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Recently diagnosed with prostate cancer, gleason 10

gleason10
Posts: 12
Joined: Sep 2017

Hello All,

I came across this forum by searching the internet, and reading the posts here gives me some hope and courage.

My dear father was recently diagnosed with prostate cancer. Case history as follows:

1. He was having trouble with urine flow, and saw an urologist who gave prostate ultrasound and PSA to test. USG denoted Prostate Hyperplasia, and PSA was 12.7. Urologist gave "Silodal 8" drug to ensure urine flow is not stopped, and repeated PSA after 10 days along with uroflowmetry. PSA was 11.3. Advised immediate HOLEP surgery.

2. On the day before operation, urine flow completely stopped and had to be admitted to hospital immediately and subsequent cathetariztion for relief. Doctor could not perform HOLEP as prostate was inflamed, TURP was performed instead.

3. Post operation, after 15 days, urine flow increased, and not much post-operative complications. However, the biopsy of the TURP chips showed malignancy.

Biopsy Report as follows

----------------------------------------------------

- Infiltrating Prostatic Acinar Adenocarcinoma

- Gleason score 5+5=10, with solid areas, comedo necrosis, and single cell infiltration

- Grade Group 5

- 20% of whole tissue is involved

- Perineural invasion is present

 

I searched the net thoroughly over last week or so, and came to know that Gleason score 10 is highly aggressive form of prostate cancer. Feeling very scared and helpless now. Doctor has advised PSMA PET Scan immediately to check for metastates. Waiting for PET scan appointment. Meanwhile, immediately after the scan test, doctor has advised to start "Calutide 50mg" which is a testesterone-suppressing medicing I believe.

Would like to know from the experienced members here, what is the usual treatment path in this case? And what are the risks? I am also planning for 2nd and 3rd uro-oncologist appointments after I get the PET scan results.

Just to add PSA was repeated yesterday after the TURP recovery and it came 12.7, i.e. not decreased at all. I suppose it's because of the malignancy present.

Many thanks in advance.

 

 

VascodaGama's picture
VascodaGama
Posts: 2706
Joined: Nov 2010

Welcome to the board. As you expect Gleason score 10 is not a good diagnosis, however, independently of the Gleason grade, your dad got several means for treatment that will be decided once he receives a clinical stage. The first step is exactly to locate the bandit to which the PET PSMA scan is the best for the job.

You did not share details on your dad's other health issues (if any) and age but these will be also considered when evaluating his status and drawing opinions. For instance; Surgery is typically not recommended for 75 plus years old patients. Radiation may be prohibitive if the patient have/had ulcerative colitis and these are located at the critical field for RT treatment. Radiation of the area involved in the TURP intervention may not be the preferable choice as it can affect the urine sphincter, highly risky for causing incontinence. If the cancer is found widely spread with metastases in bone then radicals may not be recommended and the patient is moved to palliative approaches. In this case the quality of life becomes the prime target.

I recommend you to read about the type of treatments, their risks and side effects and discuss with other members of the family. I also would insist with your dad to get extra exams and tests to check any other health issue. The testosterone is never commented by urologists but this is an important marker in hormonal therapies. The whole lipids panel should be done at this time, together with a DEXA scan (bone health) and heart health tests. You can count with the survivours of this forum to help you understanding things. We are not doctors but can tell about our experiences. Get copies of all data and paste it here.

Here are some links for you to read. Better to prepare a List of Questions in advance of meeting the doctors.

A practical guide to prostate cancer diagnosis and management;

http://www.ccjm.org/index.php?id=105745&tx_ttnews%5Btt_news%5D=365457&cHash=b0ba623513502d3944c80bc1935e0958

Prostate Cancer Staging;

http://emedicine.medscape.com/article/2007051-overview

List of questions;

http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

In this link you can read the discussions with a member dealing with Gleason rate 5;

https://csn.cancer.org/node/306682

Best wishes and luck in his journey.

