DR. ROACH WRITES: Recently, I had a chance to notice the signs of a stroke in someone who didn’t quite grasp how serious his symptoms were.
Fortunately, he was taken to the hospital promptly, where he received swift and accurate treatment; his brain function remains in good shape. Had he decided to go home for a nap, which he was actually thinking about, he probably would have faced severe neurological damage.
Any sudden change in neurological function should raise the possibility of a stroke. A useful way to remember the warning signs is through the acronym FAST: face drooping, arm weakness, and speech difficulties. The T stands for time; every minute matters, so get the person to a hospital as soon as possible—doctor’s offices just don’t have the necessary tools for diagnosis or treatment. Always call 911.
That said, the FAST acronym doesn’t encompass other significant warning signs like balance issues, changes in vision, leg weakness, or numbness in the face, arm, or leg. Abrupt severe headaches, especially in someone who usually doesn’t experience them, can also indicate a stroke.
While many individuals displaying these symptoms may not have a stroke, they should still be taken seriously, particularly if they appear suddenly.
DEAR DR. ROACH: I’m 73 years old, and my PSA levels have been climbing steadily over the years. In 2020, my result was 11.8 ng/mL, and now it has risen to 17-18 ng/mL, where it has remained for about a year. Since July 2024, I have been taking 10 mg of alfuzosin daily. A biopsy in 2017 showed no signs of cancer, and MRIs in 2021 and December 2024 also showed no signs of cancer.
After the last MRI, my urologist noted: “Your recent MRI showed no suspicious lesions; only benign prostate changes were observed. Your prostate volume was 49cc, which correlates to an expected PSA level of about 6 ng/mL. Yours is much higher, and we’re not sure why. You should keep monitoring your PSA levels, but I wouldn’t recommend a biopsy right now.”
He then retired without any further explanations. I have an appointment with a different urologist but feel a bit lost about what’s going on. — W.D.W.
ANSWER: It’s entirely natural to be concerned about a PSA level of 18 ng/mL, but both you and your urologist have taken the necessary steps to investigate the possibility of cancer, which hasn’t been found. It seems probable you don’t have prostate cancer, given the reassuring biopsy and MRI results.
I see cases like yours occasionally, where men have elevated PSA levels but with no advanced cancer diagnosed, which I imagine is a concern for you. I share your (now retired) urologist’s view that further biopsies are unlikely to provide new information given your normal MRI results.
You might want to think about a 5-alpha reductase inhibitor to lower your prostate cancer risk, which may decrease the risk by about 60%. Most men tolerate these medications well, but side effects can occur, so discussing this with the new urologist would be wise. These medications (finasteride and dutasteride) can also reduce PSA levels by approximately half.
Dr. Roach regrets being unable to answer individual letters but will include them in the column when possible. Readers can email questions.
