard about the relationship of prostate size to PSA. I am told by DRE that I have an enlarged but smooth (no nodules) prostate. My PSA has been gradually rising under TRT as has the size of my prostate as I have reached age 75. Actual volume has not been measured by ultrasound, just by DRE. I was worried by the rise of PSA above 4.4, until I heard in this video about the “10 to 1 ratio”. So 4.0 maybe be an inflection point for a “normal” size (non BPH) prostate around 40 cc in volume. But if you have a 60 cc prostate, that inflection point is raised to 6.0 PSA, and 10.0 for a 100 cc prostate, etc. This information is very valuable to me in making a decision about potential diagnostic steps and treatment for a “high” PSA, which really isn’t high for my prostate size. It should be much more universally distributed than it is, by urologists and endocrinologists, and in particular, by primary care physicians who refer you to these specialists when there really isn’t anything out of the ordinary going on.

[@30secondamerican19]

I have a 165cc prostate gland with a PSA of about 11. Does the 10:1 ratio for raising concern still hold, since it it much less than 10:1?

[@eddiegardner8232]

@@30secondamerican19 Well, the relationship is apparently often true, no question about that or Dr Scholz wouldn’t be saying it, and it correlates with what the VA urologists told me. BUT, I just had my 85cc prostate removed 3 days ago, to get the Gleason 4+5 left anterior transition zone apex lesion inside it removed. Don’t ignore a rising PSA because you are in denial that cancer can’t be happening to you. Get a multi parametric MRI done to find out what is causing your rising PSA. If it is just size, then great, shift your worries to possible BPH, and deal with any of those non cancerous problems. If you do have a lesion, the MRI will facilitate a focal fusion biopsy to properly grade your cancer for appropriate treatment. The last three days haven’t been fun, but my robotically assisted Cleveland Clinic surgeon was able to get negative margins, bilateral nerve sparing, and bladder neck sparing, about as good as possible at this stage of treatment. We will check for undetectable PSA in 6 weeks and go from there. Best wishes for your diagnosis, and treatment if it proves necessary. Ed

[@mariowestcott9889]

Precisely Correct. I Was Referred By My PCP When My PSA Rose From 2.8 In 2014 To 4.6 In 2020 And That Very Well Could Have Been From The Prostate Growing. Then At The Urologist Office This Doctor Did The Rectal Exam For Enlarged Prostate. His Finger Didn't Even Penetrate My Anus When He Pronounced I Had An Enlarged Prostate. Come On I Thought To Myself. Already Sceptical Having Worked For An Accident Doctor Who Treated Patients With Physical Therapy And Revealing To Me That There Wasn't Anything Wrong With Them!!! I Went To School With A Guy Who's A Plastic Surgeon Now Who Never Attended Undergraduate School Aside From The Campus. Never Went To Class. His Father Was A Plastic Surgeon Who Somehow Paid Someone At The School To Pass His Son. We Were Somewhat Friends And All He Did During The Week Was Passed Counterfeit $50.00 Dollar Bills All Day Going To Gas Stations Getting $4.00 Worth Of Gas Giving The Gas Station Attendees The Fake $50.00 Bill And Receiving $46.00 In Real Money Daily While Selling Coke All Day Every Day So Yes I'm Sceptical As Hell With Everyone Who Tells Me Damn Near Anything!!!

[@mariowestcott9889]

EXACTLY THE LARGER THE PROSTATE THE HIGHER THE P.S.A.

[@walterrucker1296]

@@eddiegardner8232 g

[@692ALBANNACH]

PSA is around 3.5 ! Just turned 58 had an episode last March !

[@jennyehmer9400]

Thank you 🙏

[@ronbonora7872]

Great video Doctor! Thanks.

[@dbvnyc]

I had significant Prostate cancer at 2.5 with a prostate cc volume of 27. 4k 15% MRI positive 2 lesions RADS 4

[@goranyordanoff3638]

What were your symptoms? I hope you are doing well!

