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A Case of an Elevated PSA
Jim Smith is a 55 year old athlete and outdoors man, who runs marathons and camps out. He was not at all worried about prostate cancer until he saw the Larry King Live Show endorsing PSA screening for prostate cancer. Larry King played clips showing celebrity endorsements from Colin Powell, Joe Torre, Don Imus, Charlton Heston, Jerry Lewis, Arnold Palmer, Rudy Giuliani, John Kerry, Bob Dole, Norman Schwarzkoff, John McEnroe and Michael Milken all relating personal prostate cancer stories. Watching all these celebrities urging PSA testing on the Larry King show lured Jim into a local Miami hospital offering free screening for prostate cancer.
Jim's PSA test showed an elevated PSA of 4.7 (normal is less than 4), so, Jim was sent over to a local urologist office all set for a needle biopsy of his prostate.
Working as an interventional radiologist for many years, I actually pioneered ultrasound guided prostate biopsies, and taught many urologists how to do the procedure. This procedure involves placing an ultrasound probe into the patient's rectum to image the prostate, and advance along needle into the prostate gland for the tissue sample.(repeated a number of times). As uncomfortable as it sounds, it's really not all that bad.
Above image: Colin Powell and Norman Schwarzkoff at Press Conference Desert Storm 1991. Same expression frequently seen on men contemplating prostate biopsy. Images courtesy of wikimedia commons.
Seeking a Second Opinion
Thinking the rush to biopsy was a bit hasty, Jim declined, and instead came to my office seeking a second opinion. After a brief chat, Jim complained of recent urinary symptoms. Sure enough, his lab findings indicated a simple infection of the prostate gland which is quite common.
Antibiotics, The Miracle Drug
Inflammation and prostate infection is a common cause of PSA elevation. The plan was to treat Jim with antibioticsfor his prostate infection and repeat the PSA test. After a few weeks of daily Ciprofloxin, Jim was smiling ear-to-ear because his repeat PSA was back down to 3.8 and his doctors no longer advised prostate biopsy.
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