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PSA over 30

Posted By Ruth on May 18, 1999 at 13:12:40
Dear doctor(s):  Help! My fifty year old husband had a physical last week and returned a PSA of 34.6 with a "normal exam" by our family doctor.  He has no pain, no burning or discomfort on urination, but does urinate frequently and gets up usually one time in the night to urinate.  Having said that, he drinks bottled water like a fish - so we thought nothing of the frequency.  Our doctor started Rodney on antibiotics on 5/13 (a 10 day course) and we have an appointment with a urologist on 5/27.  Since this news, we've done some research on our own and through this sight (medhelp).  What I understand is that prostatitis has a primary symptom of pain and would cause some discomfort, as would a UTI.  34.6 seems a bit to high to suggest only an enlarged prostate, though I guess that could be the case either alone or with cancer.  One more thing I should add - when Rodney and I first developed a sexual relationship (4.5 years ago), it seemed to me that he was slow to get an erection and his erections were weak.  That is not only still the case, but may be even more so.  Rodney doesn't see this as a problem, but then he's never had a sexual relationship with another man to have a means to compare.  So those are all of the symptoms.  One more thing...we have no knowledge of family history as Rodney does not know the identity of his biological father.  Here are my questions:
1.  Should we have the PSA repeated after the 10 day course of antibiotics and before the appointment with the urologist?  Would you suggest a urine culture to rule out infection?  Other lab work you would recommend?
2.  Am I correct in my assumption that a PSA of 34.6 is probably too high to indicate only an enlarged prostate?  And wouldn't prostatitis or a UTI present with some sort of discomfort or symptom such as pain, burning on urination, etc?  Also, I've read that prostate infections often have PSA's much higher than Rodney's.  Please comment on the actual number and likelihood of cancer as opposed to the other possibilities for inflation.
3.  Do the slow and weak erections go along with prostate cancer, or only with prostatitis (not a primary symptom)- which seems unlikely because of the absence of pain.
4.  Do you think that we should have a biopsy (using transrectal ultrasound) relatively quickly, or go with an extended course of antiobiotics before any further investigation?  
I guess that's it.  I'd be so grateful for any information you could share.  I am afraid (based on a call to the urologist's office yesterday) that we are going to have to know our stuff and push for the answers we need.  The nurse told me that we'd probably just do 6 more weeks of meds before retesting because my husband is simply too young for prostate cancer!  Thank you in advance.

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Re: PSA over 30 HFHS M.D.-AT 5/25/1999

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