Over-concerned wife or Not?

rinbea
rinbea Member Posts: 8 Member
edited December 2022 in Prostate Cancer #1

I hope someone can help me clarify my concerns. Husband is 54yrs old with high blood pressure (medicated) & on testosterone for (Low T.). He is not a smoker, but drinks alcohol nightly. Because of his testosterone injections, he regularly has bloodwork done. 

12 days ago he had a bloody ejaculation and it has been bloody every time he has sex (8 times). Not a little drop of blood, but red bloody.  No other symptoms, no pain, no urine hesitancy and no problems with flow output or frequency.

During this time he had his regularly scheduled blood draw and his PSA came back high 4.4.

2010-2017 -PSA ranged from 1.1-1.2

2018 -PSA 1.7

2019 -PSA 1.9

2020 -PSA 1.9

2021 -PSA  2.2

May 2022 - PSA 2.6

Nov 2022 - PSA 4.4

Today we went in to his Urologist. He is a young guy with great credentials, and has written papers on Prostate Cancers. They had him do a urine test (there was a trace amount of WBCs). And the doc said he wanted him to do a month of antibiotics and retest PSA in a month. If it’s high again, then he would do a MRI / 3D Fusion Prostate Biopsy.

I told the doc my concerns: Hubby’s PSA has increased by almost 2 in just 6 months and isn’t that a indicator of possible cancer? The doc said he wasn’t worried about that since he had bloody semen and there was WBC in his urine. He felt sure it was Prostatitis.

I also said Are you going to do a DRE? He said no we don’t do those anymore.  I said, then how can you be so sure. He said the only sure way was to do a biopsy and he said it would be premature to put him through that when he felt sure it was inflammation. He said your husband is the third man I’ve seen today with blood in their urine.

I mentioned that his father had Testicular Cancer, it metastasized and he died at age 54. The doc said there is absolutely no correlation to that and Prostate Cancer so it was not a factor.   

In the end he was put on 28 days of antibiotics and made an appointment for a PSA in 30 days.

Hubby is a Reactive type of person (he waits for the fire and then puts it out.) I am a Pro-active person, (I anticipate the fire and try to mitigate the risks before it happens.) I’m afraid that it could be cancer and we are wasting valuable time allowing it to possibly grow. Am I being overly negative and overly worried?  Do I need to chill?

Comments

  • eonore
    eonore Member Posts: 173 Member

    Hi,

    I understand your concern about delay, but be advised that prostate cancer is typically a slow moving disease and your Doctor is following a prudent course of action. An infection can cause the bloody ejaculate and the rise in Psa. In fact, sex within twenty four hours of a Psa test can cause an elevated reading. A 4.4 Psa is a cause for further investigation, but is not so high as to form any immediate conclusions. Your husband’s Doctor seems to be on top of things, so stay patient and stay the course.

    Eric

  • Old Salt
    Old Salt Member Posts: 1,258 Member

    Agreed with eonore; no reason to worry right now.

    Note that sometimes prostatitis is caused by a virus; if so, an antibiotic won't help.

  • fallonboy
    fallonboy Member Posts: 46 Member

    I think your doctor is on the ride path.

  • VascodaGama
    VascodaGama Member Posts: 3,638 Member
    edited November 2022 #5

    Hi, Pro-active lady.

    I concur with the opinions of above survivors . Your husband's doctor is following the recommended procedure and by waiting one month in the diagnosis he is not losing time for a needed treatment, if any. Prostate cancer does not spread overnight.

    Surely the doctor could have done the DRE but such wouldn't alter the course in the diagnosis steps. DRE doesn't diagnose cancer.

    WBC in urine identifies inflammation and the blood in ejaculation should be checked firstly.

    It could be a cause of testicular inflammation (epididymitis, orchitis) or inflammations at any organ of the urinary system (the kidneys, bladder, ureters, urethra).

    Infection caused by a sexually transmitted bacterium (Prostatitis, Cystitis) or excessive sexual activity or masturbation also can lead to bloody semen.

    The constant increase of the PSA since 2017 is worrisome and could provide possibilities to prostate cancer but it also doesn't identify cancer. The biopsy is the ultimate means to diagnose it.

    Testicular cancer usually is considered when it is found a lump or swelling in either testicle. However it usually causes pain or discomfort at the lower belly or groin.

    The course of diagnosis is set. It starts by obtaining a "clean" PSA followed by image studies (MRI) and a biopsy.

    Meanwhile I would recommend your man for abstaining from the testosterone intake until the just cause is found.

    Best

    VG

  • rinbea
    rinbea Member Posts: 8 Member

    Thank you for the response. Your experience is much appreciated.

