My PSA level has been stable for 10 years — is that enough? Interview with Dr. Sioufi

Sandro Rinaldoni is 65 years old. For more than 10 years, he has conscientiously carried out his annual prostate monitoring: blood test for PSA, urine test, uroflowmetry — and every year, he postpones the rectal exam, an examination he dreads without really knowing why.

This year, his doctor asked two new questions — and Sandro realized he might not have all the answers. He met with Dr. Richard Sioufi, a board-certified urologist at the Sioufi Urology Clinic in Montreal, to talk frankly about it.

SANDRO — PATIENT, 65 YEARS OLD

"My PSA has been stable for 10 years. At what point should we really be worried about an increase?"

DR. SIOUFI — UROLOGIST

A stable PSA level over 10 years is excellent news—and it reveals something important about your biology. But what matters just as much as the absolute value is the velocity: the rate at which PSA increases over time. An increase of 0.75 ng/mL per year, or a doubling of PSA in less than three years, is a signal that warrants further investigation, even if the value remains within the "normal" range. The good news is that with 10 years of history, you have exactly the curve needed to monitor this accurately.

SANDRO

"This year, my doctor asked me if my father had had prostate cancer—and he mentioned an MRI for the first time. Why are these two questions coming up together after 10 years of normal follow-up?"

DR SIOUFI

This is no coincidence. Your doctor is doing their job very thoroughly. A first-degree family history—a father or brother with prostate cancer—doubles or triples your risk. This information changes the follow-up strategy. As for multiparametric MRI, it is now recommended by major international urological societies before any biopsy. At 65, with 10 years of follow-up and possibly a family history, your doctor is right to ask the question. The MRI is painless—and it can avoid an unnecessary biopsy or, conversely, confirm its necessity with greater precision.

SANDRO

"I had a cystoscopy at one point. What exactly was it — and is it part of standard follow-up?"

DR SIOUFI

A cystoscopy is an examination where a thin tube with a camera is inserted into the urethra to directly visualize the bladder and prostate gland inside. It's not a standard screening test—it's a diagnostic procedure. It's prescribed in cases of blood in the urine, persistent urinary symptoms, or to evaluate the urethra and bladder neck. If you've had one, it's because your doctor had a specific question to answer. It's done on an outpatient basis, under local anesthesia, and takes only a few minutes. There is some discomfort, but it's brief.

SANDRO

"Every year, I forget—or avoid—the digital rectal exam. Is it really necessary when the PSA level is stable?"

DR SIOUFI

I understand the resistance—it's the test all my patients dread the most, and yet it only takes 15 seconds. The real answer: yes, it remains relevant, even with a stable PSA level. Some prostate cancers progress without significantly changing the PSA level but are palpable during a digital rectal exam. The digital rectal exam can detect nodules, hardening, or asymmetry of the gland that the PSA test alone won't show. It's the combination of PSA and digital rectal exam that provides the complete picture. For men over 60, international guidelines maintain both tests.

SANDRO

"If something is detected tomorrow — what options exist today that we didn't have 10 years ago?"

DR SIOUFI

The landscape has changed dramatically in a decade. Ten years ago, when faced with localized prostate cancer, the main options were radical surgery or radiotherapy—two effective treatments, but with significant side effects on continence and erectile function. Today, focal therapies allow us to treat only the tumor area with remarkable anatomical precision, preserving surrounding structures. At Sioufi Urology Clinic, we offer NanoKnife treatment —an irreversible electroporation technology—available in private practice. For many carefully selected patients, it represents a balance between oncological efficacy and preserving quality of life that traditional surgery could not provide.

SANDRO

"A message for 65-year-old men who are undergoing PSA testing but think it's enough?"

DR SIOUFI

First of all, well done—having your PSA tested every year is already much better than most men your age. But comprehensive prostate monitoring also includes the digital rectal exam you haven't had, a discussion about your family history, and sometimes a baseline MRI to establish a starting point. What I tell my patients is: don't let discomfort or embarrassment dictate your health. A consultation with a specialist urologist, without a waiting list or a referral—it takes an afternoon and it can change everything.

Make an appointment at the Sioufi Urology Clinic

Are you over 50 and want a complete prostate exam? Or do you have questions about your current treatment? Consult Dr. Sioufi in Montreal or Châteauguay — no medical referral, no waiting.

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