[@AbdulKhan-ur5mg]

I have a prostrate 80 gms, PSA 7.8. Doctor suggested that I get an MRI. Which I did go through. Report said a benign prostrate that is non cancerous. Of course that was very satisfying.

[@kevinjswan]

This is a great video and advice. I am in the same range in terms of size and PSA. Had both MRI and biopsy (16 samples) and all clear for the moment thankfully.

[@Momab]

I’m here for my father just realize to see online details . I’m really new to all this may Allah swt help all of us

[@gronig6pat833]

Thank you for sharing this fantastic knowlege. My young urologist is trigger happy with the needle biopsies. I did not know i have testing options. He goes straight from psa result too 6 point biopsy!!

[@robertperry2285]

Thank you. I’m anxious at this point with psa results of 19.5 at age 49. Imaging sounds good to me; not comfortable with a rectal exam. I appreciate the information.

[@bobling8093]

I was having a routine blood test and asked for a PSA test to be added because my brother had been diagnosed with PC. The test result showed a PSA level of 30.4 and I was fast tracked through for rectal exam, MRI, bone scan, second comparison MRI , before being recommended for radiotherapy treatment followed by hormone injections , three years of treatment altogether. I am now two and a half years in, just two more injections to go, latest PSA was 0.029, so the treatment is obviously working. The side effects of the treatment, loss of libido, muscle loss, hot flushes, haven't been too bad, ( at 70 I wasn't using my libido anyway ) . The muscle loss has been the most noticeable and the most inconvenient. I'm hoping that once treatment is finished that I'll be able to rebuild some of it.

[@Longtack55]

Well done Bob, and great that you are the best manager of your health.

[@galileoantonyo1336]

👍👏🏻👏🏻👏🏻

[@stevec3892]

Mine was 2 then went up to 7 . Saw a urologist. Went up to 8 … did a biopsy and no cancer

[@hodshonf]

EXCELLENT Video!!! Thank you!

[@hodshonf]

My first PSA test was November 5, 2021: 5.3 PSA, 19% Free PSA I have an enlarged prostate. My second test was December 16, 2021: 3.7 PSA, 20.1% Free PSA I avoided sex and strenuous weight lifting for the second test for 48 hours prior. It was also a fasted test. Follow up with new urologist on December 22, 2021. I would like to think the drop is a good thing. But the info I am finding about fluctuating PSA levels is less than reassuring.

[@peterfardell9267]

Excellent presentation thanks - but - surely a key indicator is not so much the ACTUAL PSA figure but HOW IT IS CHANGING WITH TIME, which would presumably rule out Cancer if the number was "high" but just sits there (same number) over the years. My suggestion is a PSA test when young to be used as a baseline check for any future rise as we age.

[@stanb.5517]

Exceptional presentation…

[@garyrathbone4586]

Just was told my PSA is 15.58. Told to see a urologist. Thanks for your video. UPDATE: Saw a Urologist. Had MRI done with Tesla 3 machine. It showed doctor where to do a targeted biopsy (not a random biopsy). 10 samples taken. Biopsy results revealed cancer in 2 out of 10 samples. Of those 2 samples, the cancer in each sample was 1/10 of the sample size. Dr. said its not very aggressive. The options I was given, were from radical to ignoring it completely. I chose the option to wait 6 months and repeat the targeted biopsy. Then we will know how fast it is growing (or not) and can revisit my options. If its still basically the same size I may not do anything. My problem peeing is being controlled by .4mg Tamsulosin so I am not at this time pressured to do anything but wait til the next biopsy, which is right around the corner now. Will update again.

[@trevorgwelch7412]

Not good if its over 5

[@PhilMelbourne]

@@trevorgwelch7412 I guess you didn't watch the video, if you have an enlarged prostate it can be 6 to 10 and be normal

[@PhilMelbourne]

@@trevorgwelch7412 You must be a primary care doctor, hahaha

[@garyrathbone4586]

@@trevorgwelch7412 I provided an UPDATE. 👍🏼

[@garyrathbone4586]

@@PhilMelbourne I provided an Update if interested. 😊

[@arthurwatt5162]

Mine is 6.1. They look for a steady climb and it was the same 10 years ago. I'm going to the urologist this week and I'm prone to prostate infections.

