Month: February 2014

The subjects which people search for and then ultimately end up on this blog are very informative.  Castrasted monks is a popular one. Another is prostate  humor and famous people with prostate cancer. I have addressed these previously.

The issue of a man being told his PSA is high and then he has a biopsy that does not show cancer is also commonly searched. “High PSA negative biopsy.”  What does this mean? Does it mean that you had a unecessary biopsy or that the PSA is a terrible test, or that your urologist subjected to torture for monetary gain  alone?

Well, it means that for some reason you produce more PSA than the “average bear.” (That’s Yogi speak.) The chances are that your particular PSA is the norm for you and that you will never develop prostate cancer. If you were my patient, however, I’d advise a twice  a year…

Well…I see patients all the time who have had an elevated PSA in the past and their family M.D. put them on 2 weeks of Cipro and then had the PSA repeated. Often times the PSA will go to normal and the family M.D. will then repeat a PSA at say 6 months. Often times it is elevated again and then the patient is sent to the urologist. This scenario happened this morning in my office. The patient wanted to do antibiotics again and then repeat the PSA again before consenting to a biopsy. A reasonable approach. We redrew the PSA. His father, a doctor, told him not to consent to a biopsy and this was the patient’s mindset before I saw him as a patient. What we will do in terms recommendations will be heavily influenced by this patient’s preconceived ideas.

My PSA was high and I did a…

Question: I have a 70 yo friend with a strong fam hx of prostate cancer — his father died of it.  Despite a psa of 1.2, he recently had a nodule felt by his family doctor and his urologist on dre, which was followed by a biopsy that was negative — no cancer, and nothing else unusual found.  His urologist told him yearly exams were all he needed at this point.  Would you be more aggressive?  Please explain.

The term “nodule” is used a bit broadly and even I in yesterdays video with Penelope spoke of a nodule in “broad strokes.”

• A true palpable prostatic cancer nodule of the prostate would most commonly show cancer on biopsy.
• It is very common for the prostate to have asymmetry and I am sure the doctor or the patient “mis-communicates” exactly what the exam revealed. I could see me telling a patient that I felt…