VGama

Rakendra's picture
Rakendra
Posts: 198
Joined: Apr 2013

I am sorry that you have to be here to get help for your father.  Cancer is a very scary word.  However, if you have o have cancer, prostate is a good choice.  This is because each case is individual and cannot neccessarily be judged by referring to a similar case.  Some with high Gleason score go on for years.  And, even in dire cases. often treatment can give the patient much added time as well. I always use myself as an example.  I have very agressive Stage 4 prostate and bone cancer and I have survived for almost six years now, and plan on a lot more.  My prognosis was very bad and the cancer very widespread.  There really is no telling about Prostate Cancer.  My advice would be to accept what is, celebrate the time you have left with your father, whether short or long, be grateful for the lifetime that you have already shared with him, and just live in a state of "not knowing and not worrying", and make every day count.  I wish you the very best.  And, you are on notice now.  Rejoice in each moment that you can share with your father.  

Best wishes for a good outcome.  Love, Swami Rakendra

gleason10
Posts: 12
Joined: Sep 2017

You are so right and thanks for reminding this!

Amidst all the research and nervousness, often we ignore the present... that should not be the case. Still, it is very hard to accept and I am trying to put my bravest face forward...

SPT
Posts: 40
Joined: Aug 2017

Quality of life are just words for doctors.  Any treatment offered to your father will cause signifant, permanent reductions in his ability to enjoy life.

The decision looks a lot different if he is 87 versus 53.  Prostate cancer is generally slow, although a Gleason 10 may not be slow.  But a man of advanced age would be wise to be very cautious about letting doctors ruin whatever time he has left.

gleason10
Posts: 12
Joined: Sep 2017

Thanks all for taking time to read my post and share your valuable opinions.

My father's age is 67 yrs now. Since PSMA PET scan appointment is taking longer, doctor has asked us to go for the following scans asap:

- MRI of the prostate pelvic nodes and retroperitoneal nodes

- Whole body Bone Scan

Medical history of other illness:

-------------------------------------------------

- Has Type II diabetes mellitus for almost 10 yrs now, under regular medications and blood sugar levels under control for last 6-7 yrs

- Under regular check-up of cardiologist for cholesterol, hypertension, diabetes, and taking medicatons and all under control.

- Got blood sugar, lipid profile, urea, creatinine, triglycerides etc all tested before the operation, and all are in normal levels

@VascodaGama - Not clear what is meant by palliative approaches? Can you explain?

Many Thanks in advance.

hopeful and opt...
Posts: 2188
Joined: Apr 2009

Strongly suggest that your father see a Medical Oncologist, the very very best that you can find to lead your Medical team. The Medical Oncologist is best qualified, much more so than a urologist, to select the drugs that will be most effective for your father. Additionally the Medical Oncologist will not be biased toward wanting to do surgery as a urologist (surgeon) is.

His cancer has escaped the prostate so localized treatment, such as surgery will not cure. There are side effects from each treatment type that are cumulative. 

As well as speaking with a Medical Oncologist, it may be advisable to speak with a radiation oncologist. Depending on pet scan and bone scan results( how extensive the cancer as spread) hormone treatment only, or a combination of radiation and hormone treatment may  be considered. (When radiation is administered the radiation can be directed to the prostate as well as surounding areas). 

Ask that the MRI that will be done to be a T3 MRI, (this MRI machine uses a tesla 3.0 magnet, that provides the highest definition in clinical use)

.....................

There is a higher percentage of family members who can be diagnosed with prostate and breast cancers, so if you are a woman, get that regular mamogram  ; and if you are a man, have a PSA and a digital rectal exam on a regular basis. The rate of change is important to the PSA indicator. Eat heart healthy. Let others in the family know of this brothers, sisters, sons, daughters, even cousins...it's the right thing to do.

