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My PSA is 10

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

i would like to ask your opinion. i took my psa on may 25th. the results came back today 10.84 my uro prescribed me with cipro, because he believes it may be an infection. i'm instructed to take it once every 12hrs for two weeks, then come back july 3rd. for another psa testing. from my understanding cipro don't always bring down the psa or doesn't do a good job of treating infections/inflammation. 

if you take a look at my signature, that would give you a good idea of my history. last friday, my urinalysis showed that i had leukocytes in my urine. the urine was taken for a culture, but came back negative. so, if the test came back negative, but the psa is ten, why would my uro think it may be an infection? if my psa was 7.74 in november, and 10.84 in may, that is a 3.1 spike. shouldn't that be a concern?

my uro also performed a dre after having blood drawn. he said everything felt smooth and normal with the exception of a slight enlargement. he went on to say that it was to be expected considering my age and that i have bph. 

what R your thoughts on this matter?

Grinder
Posts: 437
Joined: Mar 2017

Hi SW...

I can only speak from my own experience... and is only my opinion.

Did you have other symptom s of infection that would distinguish your elevated PSA scores from typical PSA rise due to BPH? Sudden bouts of infection of the prostate are called Acute Prostatitis.

Some symptoms of infection include a Urinary Tract Infection causing a painful burning sensation in the urethra when urinating. Also fever, nausea, and other symptoms of Prostatitis that are also common to bouts of influenza. Also, for me I could not feel the infection in the prostate since there is limited sensation in the prostate, BUT the surrounding tissue feels like there is a hot, feverish, soft enlarged ball pressing against other tissues and body parts.

But BPH is not caused by pathogens that cause inflammation. It is said to be caused by unnecessary over-replication of normal prostate cells causing the prostate to grow out of proportion. That causes the main symptom typical of both prostatitis and BPH... stricture and blockage of the urethra making urination difficult and sometimes impossible.

So if your symptoms do not include the prostatitis symptoms, it is  likely BPH is the culprit, and your urologist prescribed Cipro as a routine treatment in case it was infection.

However, I just learned recently that during the DRE, the top half is inaccessible to the inspection, and abnormalities could exist there undetected. That's not good!

Has your doctor said anything about a biopsy? If he/she is not concerned, they probably know best, but I would ask some of the ither guys on here if a PSA score of 10.84 justifies a biopsy for prostate cancer... I an inclined to think that it does, but I would wait to hear from other guys. Keep in mind a biopsy that tests positive for prostate cancer is not the end of the world... It just determines what treatment may be necessary, if any.

If you research it, you will discover that most men have cancerous prostate cells laying dormant in their prostates and dont know it, and it never affects them, but others have aggressive cancer that grows tumors in the prostate, can escape into surrounding tissue, and even metastasize. Only the biopsy and other detection methods will tell you that... not the DRE and PSA score.

If you read farther into this forum, and wait for responses from other guys, you can get a clearer picture of Prostate Cancer as opposed to Prostatitis and BPH.

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

some of my symptoms include

frequent urination, pelvic pain from holding my urine in my sleep, [not every morning], i believe i have experienced "the surrounding tissue feels like there is a hot, feverish, soft enlarged ball pressing against other tissues and body parts."

Grinder
Posts: 437
Joined: Mar 2017

One caveat I should mention... has your uro logist suggested a TURP?... " A transurethral resection of the prostate"... a surgical procedure that involves cutting away a section of the prostate...  a sort of roto-rooter of your prostatic urethra?

Just my opinion... but anyone who has a TURP procedure done sgould have a prostate cancer biopsy FIRST, so the patient doesnt have the misery and expense of the TURP procedure, only to have a prostatectomy or a SBRT destruction of the prostate a few months later anyway, because they had prostate cancer anyway. And I am personally suspicious that there are times when a previous TURP procedure interferes with cancer treatments later on.

But this is all my opinion, and you should get more input to your questions to get a bigger picture.

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

no. suggestion of the turp

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

I cannot add much to what Grinder has told you. I also think that your urologist prescribed Cipro as a routine to verify the cause of the high PSA. This is typical before a biopsy. I wonder your age but the PSA of a 60 yo man, with a normal size prostate gland, should not be higher than 2.60 ng/ml.

With such high PSA and a doubling time of 12 months, the biopsy is granted and it may provide you peace of mind.

Let's hope for a BHP reason alone.