  • rinbea
    rinbea Member Posts: 8 Member

    Thank you for going over each of my concerns. Your response has allowed me to stop and take a deep breath. I'm just so scared. His next PSA /Consult is scheduled for Dec 29th. I'll post an update when we have the results. Thank you

  • rinbea
    rinbea Member Posts: 8 Member
    edited December 2022 #8

    Update on my original post. The doc put my husband on antibiotices for 28 days to see if it was a prostate infection and retested his PSA. Well in the last 30 days his PSA went up an additional 1.12 points and is now 5.52 His PSA readings for the last 3 times below:

    May PSA 2.61

    Nov PSA 4.40

    Current Reading: Dec PSA is 5.52.

    We don't have an appointment with the doctor until Dec 29th. At our last appointment, he said if his PSA had not gone down with the antibiotics, then he would have to do a biopsy. They do a MRI/3D fusion biopsy (ExactVu Imaging system that combines MRI & Microultrasound Technology). Is anybody familiar with doing a biopsy like this? And what is that procedure like?

    Any info regarding this is much appreciated. Thx

  • Old Salt
    Old Salt Member Posts: 1,258 Member

    The procedure that you referred to is 'state of the art'. I had a biopsy about ten years ago when this technology wasn't available. Hence, I won't be able to comment, but I imagine that one can find general info by searching the internet.

  • VascodaGama
    VascodaGama Member Posts: 3,638 Member

    Fusion biopsy is more accurate than the traditional blind template of 12 needles. It will focus the lesions seen on the image study which could increase the number of drawn cores (12 plus Alpha).

    However, they should also check (MRI) the whole lower abdomen, particularly the lymph nodes, seminal vesicles and surrounding tissues of the prostate gland, to provide a more accurate clinical status.

    Best,

    VG

  • rinbea
    rinbea Member Posts: 8 Member
    edited December 2022 #11

    Thank you for the info. Much appreciated.

    Maybe it's just me, but I feel like the doctor's office (doc & nurse) act so blase'. I know they deal with this all day, but it makes me feel like they aren't concerned enough. The previous appointment I felt like he kind of downplayed my concerns by telling me "your husband is the third man I’ve seen today with blood in their ejaculate." He also dismissed my concerns about how rapidly his PSA increased in a short time by telling me "His PSA is relatively low, I've had men with much higher numbers."

    I think it just irratated me that he kept bringing up other men as if he were grouping my husband's results with everyone else. It makes me feel like he is not looking at the individual.

    Inside, I"m in a panic and I'm scared. I want to trust this doctor... is this type of attitude with test results normal?

    Note: I realize that I am stepping out of bounds as this is MY husbands body and I know that his thoughts & feelings are the most important. But I also know my spouse. He would never question a doctor. He looks at things as what is suppose to be will be and is just more compliant. And would never want to disrespect a doctor who is caring for him. But, I believe that doctor's are people just like me and you. That they should be questioned. My husband will take his diagnosis and if it's bad he won't like it, but I don't believe he will fight it (at least not fight hard.) Regardless, I will.

    Thanks for listening.

  • lighterwood67
    lighterwood67 Member Posts: 374 Member
    edited December 2022 #12

    Well, when my PSA climbed to 4 something. My doctor put me on an antibiotic, thinking maybe it is prostatitis. He did do a DRE. PSA did not go down. Urologist wanted to do a MRI (3T), then do a fusion biopsy using that. Long story short: Biopsy (definitive test for prostate cancer): Gleason 4+3 =7. 67 yrs old. RP 03/2018. Status; PSA undetectable; continent; intimate with wife (only when I can catch her, she is awfully fast). All I can say is, I did not have cancer definitively until the results of the biopsy came back. My wife, daughter, and the folks on this site were fully supportive of me on my journey. And through this day, I am still me. Best of luck on your journey.

  • rinbea
    rinbea Member Posts: 8 Member

    Lighterwood67, thanks for sharing your experience. It seems very similar to ours.

    At this early stage, everything seems so far away before we will get the answer. Waiting for next appt to consult the rising PSA, then wait for a biopsy date, then wait for results and then wait for treatment. The unknown is tough. But I know you have all had to go through the same thing. Reading your stories helps.

  • eonore
    eonore Member Posts: 173 Member

    Rinbea,

    Your concern is natural, as is your frustration at the pace of services. However, your Doctor is following the recommended course of action, and you will soon have more definitive answers. Your Doctor is probably trying to reassure you, unfortunately, it seems to be having the opposite effect. What you should concentrate on is that even if your husband turns out to have cancer, you have more than likely caught it at the earliest possible time, where the cure rates are extremely high. To contrast, my PSA at diagnosis was 25, virtually guaranteeing a bumpy ride. Hopefully, you will have smooth sailing, and will get through this in fine shape. Even though you are feeling that your husband is not being treated as an individual, in some ways that is the nature of medicine. The standards of care are based on data and results from millions of patients, you husband is being treated based on that data, hopefully leading to the best possible outcome. Hang in there, and keep us posted.


    Eric

  • rinbea
    rinbea Member Posts: 8 Member

    Thank you for your reply. I know you are right. It means a lot to hear from others going through or have gone through the same scary process.

  • rinbea
    rinbea Member Posts: 8 Member

    Yours sounds similar my husbands. Thank you for the insight.