VascodaGama's picture
VascodaGama
Posts: 2706
Joined: Nov 2010

My meaning of a palliative approach is when the choice of a treatment is done to alleviate the burden of the malady instead of aiming cure. Typically in PCa cases palliative are recommended to those with many tumours spread at many places in the body, so extensive that cure becomes futile. In such a case one may choose to remove only a portion of the cancer with a surgical procedure (debulking a tumour) or a spot radiation (tumours in bone) or just a treatment to control the advancement of the disease (such as chemotherapy or hormonal treatment), etc. These therapies all got associated risks that would prejudice the quality of living of the patient without assuring cure, as commented by SPT above.

At this moment, your dad should give preferences to the most precise diagnosis possible as such will influence greatly in the choice of therapy and consequent risks. His doctor decided to skip the PET scan but in your shoes I would not follow his request. The traditional MRI and bone scan now advanced by the doctor are much associated to false negatives which are not what your dad wants. I would force and wait for the PET PSMA exam to draw conclusions on his diagnosis, in particular in the presence of an aggressive type Gleason rate 5. Surely there is no harm for having additional exams (MRI, CT, Bone scan, etc) but the PET is the one that will tell where the cancerous cells exist.

With regards to the other health issues, I would get a medical oncologist to lead your dad's case, as commented by Hopeful above, because of the medication for the type 2 diabetes mellitus (DM2). I wonder if the kidneys are at 100%. DM2 is a major risk factor for kidney disease and that would prohibit the use of particular contrast agents in image studies. You need to discuss the above with the physicians treating your dad and when at consultations for second opinions.
Can you describe the medications of your dad? Metformin is used in the treatment for diabetes but it also has shown benefits in the treatment of PCa. (just like killing two birds with one stone) 

Regarding DM2 and PCa;

http://ascopubs.org/doi/abs/10.1200/JCO.2016.67.4044?journalCode=jco

Regarding DM2 and the kidneys;

https://www.kidney.org/atoz/content/diabetes

Regarding DM2 medication;

https://www.ncbi.nlm.nih.gov/pubmed/27079349

You doing it well in researching and educating on the matters of PCa. Your dad is surely greatful for your help. Prostate cancer does not change overnight even in Gs 10 guys. Do things but use wisdom, move forward coordinately and timely.

Best wishes,

VGama   

gleason10
Posts: 12
Joined: Sep 2017

My father is on the following diabetic medications:

Metformin Hydrochloride 500 mg

Glimepiride 1mg

 

Have a question - I have received MRI and Whole body bone scan appt on Monday. Still trying for PET CT Scan appt. Can PSMA PET Scan be done while on Bicalutamide dosage? Or the results will be impacted because of the drug?

Thanks.

hopeful and opt...
Posts: 2188
Joined: Apr 2009

To avoid any confusion....I was thinking that your Father's doc recommended an MRI in addition to a PET Scan, not instead......by all means, as Vasco commented, insist on having a PET scan.

Best

VascodaGama's picture
VascodaGama
Posts: 2706
Joined: Nov 2010

I would suggest you to copy our discussions if they are dear to you. I believe that the CSN administration is not satisfied with my comments/posts to the many. They just deleted one entire thread addressed to me recently.

The best person to inquire about all drugs (your dad's taking) interaction or influence on the PET PSMA scan is the radiologist doing the exam. My lay opinion is that bicalutamide will cause no interference with the PSMA nuclear tracer as this does not use the cell's AR (androgen receptors) for its pathway to identify and glue to a prostatic cell. A LHRH agonist or antagonist (Lupron, Firmagon, etc) could have some influence as it would turn prostatic cells less active.

However, the contrast used in the CT exam or even in the MRI, may be prohibitive if your dad has advanced CKD (chronic kidney disease). As I commented above, DM2 is a major risk factor for kidney disease and many guys do have CKD without knowing. I wonder what may be his filtration rate (GFR) and creatinine level. This issue may constitute a problem in the exams required for PCa matters. A medical oncologist would provide you the answers and peace of mind.

