Harvard Perspectives on Prostate Disease

Choosing - and sticking with - active surveillance: A patient's story

Choosing — and sticking with — active surveillance: A patient's story

In 1997, Jeffrey Caruso's physician recommended prostate-specific antigen (PSA) screening as part of Caruso's annual checkup. Then a 57-year-old businessman and avid bicyclist, Caruso* hadn't had any prostate problems, but he agreed that regular PSA screening was probably wise for someone his age. The result — 3.9 ng/ml — raised some concern because it fell at the upper end of what was considered the normal PSA range: 0 to 4.0 ng/ml.

*Editor's note: To protect his privacy, the patient's name and some biographical details have been changed. All medical details are as reported. In keeping with editorial policy, the patient's physicians are not named.

Caruso and his doctor chalked it up to his daily bike rides. During a long ride, the bicycle seat can put a lot of pressure on the perineum, the area between the anus and the scrotum, which can raise the PSA level even when cancer isn't present. So neither doctor nor patient worried much about the finding.

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