Question Title: prostate biopsy revealed atypical cell changes but no cancer

My fiance has been undergoing prostate care for the past year, he is 51. His first PSA test indicated an above normal level, (between 4-10), so a biopsy was done. The ultrasound showed some "suspicious" areas as well. The biopsy came back negative and he has been on antibiotics for the past year with regular checkups by his urologist. He has not responded to the antibiotics in that the PSA is still up around 6, and his last test revealed a free PSA of only 6%. His latest ultrasound showed no marked changes, and a biopsy was done. It came back with no cancer but some (a small amount) atypical cell changes. The pathologists are meeting to discuss his results to see if they can come up with anything else, although they have ruled out cancer. He is to undergo another biopsy in a couple of months to see if there are any changes. My question (s) is this: What benign conditions could lead to a) an elevated PSA level, b) atypical cells, and c) non response to antibiotic treatment in as far as not lowering the PSA level? Also, are atypical cells always a pre-curser to cancer? One more, can the atypical cells, if specifically located be removed, or can they cure themselves? I, along with my fiance, would greatly appreciate you knowledge in this area. He is walking on eggshells, and although I know prostate conditions can be difficult to diagnose and treat, I must believe that there are some more definative answers out there somewhere. Please help if you can. Sincerely, Stressed Over Prostate

Dear E1,
Men over 40 with a family history for prostate cancer, or who are African American are recommended to have yearly prostate cancer screening. All men over 50 should have the screening unless their life expectancy is clearly less than 10 years. Prostate cancer screening is for asymptomatic men, if
a man has urologic symptoms he should have early detection studies regardless of age or race. The prostate cancer initial evaluation involves a digital rectal exam and a prostate specific antigen (PSA) blood test. If either or both of these tests are abnormal, then a transrectal ultrasound of the prostate gland with a needle biopsy is suggested. A nodularity on the prostate exam is abnormal. PSA abnormalities are based on age, size of the prostate, increase in PSA over time, and wether or not a negative biopsy has been obtained at that level. Free to total PSA level is being evaluated as a possible added piece of information to be used when deciding on repeat biopsies.
PSA may be elevated by cancer, infection, benign growth of the prostate, recent ejaculation, recent biopsy or insrumentation, death of prostate tissue (infarction), and bicycle riding (in rare circumstances). Antibiotics would only affect infection.
Atypical cells or glands on prostate biopsy do not always end up as cancer. These cells cannot be treated separately. Atypical cells may be further defined as high grade intraepithelial neoplasia (PIN) in some cases; this is a premalignant lesion requiring close follow-up.
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available through our department at the Henry Ford Hospital and its suburban locations (I-800-653-6568).
Sincerely;
HFHS M.D.-CK
* Keyword: PSA, prostate cancer screening, biopsy

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