Best

VG  

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 2865
Joined: May 2012

Your comment about the deletion is so sad, Vasco.

A sentence from you is worth more than everything the CSN Administration has ever done in their combined lives.

max

gleason10
Posts: 12
Joined: Sep 2017

We got his creatinine level tested 2-3 days back, and it was normal. Haven't tested GFR though.

Your replies are so informative, thanks a lot! Really helps in these tough times.

Thanks.

VascodaGama's picture
VascodaGama
Posts: 2706
Joined: Nov 2010

Clearance at 24Hours is the due exam. A very low percentage would mean the need for dialysis after any MRI or CT done with contrast. Please do the tests and discuss with his doctors.

gleason10
Posts: 12
Joined: Sep 2017

Hi All,

Some updates to my dad's treatment:

We got the Bone scan and MRI done.

Bone scan - No metastates found in scan report.

MRI - Large extra-prostatic extension, more on right side with involvement of both seminal vesicles, right antero-lateral wall of rectum and right lateral pelvic wall. No evidence of retroperitoneal lymph node enlargement is noted.

Clinical stage given by doctor - T3 N1 M0.

Doctor has ruled out surgery or prostatectomy as the cancer has spread beyond the prostate. They have advised the following treatment (ADT + EBRT):

1) Currently Bicalutamide 50mg 3 times a day

2) Injection Triptorelin - once in every 3 months for 2-3 years - Bicalutamide to stop after 1st injection

3) EBRT - radiotherapy for 4 -6 weeks

followed by regular PSA follow-up.

I have taken 2-3 opinions (treating urologist + oncologist), and all doctors are agreeing on the same treatment plan. As per them, this is the standard treatment for this stage of prostate cancer.

Need your opinions on this, are there any other treatment approaches to this case?

Thanks in advance.

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 2865
Joined: May 2012

gleason,

There are always "alternatives" I suppose.  But his treatment plan sounds very thorough and reasonable.  Surgery would indeed be a bad idea for a man his age with diabetes, since there is presumption that the disease has escaped the gland.

The EBRT has some slight possibility of eradicaiting all of the disease, but regardless, HT, when played well by a medical oncoogist, can often give many years of quality life to a man, even with advanced disease.  His medical team leader needs to be the medical oncologst incidentally, not his urologist.

max

VascodaGama's picture
VascodaGama
Posts: 2706
Joined: Nov 2010

I would think that his doctor has also discussed about chemotherapy, but he may want to keep it as a future weapon in case this combi (RT + HT) fails. Surely the results from the MRI suggest your dad's case being very advanced. This together with the high Gleason score 10 is suggestive of an aggressive cancer that needs to be tackle the soonest. Starting with HT (Bicalutamide) was proper but the RT is questionable as commented by Max above. Will RT treat such advanced case or will RT just provide some relief on the burthen of the widely infested area?

I believe that his doctor's recommendation of RT is solo based on the scans which imply the possibility of that being a localized case and that the reason for the clinical stage of T3N1M0, but is it correct? Well, .... independently of the real situation RT may not cure your dad but will surely kill the cancer on the field of the rays. The worries set in the risks and side effects of the therapy. How much can your dad with DM2 handle with the medication for any RT consequences?

The terms in the clinical stage mean the following: T3 signifies that cancer is not contained. N1 signifies that the lymph nodes were invaded (no comment on its location). The M0 may have been attributed for the negative bone scan however this test is not reliable in finding small sized PCa and would not provide a clue on metastases at lymph nodes in the upper body, the lungs or the liver. My lay opinion is that this M0 is questionable and quite often in similar cases they are false negatives for existing far metastases (M1). Maybe attributing an "MX" would be better. If M1 has been attributed then RT would not be recommended but chemotherapy (plus HT). The PET scan could give you a more realistic conclusion.

Please note that DM2 patients have limitations on medication and therefore limitation on treatments. Constant vigilance is required to avoid deterioration of patient's health. Urologists and radiologists have no clue on the matter.

Best

VG

gleason10
Posts: 12
Joined: Sep 2017

Hi All,

Writing on this forum after a long time. The following updates on my dad's condition:

1. He has taken the first Triptorelin 11.25mg injection on 6 Oct. Bicalutamide has stopped.

2. Repeat PSA in Nov 2017 (after first ADT injection)- 4.4 approx - which doctors said should have come down more.

3. Also, since he was having issues with the urine flow towards beginning of Dec 2017, urologist had done a cystoscopy to clear the passage - cystoscopy revealed tumour growth in prostatic urethra - which doctor said will improve after the EBRT only.

4. 2nd Triptorelin injection to be given on 5th Jan 2018.

5. PSMA PET CT scan done. Reports will come in 3-4 days.

He is having severe issues in quality of life mainly because of the following increasing symptoms. These symptoms have developed rapidly over the last 2-3 weeks.

1. He has to get up multiple times at night (5-6 times) for urination. This means he gets very little sleep and normal body functions are hampered.

2. Hematuria (blood + CLOTS) coming in urine, and this happens multiple times a day. It increases if he has to travel or sit for a longer time. Doctor said that these clots are coming from the tumour cells, however not clear why clots are increasing though he is on Triptorelin injection already.

3. Extreme fatigue - gets tired very easily. He was a very active person and loved to go out always. But now, it is difficult for him to even go out of the house for walking for 10-15 mins.

4. Pain in pelvic area, thighs. Also has pain if required to sit for longer period of time.

Are the above symptoms because of "tumour flare"? Urologist has asked him to take bicalutamide again (twice a day for 15 days) and given another tablet for pain (Baclofen 10mg). However, all these symptoms continue to be there.

Oncologist had suggested starting EBRT by end of Jan 2018 - he expected the tumour to shrink a bit after 2 Triptorelin injections, so that EBRT side-effects are less. However, he will give final advice after PSMA PET scan results.

My question is - anybody can advise regarding the above symptoms, and the causes for it? Also, what are the medications to alleviate these symptoms? Are these symptoms common or is an indication of a growing tumour?

Very worried,

gleason10

gleason10
Posts: 12
Joined: Sep 2017

Hi All,

Any pointers regarding the symptoms would be very helpful. Really pains me to see my dad suffering day in and day out with this :(

Worried,

gleason10

 

VascodaGama's picture
VascodaGama
Posts: 2706
Joined: Nov 2010

The symptoms you describe above under the items 1 and 3, are typical side effects from ADT. Items 2 and 4 could be due to Urethritis, an inflammation caused during the intervention to unclogged the urethra (done together with the cystoscopy). I believe his doctor did it using a boogie to widening the stricture. The area is now very sensitive and the wound hard to heal for the constant flow of urine. The inflammation could also be causing urgency in urinating. Your dad may have to use a catheter to allow proper healing. To improve fatigue, afternoon naps are good. To avoid frequency he may try changing his life style, eating dinner earlier and lesser liquids at evenings.
I think it better you inquire his doctor. He will provide medication to counter the effects.

SBRT will also cause inflammation in the urethra, so that it should be started after proper healing. I still think it better for your dad to do extra exams now in preparation for the treatment. A colonoscopy to verify any ulcerative colitis (would prohibit any radiation to the area) and a DEXA scan to check bone health (bone metastases would require extra treatment). Surely if the cancer is widely spread then SBRT may not be proper to care for your dad's case. Please read previous discussions.

I am curious on the PET results.

Best,

VG

gleason10
Posts: 12
Joined: Sep 2017

Hello VG,

Here are the PET scan results:

Prostate gland is enlarged with heterogeneously increased mass lesion. The lesion involves both sides of the midline. Extra-capsular extension  is seen on right side up to the right lateral pelvic wall. The lesion is not separable from the bladder neck and rectal wall. Extensive heterogeneous radiotracer uptake (SUV max 10.0) is seen in the lesion.

Post TURP status is noted. No abnormal PSMA expressing pelvic or retroperitoneal lymphadenopathy is noted.

No PSMA expressing skeletal lesion is noted.

Liver/GB/Spleen/Kidney/Pancreas/Adrenals appear unremarkable show no abnormal radiotracer concentration.

1. Large prostatic mass lesion with heterogeneously increased PSMA expression

2. No abnormal PSMA expression lesion elsewhere in the body

Urologist changed his 2nd injection from Triptorelin to Lupron 22.5 mg.

Repeat PSA (2 days before) - 3.4

Thanks,

gleason10

VascodaGama's picture
VascodaGama
Posts: 2706
Joined: Nov 2010

Thanks for sharing the results. The report states a localized affected area similar to what was indicated in the MRI report. The treatment RT + HT seem correct. Lupron is a good substitute to triptorelin but adminestered during two years may be prejudice to your dad's diabetes. I think that 6 months post RT would be enough. I recommend you to inquire with a medical oncologist.

Surgery with adjuvant RT may also be an option for the characteristics of the cancer (Gleason 10) and the spread at the seminal vesicles. Surgery would debulk the big tumor (the whole gland), and the radiation would focus the bed plus the tissues confirmed by the PET. Surely two radicals would increase the risks and side effects. I wonder what may be the opinion of his doctor on such approach now that a more reliable image was obtained.

Best

VG

gleason10
Posts: 12
Joined: Sep 2017

Hi All,

Here is the treatment update regarding my father's RT:

- RT started 1 week back, he has completed 8 RT sessions

- After 1st day of RT only, there was urinary retention and he had to be put on catheter.

- He is continuing his RT sessions with catheter. However, he has some side effects w.r.t. catheterization which worries me. Symptoms as follows:

    -> He has been put on Foley 18F catheter, but even being on catheter, he sometimes feels urinary pressure in bladder, and urine would come out from the sides of the catheter instead of coming in the urine bag.

    -> He also has blood clots coming out from the sides of the catheter.

- Also, oncologist has said that he would need to have catheter put on till about 1 month after RT as well.

Have a couple of questions:

- Are these symptoms with catheter while on RT common? Anybody else experienced this?

- Are there any chances of infection for long term catheterization? Do we need to have latex or silicone catheter?

Any pointers would be very helpful.

Thanks

gleason10

 

Grinder
Posts: 348
Joined: Mar 2017

I can tell you this. Keep the catheter as absolutely sterile as possible. One of my catheter experiences got infected... even though I was being careful. It was one of my many ER visits to have catheters put in, or a catheter taken out. After that, I was ridiculous in my diligence, using diluted colloidal silver to wash out the Legbag and Bedbag, and assorted antiseptics to wipe everything down including tubes, anchors, etc and especially my junk. Be sure he gets a leg anchor positioned close to his junk so the catheter tube doesn't pull on it every time he moves. 

And yes, I used to have it leak around the sides of the tube, especially if I was straining, as my muscle contraction would push urine past the entry into the catheter tube into the urethra, especially if something is blocking the entry... like a blood clot. 

As much as I hated Foley catheters, they were better than the alternative. And I don't remember a variety of self-catheters available at the time. I would never recommend self catheterization, but then again I have never used the wide assortment available. Maybe someone else can give you better advice than I can about that.

Once he gets his  Foley installed, he should go on Amazon and see what peripherals are available to ease  some of the issues.

Somebody else will have to advise you on the blood clots... My clots had typical reasons for their presence... When I got the needle biopsy, when I got infected, when the ER personnel made a bloody mess of things when they couldn't get the Foley passed a massive infected prostate, etc. 

Also, I  was told a Foley should not be in longer than two weeks. And that was my experience BUT this is your doctor's call.

