Case report: endurance cycle ride associated with a significant rise in PSA.

A number of disease processes are associated with an elevation in serum PSA. However, several studies have concluded that cycling is not an activity associated with an elevation in PSA. Herein, we summarise the literature and describe the case of a 54-year-old man who had presented to his General Practitioner (GP) with lower urinary tract symptoms 3 days after the completion of a 39-h endurance cycle ride. The PSA level was initially found to be elevated at 28 ng/ml, but decreased to 4 ng/ml and then 2 ng/ml within two and six months of the date of the cycle ride, respectively. It is probable that the elevation in PSA was caused by prolonged mechanical stimulation of the prostate during the cycle ride.

Dutasteride: a new 5-alpha reductase inhibitor for men with lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Dutasteride is a new 5-alpha reductase inhibitor for the treatment of men with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia. It has been available in the UK since March 2003. It is a competitive inhibitor of both type I and type II isoforms of the 5-alpha reductase enzyme that converts testosterone to the more potent androgen, dihydrotestosterone. Randomised controlled studies have shown dutasteride to be statistically more effective than placebo in reducing lower urinary tract symptoms and increasing maximum urinary flow rates. This is a consequence of a reduction in serum dihydrotestosterone and hormone dependent prostate volume. Dutasteride has also been shown to decrease the absolute risk of urinary retention and the need for prostate-related surgery when compared to placebo taken over a 24-month period. In this review article we discuss the pharmacology and clinical effects of dutasteride, a new dual-acting 5-alpha reductase inhibitor.

Failure of detection of pneumothorax on initial chest radiograph.

Failure to detect a pneumothorax may have serious complications. A case of a pneumothorax, which may have been overlooked if thoracic computed tomography had not been performed, is discussed.