“We keep testing and biopsying and still there’s no cancer.” The case of Marshall P. Chief Complaint: Abnormally high PSA Clinical History: Marshall P. was a 72-year-old Anglo man who had been in the...

“We keep testing and biopsying and still there’s no cancer.” The case of Marshall P.

Chief Complaint: Abnormally high PSA

Clinical History: Marshall P. was a 72-year-old Anglo man who had been in the care of a urologist for many years. His initial urologic visit was about 25 years earlier because he had not been circumcised. His erections became painful because his foreskin would not retract. He was circumcised successfully. After turning 50, Marshall began having a blood prostate specific antigen (PSA) test with his regular annual medical checkup. His first few PSAs were normal but each year they crept higher. When he was 63, he had an elevated PSA (5.2 ng/ml; normal<>