Just wanted to throw a few things out there.  There are others here that are way more knowledgeable about the procedures and treatments, and hopefully they will continue to advise you, but I do want to help your dad through his unpleasant catheter experience... Been there done that.

gleason10
Posts: 12
Joined: Sep 2017

Hi All,

Posting an update here after some time.

My dad complete the RT treatment in last week of March. He was on catheter for the entire duration of the RT, and then around 20 days after RT.

After catheter removal, he was able to pass urine, for which his doctor was also happy that healing would be proper. He asked for a repeat PSA in first week of June. However, he started developing multiple symptoms 3-4 days after cathether removal only which is of great concern to me.

Symptoms as follows:

- Frequent urination during day, and especially at night - almost 7-8 times per night

- Temporary urine blockage at night, and he had to get up and walk or just be restless and not get any sleep at night. It took 3-4 hrs to be normalized again as the next morning progressed.

- Weak stream of urine during the day as well, at some time it will be so less that it feels it might lead to urinary retention

- Pain and discomfort in pelvic region

He had the ADT Triptorelin injection in first week of April as well. After about being 20 days off catheter, with all the above symptoms, one night suddenly he had full urinary retention and had to be catheterized again. During this period, he was complaining of fever and Urine RE and culture showed UTI as well. Doctor has given him FOSIROL (fosfomycin trometamol) antibiotic which worked and decreased the fever. He needs to take this antibiotic now every 7 days for 3-4 weeks.

After this catheterization, he is complaining of persistent pelvic region pain and bladder/pelvic muscle spams. Doctor has advised to keep the catheter for 2-3 weeks, and then try removing it.

My question is - are all these symptoms commom after RT? Or are these happening for my dad because his cancer was aggressive - gleason 10? Till how long after RT, do the symptoms stabilize?

Any pointers and info would be very helpful.

Thanks in advance,

gleason10

 

Grinder
Posts: 348
Joined: Mar 2017

Someone else will have to address the RT potential side effects, but the symptoms you describe are typical of acute prostatitis... an infection of the prostate, urethra, and sometimes the bladder as well...

"Symptoms of prostatitis include painful urination; blood in the urine; pain in the groin, abdomen, or low back; fever, and painful ejaculation or sexual dysfunction" ...medicinet.com

If he had a culture done, what was the result? What was the pathogen causing the infection? Typical pathogens that infect the prostate are E coli, Staph, Chlamydia, etc. I am guessing the antibiotic your doctor prescibed was pathogen-specific which would account for the long duration of treatment. Plus, the prostate is very difficult to treat under the best conditions. Add a difficult to treat pathogen like Staphylococcos, and 3-4 weeks is not surprising.

If it was a UTI only, it would be easily treated because antiobios can be introduced in the urine flow.. But the prostate is buried deep, and is accessible only through the bloodstream, and  with difficulty at that. So the antibiotic prescribed is a blood borne antibiotic. Any antibiotic normally used to treat UTIs are ineffective for prostate infection.

 

gleason10
Posts: 12
Joined: Sep 2017

Hello,

Many thanks for your reply.

Urine culture report showed E coli bacteria.

Doc had given the antibiotic based on the sensitivity report in urine culture.

Thanks

gleason10

Grinder
Posts: 348
Joined: Mar 2017

I just read in your original post that he had TURP procedure done...

Welcome to the catheter - prostatitis merry go round.

The prostate gets infected from catheter use... causing it to swell up and shut off urine flow, which requires use of Foley catheter to relieve retention, continuing the catheter induced infection, that causes continued catheter use.

Add a TURP procedure, and I suspect the exposed tissues of the prostate that urine passes through could be even more susceptible to infection from the tube of the catheter. But that's just a guess.

This is probably another reason for the duration of antibiotic treatment... your doctor wants to treat the infection for as long as the Foley catheter remains inserted. Earlier I mentioned that Foleys should not remain inserted longer than 2 weeks... this is why, but unfortunately, there is no other alternative in this case, so your doctor is keeping him on antibios as long or a bit longer than the catheter.

