<s>[INST] I have a PSA - Prostate Specific Antigen Level of upto 45, and use lot of force to expel Urine with current medicine Flowmax 0.4 mg, I am feeling much better what all I can do to bring down PSA to about 2.5 which is normal for my age - 52 Indian - from Delhi Origin [/INST] Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. There are a certain condition in which PSA is raised most common are BPH, prostatitis and prostatic cancer, but this much rise in PSA warrants further investigation. I would have advised you to get your prostate biopsy to rule out the actual disease. Hope I have answered your query. Let me know if I can assist you further. </s>