Q: My prostate specific antigen (PSA) is 7.1. The digital rectal examination (DRE) shows it is benign prostatic hyperplasia (BPH).I have no specific problem except increased urination at night(3-4 times). Uroflowmetry shows flow is normal. I have been prescribed Contiflow at bed time and Prosteeze (charak manufactured) twice a day. How long I should continue the medicines? As mentioned earlier I have no problem except nocturia which has marginally reduced after one month medication. What are the tests should I take to find out if it will turn cancerous?

A:Your PSA (7.1 ng/ml) is marginally elevated. There can be different reasons for an elevated PSA level, including prostate cancer, benign prostate enlargement, inflammation and infection. PSA level up to 6.5 ng/mL could be normal for men in their 70s. It is important to know the volume of your prostate, as PSA is directly proportional to the volume of the gland and a very large glands may have higher PSA even with a benign gland. I would also like to know if you had any previous PSA evaluation and its value, as it is equally important whether there has been a recent rise (a PSA velocity above 0.35 ng/mL per year had a higher relative risk of cancer prostate). If these are not known, you must repeat you PSA and have both free and total components of PSA evaluated. A free to total ratio of less than 18% would signify a significantlly high risk of cancer of prostate despite a normal digital examination and would warrant postate biopsy.