Dear Dr. Roach: My age is 73, and I’ve had a steadily increasing PSA level for many years. In 2020, the result was 11.8 ng/mL, and it has risen to 17-18 ng/mL, where it has stayed for the past year. Since July 2024, I have been taking 10 mg of alfuzosin daily. I had a biopsy in 2017 with no sign of cancer. I had MRIs with/without contrast in 2021 and December 2024; these showed no sign of cancer.

After the last MRI, my urologist wrote: “Your recent MRI showed no suspicious lesions. Only evidence of benign prostate changes is noted. Your prostate volume was 49cc, which gives a predicted PSA level of approximately 6 ng/mL. Your PSA is much higher than this, and the reason is unclear. You should continue to follow your PSA level. At this point, I would not recommend a biopsy of your prostate.”

He then retired with no further comment. I have an appointment with another urologist but have little idea as to what is happening.

— W.D.W.

Answer: It is completely understandable to be concerned about a PSA level of 18 ng/mL, but you and your urologist have, in my opinion, done everything appropriate to look for cancer, which hasn’t been found. It is likely that you do not have prostate cancer as the MRI and biopsy results are reassuring.

I do see this in my own patients from time to time; in these cases, men have continued to have a high PSA level, but I have not seen advanced cancer diagnosed, which is something you are probably worried about. I agree with your (now retired) urologist that additional biopsies are unlikely to be helpful given your normal MRI.

You might consider a 5-alpha reductase inhibitor to reduce your prostate cancer risk. These give a 60% expected reduction in prostate cancer risk. Most men do not have side effects, but some men do, so I’d suggest discussing this with the new urologist. These medicines (finasteride and dutasteride) also reduce the PSA level by about half.

DR. ROACH WRITES: I recently had the occasion outside the hospital to recognize an ongoing stroke in a person who did not immediately recognize the importance of his symptoms. Fortunately he did get to the hospital right away, and they treated him rapidly and correctly; his brain function is very good. Had he gone home and taken a nap, which he was considering, it is likely that he would have suffered significant neurological damage.

Any dramatic change in a person’s neurological function should prompt the consideration of a stroke. One tool to help people remember the warning signs of a stroke is FAST: face drooping, arm weakness, or speech difficulty. The T is for time; every minute counts, so get the person to definitive care at a hospital as soon as possible. (Doctor’s offices don’t have the tools for diagnosis and treatment. Call 911.)

However, the FAST memory aid doesn’t include some other warning signs such as loss of balance, vision changes, leg weakness, or numbness of the face, arm or leg. Severe headaches out of nowhere (in a person who has never had them before) may also be a warning sign of a stroke.

Many people with these symptoms will not be having a stroke, but any of these symptoms could be signs of a stroke, especially if they come on suddenly (hence the name “stroke”).

Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu.