Q: My father is 62 years old. For quite some time now, he has been suffering from urinary problem. Recently, I consulted a doctor, and after initial examination, the doctor advised my father to undergo a few tests. His ultrasound report shows that the urinary bladder is distended; bladder wall is thickened with mild trabeculations seen; no calculus; pre void urinary bladder volume is 621 cc; post void residual urine is 281.8 cc (45.3%; significant); prostate is enlarged in size, and shows mild heteroechoic echo texture. It measures 4.5 x 3.8 x 3.6 cc approx. (volume: 33 cc). There is no free fluid in the abdomen. The blood report shows prostate specific antigen is 4.6 ng/ml. Urine culture report is negative with no growth of organisms. I have tried to put things as they are. Kindly suggest how my father can get rid of his problems.

A:The information that I have gathered is that a 62 years old man with urinary symptoms and unremarkable prostate for his age has been reported to have high residual urine on an ultrasound study, and has grey zone PSA. The next steps are:

1. Try and treat his symptoms with medications and observe.
2. Repeat ultrasound study for residual urine in a normally filled bladder (single value of a high residual urine on ultrasound does not have significance since ultrasound is done in artificial surroundings, and in an unnaturally over-distended bladder.
3. Have free and total PSA done to check free-to-total PSA ratio, which will determine whether to give any significance to borderline high PSA indicating a risk of malignancy. If ratio is less than 15%, a biopsy in indicated to rule out cancer, while a ratio of 18% or more is more likely to occur in a benign gland, and needs a close follow-up with a repeat PSA after 3 months.