Very High PSA

Dear Doctor,
I have a few questions you may be able to answer. It started out with gross hematuria 2 times in the beginning of  June.I then went to my doctor he examined me digital rectal etc, urine and PSA was 54.7 the urine showed no growths, he said the prostate feels normal.He said it looks like Prostatitis, then he put me on ciprofloxicin 500mg 2 x a day for two weeks. He the told me to get a ultrasound of the kidneys and bladder and a cyscoptophy.The ultrasound showed the top part of the prostate pushing into the bladder.I then went to a uroligist for the cyscoptophy another PSA and a digital rectal exam and a cat scan.The PSA was a 58, the rectal exam felt ok.The cyscoptophy showed the top part of the prostate was inflammed.The urine had a RBC of 20, and a scitology was performed on the urine and came back with no cancer cells.He then put me on Proscar 1 a day and ciprofloxicin 250mg 1 x a day for 30 days.Then he told me to come back in 60 days for another cyscoptophy,I asked why not check me after I run out of the medication, he replied because I want to see how your doing without it.He told me to get another PSA done prior to me seeing him next visit it was 55. The questions I have  are, once the urine is checked for cancer cells and none are found does that mean I do not have prostate cancer. Also do you think this Proscar should be taken for more time in order for the PSA to drop.And Question number three is, could Marijuana use interfere or raise your PSA level.I will see him next week and let you know what he wants to do next.
                                    Sincerly,
                                  PJG263

[Kevin Pho, MD]

You PSA remains elevated despite antibiotics.  Cystoscopy shows that the prostate was inflammed.  

Possibilities include continued prostatitis, but with the continuing elevated PSA, I would make sure that cancer isn't present.  Prostatitis can be notoriously difficult to treat and the resulting inflammation may be due to incomplete treatment.

To further evaluate whether cancer is present, you may want to fractionate the PSA into Free and Total PSA.  However, with the continuing symptoms, I would push for a prostate biopsy.   Checking the urine for cancer cells (known as urine cytology) is not enough.  

I am not aware of marijuana affecting the PSA level.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[bob86336]

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