Dear Dr. I am a neurosurgeon in Istanbul Turkey. My cousin who is 58 years old male very healthy otherwise nothing remarkable in his medical history. He had light brown semen during ejaculation since 2 days no pain or any complaints during urination and his labs were checked yesterday after the colour change in his semen and his; WBC: 6.4, CRP: normal, U/A: with 1-2 WBC Leukocyte esterase +, 8-10 epithelial cells, Urine culture is pending, his CEA is 9.3 (Normal≤4.7), CA19-9: 13.6(0-39), PSA: 3.31 (Normal≤4.31ng/ml), PSA free: 0.47 ng/mL. He never smoked in his life, no alcohol and works out regularly. Several physicians had conflicting suggestions from that CEA increase is not meaningful to CT/MRI, U/S, chest X-Ray to Colonoscopy here in Istanbul. Although it is hard to make suggestions without seeing a patient how would you manage such a patient. What would be next step to check the source of increase his CEA. I look forward to hearing from you soon. Thank you very much in advance. Best regards Oktar Babuna MD Mobile: +90 0000 YYYY@YYYY