VascodaGama's picture
VascodaGama
Posts: 2706
Joined: Nov 2010

I agree with the comments of Grinder above. Long time catheterization could be behind the symptoms from the very beginning. Radiation has caused inflammation which may have progressed to infection of the tissues in contact with the catheter. The all area become very sensitive and any movement or squeezing of bladder wall would lead to sensations of urgency and frequency in urination, even if the bladder was/is empty. Standing or in laying position easily causes irritation of local nerves faking any need to urinate. One should be sure that additional catheterization is in fact required for voiding. I have experienced retention three times due to blood clogs in the urethra (hematuria). I had urgency but when peeing nothing come out. I could sense in my tummy the urine flowing backwards so I forced it and the pressure unclogged the thickened blood that I saw in the sink. My situation improved since I stop taking the daily aspirin (blood thinner).
Improvements from radiation therapy may take 4 months to get to acceptable levels. In my SRT I did have frequency and pain when urinating during three weeks for which I took some medication. Soft stool and occasional diarrhea was there too but it all improved in three months past RT.

Best wishes for fast improvements.

VG

 

Grinder
Posts: 348
Joined: Mar 2017

Did you quit the aspirin regimen entirely?

My GP has been pushing me to do low dose aspirin. But my mother was doing aspirin daily and started hemorrhaging in her stomach. Not only does aspirin thin your blood, but can also lacerate your stomach and intestinal walls, from what I understand.

I have been trying anti-inflammatory blood thinning like ginger tea and the like, and trying to avoid large doses of vitamin K in hopes of thinning blood without aspirin or meds.

How do you handle blood thinning? Or is it an issue for you?

MK1965
Posts: 128
Joined: Jun 2016

Aspirin 81 mg, also known as baby aspirin is recommended when MCH and MCV values are elevated.

THis 2 mentioned lab values measure viscosity of the blood.

When Aspirin 81 mg is recommended it is always recommended to be enteric coated, which means it wont dissolve in the stomach but rather in the lower G.I. tract , in the small intestine.

So, stomach is sparred.

MK

Grinder
Posts: 348
Joined: Mar 2017

I appreciate the advice... however my issues are a little more complicated.  I wohld not risk even enteric coated low dose aspirin because I was dealing with a GI infection, gastritis, GERD, and a hiatal hernia during my PC issues. The hernia and GERD issues border on Barretts Esophagus which is the precursor to esophageal cancer. And with my painfully slow metabolism, I cannot afford to put inflammatory agents into my GI system on a daily basis. (If my wife and I eat the same thing at the same time and get food borne illness, she will feel the effects in an hour. I wont know it until 8 hours later.) If, and thats a big if, it got past my stomach, it will still act as an inflammatory agent.

Keeping in mind even though aspirin is considered an ANTI inflammatory agent... it can create inflammation and damage to the stomach lining and intestinal wall through excessive use, hence the enteric coating.

I'm not down on aspirin as a remedy for temporary pain relief or even emergency blood thinning in case of a heart blockage... but daily aspirin regimen is not practical for me.

Before all this happened, my GP was concerned about a prothrombin gene mutation. But it is only one of two markers, so that puts me at moderate risk for DVT and pulmonary embolism. As it is I am always on the lookout for anti-inflammatory naturopathic blood thinners, such as ginger, wanting to steer clear of major meds like Warfarin and Xarelto unless absolutely necessary.

I am guessing that Vasco needed blood thinners at the time to speed healing during his radiation bouts by delivering adequate blood circulation through the affected area. So I 'm still looking for suggestions beyond aspirin and meds... though this may not be the forum for  it.

Something I should mention to anyone reading this... Watch for Vitamin K, the clotting agent, in your multi vitamin, even the over-50 ones. There is plenty of K in a wide range of foods sufficient to clot blood. It does not need to be supplemented unless you have a ridiculous processed food junk diet.

Keeping in mind this is all my opinion only.

 

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