Q: My 65 years old father had high fever last week due to which his blood pressure became 90/60 mmHg, though he is hypertensive. On treatment he improved. But during the course of investigations the prostate specific antigen (PSA) was found very high (37.1) and ultrasound scanning of the abdomen reported Grade I prostatomegaly. During fever he complained of pain and burning sensation during urination and he also had to go frequently to pass urine though in small quantities. But now there is no pain and burning sensation during urination following recovery. Prior to this he had no urinary complaints. Is the high level of PSA an indication of prostate cancer? What are the effective methods of treatment?

A:Clinical diagnosis in an elderly male with acute urinary tract symptoms, fever and lowering of blood pressure is urinary tract infection (UTI) complicated with sepsis. It may be a serious and life threatening condition. Usual causes that complicate a UTI in men in this age group are urinary tract obstruction (bladder outlet or ureteric obstruction), anatomical abnormalities and diabetes. Even though he was not suffering from urinary symptoms prior to the episode, he needs investigations to exclude all these to prevent such recurrence in future. It is not uncommon to have a high PSA at time of UTI, hence PSA estimation should be deferred at an acute episode. Having found a raised PSA should not alarm you, and the estimation should be repeated after a reasonable time, usually after 2 to 3 weeks. Persistently high PSA would require a prostate biopsy.