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Few treatments left for plantar warts

DEAR DR. ROACH: I have had plantar warts on both feet for decades. Unfortunately, they are on the pressure points of my feet (balls and heels). Nothing seems to eradicate the virus. I have tried bleomycin shots, Cantharidin, Candida antigen shots, liquid nitrogen, surgery, pulsed dye laser treatments, electrolysis, radiation (it did work for a couple of years, but it was all an out-of-pocket expense, and they eventually came back), salicylic acid, green banana peels. You name it, I have tried it.

Since it is a virus, one’s immune system should be able to fight it. The one area that I haven’t tried is immunotherapy, because it seems no one knows what type of immunotherapy would work. Do you have any recommendations? — K.G.L.

ANSWER: You have tried nearly everything I have heard of (and at least one I hadn’t: green banana peels?). It’s possible you have tried some other treatments but didn’t include them in your long list. For example, there is some benefit to the medicine cimetidine, normally used as an antacid treatment. It seems to help other therapies work a little better.

I know of three treatments that use the body’s immune system to fight warts: The first is a topical treatment, imiquimod. This treatment is painless and, in my opinion, certainly worth a three-month trial. The second is the use of contact allergens (one is called DPCP). This needs to be administered by an expert, usually in dermatology or immunology. The approach is like the Candida antigen injection you had done. They are intended to increase the immune system activity locally in and around the wart.

The third is to stimulate the body’s immune system with a vaccine. A study using the HPV vaccine showed almost 50% response rate. The downside to the vaccine is small. Apart from a sore arm, it’s very well tolerated. However, it is not approved by the Food and Drug Administration for people over 45, and you would likely have to pay out-of-pocket for it.

DEAR DR. ROACH: At age 67, my baseline PSA jumped from 4.0 to 10.5, prompting my urologist to perform a prostate biopsy. Luckily, no signs of cancer. Does the 10.5 reading appear to be a false positive? How common are PSA false positives for my age? — D.H.
ANSWER: That large of a jump in the PSA is concerning for aggressive prostate cancer, but there are other causes. One is infection of the prostate. You don’t mention any symptoms, which makes prostatitis less likely, because most often there is fever, pain and urinary symptoms similar to a urine infection. A digital exam of the prostate normally shows tenderness in cases of inflammation and infection of the prostate. Prostate infection is treated by antibiotics, preferably guided by identification of the organism by urine culture.

Your negative biopsy is reassuring. Unfortunately, it is possible to miss prostate cancer by biopsy. Years ago, most prostate biopsies were done “blind,” that is, without any imaging. Most commonly now, biopsies are guided by imaging such as MRI or ultrasound. This enhances the ability to diagnose cancer if it is present.

If your PSA level drops back to the level of 4, that’s good evidence the 10 was a false positive. If it keeps going up, I would recommend a re-evaluation. The higher the PSA jump, the less likely it is a false positive reading for cancer. If the high number persisted, it would be worth considering another imaging-guided biopsy.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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