I am a 57 year old sexually active male in excellent health. Drink alcohol pretty much every day, sometimes one drink or glass of wine, sometimes 3-4. PSA history: 9/01 2.48, 7/04 3.99, 6/05 2.63, 12/06 3.2, 9/07 3.1, 12/07 3.7, referred to Urologist by PCP. Off and on symptoms of testicular discomfort for years. Said symptons worsened at this time with the addition of discomfort at tip of penis and less than spectacular ejaculation. No other symptoms. Saw Uro 1/17 DRE neg, urine neg. Had bladder and kidney sono done, neg. Returned to Uro 3/11, dre neg, prostate warm and boggy, recommended biopsy, took blood for total psa which was 4.7. I stated that my symptoms appear to be prostatitis. He did a quick massage. Put me on Levaquin for 21 days. Not much if any improvement of symptoms. 4/21 another 21 days of Levaquin. 5/20 psa 3.7 symptoms much less severe but still exist. Uro insists on biopsy. 5/29 psa 3.54.
I obviously want to avoid an invasive biopsy if possible. I feel my Uro is pushing the biopsy, almost from day 1, and is not interested in going further with other blood, urine or prostatic fluid testing, massage therapy etc. Uro refused to do free psa or any other kinds of testing for prostatitis. I am inclined to go see another uro who might be more progressive in that area. Psa is trending down. What would you recommend I do?
As regards your numbers, they are borderline concerning. The definition of normal values are in flux. Trends and speed of change are important considerations and some of your changing values do make me concerned. Your psa's are all over the place, which does happen in some men. A recent orgasm, urinary tract infection/bacterial prostatitis, recent prostatic massage/exam and prostate cancer can raise your psa. I suggest that all psa's be done after three days without an orgasm and either immediately following a rectal exam or three days later. A percent free psa is reasonable as is a second opinion. You need to be comfortable with you physician and have confidence in that individual's decisions.
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