Hello krr,
I see it the way daff does, a "maybe" on whether to be concerned.
That level of 4.77 compares to an age-adjusted normal PSA level for ages 60 to 69 of 0 to 4.5 (0 to 4.0 for African Americans), according to tables I've seen, and quoted in a book co-authored by Gary Onik, MD. You are pretty close to that age adjusted norm, especially when you appear to have BPH that is likely contributing PSA, perhaps more than is normal for that age.
The urologist can probably give you an estimate of the size of your prostate from the DRE that he will most likely do. A rule of thumb for the amount of PSA produced by healthy prostate cells is .066 units of PSA for every 1 cc of gland. (Page F4, A Primer on Prostate Cancer) Dividing 4.77 by .066 yields an estimate of a prostate of 72 cc if all the cells were healthy. That's quite large but not rare as I understand it. The urologist can get a more precise estimate by doing an ultrasound, but he might advise going straight to an ultrasound guided biopsy.
You might want to ask him about taking
Avodart or finasteride to shrink the prostate and give you a clue to cancer by the percent of PSA reduction by the sixth month after starting the drug. Urologists in the lead with this technology are advising their peers that the PSA should drop by about 50% or more if the PSA is due to healthy cells. If it does not drop that much, that's a clue that cancer is more likely. Finasteride also increases the meaning of PSA trend information (after the new baseline has been established), and makes the DRE more informative. As I understand it, it does both by reducing or eliminating the "noise" that is associated with BPH, leaving a clearer field to detect cancer. Finasteride has been proven to have some cancer prevention activity (and do it [U]safely[U] without fostering high grade disease according to accumulating recent studies), and
Avodart, in the same class of drug, almost certainly has the same activity, though clinical trial results will not be available for another year or so. Of course, both drugs were approved by the FDA based on their ability to counter BPH, so you should get a benefit from that.
I think your doctor did the right thing by referring you. It looks like a good chance that BPH is your only problem from what I've learned as a layman from listening to fellow patients, but there is also a fair chance of cancer, and it needs to be checked out.
PS - that rise from 3.1 in early 2005 to 4.77 now, a rise of 1.67 in about 3+ years or around .56 per year, is below the old rule of thumb for concern but a bit higher than a more recent revised rule of thumb. Still, it's not a clear red flag as I understand it, more of a yellow flag.
Good luck,
Jim
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