Best,

VG

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

i'll be 45 in december

Clevelandguy
Posts: 415
Joined: Jun 2015

Hi SW1218,

Did your doctor mention anything about an MRI?  Seems like that would be a non invasive test to determine any suspicious activity in your Prostate.  If they do the MRI and then need to to a biopsy later they will know where to take the samples from and not just shoot in the dark.

Dave 3+4

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

hi, thanks for asking. yes, six months ago, the doc said if the PSA is at a 9 or above, he would prescribe meds. if the PSA won't budge or goes higher, he would recommend another MRI and based off those results, possibly a saturated biopsy. 

hopeful and opt...
Posts: 2218
Joined: Apr 2009

.

hopeful and opt...
Posts: 2218
Joined: Apr 2009

PCA3 test
This test is a ( only an indicator) urine gene test that is available. The test is a molecular biologic assay. This test has a specificity of 75% and a sensitivity of 57%. (What that means is that among 100 bad tumors, for example, they only can identify 75 of them. And among 100 good tumors, they identify them as bad in 57). The test is done by a doctor who does a DRE and vigorously massages the prostate; the patient gives urine and the results are sent to Bostwick Laboratories(the only laboratory that does this) for analysis.

The test is not invasive, and is an indicator for obtaining a biopsy.


So the way the results work, 35 is the magic number, so the less one score is below 35 the better. Mine was 8.3 "Prostatic cells are present but do not over express the PCA3 gene", "value of 35 or greater suggests a high likelihood of prostate cancer"

It is also stated that only a prostate biopsy can diagnose prostate cancer. The test's preformance has been established by Bostwick Laboratories. It should not be used as the sole evidence for or against the diagnosis of prstate cancer. Clinicco-patholological correlation is indicated.

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

sw... I wonder your race, and family history of prostate cancer, if any?

 

 

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

yes. in november, my uro said, if my psa is a 9 or above, and cipro won't bring it down, he may suggest another 3t mri. i had one last may and it turned out negative.

Regulator
Posts: 42
Joined: May 2018

Sw1218:

You've indicated that you had a 3T-MRI done "last May" that was reported as "negative" . . . does that mean May 2017 or last month (May 2018)? If it was performed over a year ago (in May 2017), it is likely (given your PSA trajectory), that your PSA was very low or maybe even undetectable at that time. It may also be true that the "slight enlargement" that your urologist has since discovered was not present at that time. But in the realm of prostate pathology, a full year is a long time, so if that first MRI was in-fact a 3T-MRI, and if it was in-fact "negative" (i.e., it didn't show that "slight enlargement"), then I agree wholeheartedly with 'Clevelandguy' above, that another 3T-MRI would be highly recommended, as it will provide a better picture of just what's going on 'now' (not a year ago), and it will have the very important added bonus of providing your urologist with a fairly precise guide to the key target spots to sample on the prostate, when the future biopsy procedure actually takes place.

When my own biopsy was performed earlier this year, only five (5) of the (12) total core samples were deemed "positive", but it is quite likely that the sampling simply missed other 'hot spots' because the urologist in my case was guided by ultrasoiund, which is a much less definitive and lower resolution technology.

Also, from what I've learned over the months, the antibiotic Cipro tends to have widely differing efficacy or mixed results in different people. For that very reason, urologists will often times prescribe it first to see if it results in a reduced PSA value, but if not, they may then follow it with something like Sulfamethoxazole/Trimethoprim just to be sure that the elevated PSA is not from an infection. So, you might want to ask your urologist about that and whether he/she would be willing to prescribe that too for a short period of time, before moving forward.

Good luck!

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

My 3T MRI was done, last year. My PSA was 7.2

Old Salt
Posts: 720
Joined: Aug 2014

A prostate MRI report gives probabilities of finding cancer. This probability is expressed as a PIRAD score. For instance, PIRAD5 indicates high probability. In the context of this thread, it would be useful to have more info regarding the MRI. 'Negative' just isn't good enough.

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

the PIRAD score was 1. it went on to say very low {clinically significant cancer is highly unlikely to be present}

Grinder
Posts: 437
Joined: Mar 2017

From what I understand, ciprofloxacin is commonly prescibed as the initial antibiotic because "last resort" antibiotics are held back to keep certain pathogens from becoming resistant to those last resort antibiotics. We are getting very close to "end stage" in the antibiotic war with pathogens where bacteria are evolving that will be resistant to all available antibiotics. 

So they won't prescribe the others, sometimes not at all, and sometimes not until they are sure cipro, like Regulator said, just isn't working.

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