[@mgviswanathannair9350]

Valueable information thanku Dr.

[@joec9016]

Thanks for this information. I'm going to my first urology appt after test showed rising PSA of 4.3. Now I'll be more informed.

[@mariowestcott9889]

Yeah Buddy Get Ten (10) Opinions Before Letting These Quacks Capitalize On Your Body!!!

[@JDR18297pr]

Hi there Joe, My PSA value was 0.5 in 2018, i went to do my bloodwork last month and on my results the PSA level came up at 0.8, and i see yours is 4.3, so why im i concerned then? should i be? my Dr told me to go to an Urologist, should i go? any advice?

[@joec9016]

@@JDR18297pr I would follow the advice of your Dr. If in doubt, get a second opinion. I am far from a subject manner expert. I have seen the urologist at this point and go for the MRI in two days at a major Boston Hospital. I wish you good health.

[@JDR18297pr]

@@joec9016 thank you very much for your response, really appreciated, im 58 years old, with no health probles so far, no family history of orostate cancer, of course on my Father's part, Uncles' etc,,i thought i didn't need to go,i wish you good health!🙏

[@nazirullahkhan8533]

How old are you if I may ask?

[@Richie07a1]

I'm in my 70s and I made a mistake a few years ago of thinking my rising PSA was just a sign of old age. The doctor finally convinced me to get a biopsy and it turned out that I did have cancer......which has since been treated. So guys don't ignore the warning signs.

[@67daltonknox]

Autopsies of men dying after the age of 80 show that they all have malignant cells in their prostates, regardless of the cause of death. The UK and Sweden believe that treating prostate cancer after the age of 65 does not prolong life, but does cause complications both of testing and treatment, so they have stopped testing after 65.

[@Richie07a1]

@@67daltonknox many years ago I heard that same statistic that a lot of men who have died and had an autopsy showed that they had cancer cells in their prostate even though that's not what they died of. I don't have a medical background to make an assumption of that fact but I do believe that some prostate cancers do spread and do cause death.

[@cheshirecat9081]

Hi Richie, I was wondering how high your PSA had got before you sought a biopsy. Best Regards

[@Richie07a1]

@@cheshirecat9081 I don't remember exactly what it was but I'll say it was like an 8 or a 9. I got tested for blood work every year and it hadslowly gone up about 1or 1.5 points every year but I thought that was due to old age and I didn't think it was going up that fast. But my doctor insisted I get it biopsied and I finally agreed.

[@cheshirecat9081]

@@Richie07a1 thanks for your reply Richie .

[@tejpalchowdhury7151]

Very useful information. Many thanks. Tejpal Chowdhury

[@jacwar55]

After years of dealing with an enlarged prostate ( my urologist was against me taking finasteride because he claimed it “masked” detection of cancer, prostate finally measured at 95cc) & a mri biopsy showed 2 areas of cancer, Gleason score 7 with a rising PSA I decided to opt for robotic prostate removal to avoid years ahead of more biopsy’s that would cause swelling to the point that I would need a catheter everytime because my prostate was so large. My first PSA after surgery was .01 but 6 months later .06, so in the watch phase now. After seeing some other peoples recovery go smooth ( back fully functioning after just 6 weeks or 3 months) my case is different , I am 8 months out from my surgery & still have leakage, despite doing my daily kegels & going for PT. 6 months is when most recover fully & I am in panic mode. My urologist retired in the middle of all this which kinda threw me a curveball in my decision for surgery. If you go for the surgery, remember everybody is different, I just hope I don’t have to keep changing pads the rest of my life !

[@ThePCRI]

Hello, sorry to hear about that. Our helpline may be able to provide you with some information about monitoring and salvage treatments regarding the rising PSA and time lines and possible solutions if things do not return to normal regarding the side effects. If you are interested, get in touch with us at pcri.org/helpline.