Is there a history of prostate cancer in your family and if so, what should you do? In this Q & A from an issue of the Johns Hopkins Prostate Bulletin Dr. Jacek Mostwin gives advice to a reader from California with prostate cancer in the family.
Question. My grandfather died of prostate cancer at 58, and a first cousin on my father’s side was also diagnosed with prostate cancer at 66; he sought treatment, and lived to 75.
I am 57 and my prostate is not enlarged. My PSA was first measured in 2003, and it was 8 ng/ml. I have had it checked every six months since then and it has gone as high as 10.5 ng/ml. Two in-office prostate biopsies have revealed no cancer. After suffering urinary retention, I was catheterized last fall, but otherwise have had no particular problems with urination.
I follow a low-fat diet and take a daily multivitamin, plus 300 mg of vitamin C. I am concerned with my family history of prostate cancer and wonder if I should be doing anything in particular to protect myself? Sacramento, CA
Dr. Mostwin answers: You have more than twice the risk of most men of having prostate cancer, yet two prostate biopsies have been negative, despite the high PSA. Your PSA may be high because of a large volume of benign disease, or because of inflammation or congestion.
If there has been an episode of retention, it suggests significant obstructive trouble. Retention is usually considered an indication for surgical treatment. In this situation, depending on the patient’s age, I have previously performed TURP (transurethral prostatectromy) to relieve outflow symptoms and to harvest a large amount of tissue for biopsy from the central portion of the prostate.
One of the advantages of performing TURP in this setting is the acquisition of the tissue for pathological examination. If cancer is found, the grade and amount can be determined, and treatment recommendations provided. If there is no cancer, or only an insignificant amount, the result can be very reassuring, and conservative surveillance can continue afterwards. This approach would be most suitable in a case where the primary choices after TURP would be between radiation treatment and further watchful waiting. I would be very cautious about performing or advising TURP in a patient whom I thought would be a candidate for radical prostatectomy if cancer were found.
Editor’s note: TURP is the "gold standard” treatment for benign prostatic hyperplasia (BPH). In this procedure, a long, thin instrument called a resectoscope is passed through the urethra into the bladder and used to cut away prostate tissue and seal blood vessels with an electric current.
