elevated PSA

  A very close friend of mine has been diagnosed as having Prostrate Cancer. He has had biopsies and has been on chemotherapy for over a year. Lupron is one of the drugs he is currently taking. His PSA runs all over  the place he has had readings as high as 1700 and as low as 24. Fluctuations occurr often..one time up real high then down next test. He now believes there is some correlation between his elevated PSAs and
  infection in his urinary tract. Is there any such correklation and is his assumption valid?
  Thasnks.

[HFHS MD JL]

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Dear Joe,
Prostate cancer screening is performed with a digital rectal exam (DRE) and a serum prostate specific antigen (PSA).  Either abnormality will warrant further evaluation with a prostate biopsy.  However, there are other conditions which cause an elevated PSA.  Benign prostatic hyperplasia (BPH), prostate biopsy, infection and cancer are some of the causes of an elevated PSA.  
In this instance, the patient is already being treated for prostate cancer.  The fluctuations of the PSA may be due to infection.  This infection may be in the prostate itself or in the urinary bladder.  However, once the infection is cleared, an increasing PSA may indicate progression of the cancer.  Lupron is a medication used to starve the cancer of its hormonal nourishment.  The next step would be to check testosterone levels to make sure they are adequately suppressed.  If the testosterone levels are suppressed, he may be developing hormone refractory prostate cancer.  In this event, he should be managed by an Oncologist as well.

More individualized care is available at the Henry Ford Hospital and its urban campuses by calling  (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians' notes and lab test results that you  may be able to obtain. These will help us greatly.
HFHS M.D.-JL
*keyword: prostate cancer, PSA