12-08-2008, 07:11 PM
Senior Veteran (male)
Join Date: Nov 2007
Location: Annandale, VA, USA
Re: My Biopsy Was Negative But PSA Is Still High.
I'm adding some comments in green.
My impression from reading is that often it would feel normal even with prostatitis. Sometimes prostatitis causes an abnormal DRE. I know that from "A Primer on Prostate Cancer," page 41: "The DRE is used to: ... [three purposes listed, then ] Evaluate the possibility of prostatitis if the gland is highly tender and/or mushy." Also remember that the doctor can feel only part of the prostate during a DRE.
Originally Posted by builder
My PSA had gone from 4.4 to 5.7 in two months. Free PSA was 13%. It went up after I stopped taking an month of antibiotics. All that is you describe is consistent with prostatitis, in my experienced layman's opinion, including that low free PSA. But that does not guarantee the absence of cancer. It's possible you have a combination of both, and of course it's possible you have just prostatitis and no cancer.
I had to be off antibiotics one month also to get an accurate reading. I had a 12 core biopsy and no sign of cancer. ... Why can't doctors find a reason for the raised PSA levels? As of 2008 it is still impossible even for excellent doctors to nail down the cause of every case of prostatitis, let alone cure it - many cases are chronic, and some prostate cancers are so small that they cannot be found without a lot of luck. I read a summary of a presentation to doctors about the issue you are facing - trying to tease out prostatitis from cancer, and a key point it mentioned is that some bacteria that cause prostatitis are now resistant to medications. That means the doctor may no longer be able to confirm prostatitis if a certain medication does not cause a sharp drop in the PSA.
The DRE was normal. I read on here that some men found cancer on their second ot third biopsies. If it is missed on the biopsy, does this mean it is so small it was missed? It's possible it was so small that there was a very small chance for a biopsy probe to happen to find it, but it's also possible that it was large enough that it would have often been found but, by chance, was just missed. With 12 biopsy cores taken, probably with trans-rectal ultrasound as a guide, it seems likely that at least you don't have any large tumors in the prostate, if there are any at all.
There are at least a couple of ways to get a more precise look. One is a saturation biopsy with an abundance of cores - not just 15, or 18, or 21, but more like 40 to 100, depending on the size of the prostate, a technique described by the well known doctor Gary Onik, MD. Another technique is a color Doppler ultrasound guided biopsy, performed by one of the handful of experts in the country that has both the knowledge and the special equipment - not just any color Doppler ultrasound set-up will do. The tell-tale red color in the scan helps locate tumors that might otherwise be missed.
"Finasteride challenge," and some other techniques could also help clarify whether you are free of prostate cancer, as mentioned in other posts in similar threads on this board.
Have you thought of getting a PCAPlus test? That lengthier DRE/urine based test might give you peace of mind.
Are there men that go through their lives with elevated PSA and never get cancer? I have a strong impression that that is the case. BPH and, or prostatitis, as well as some other causes, can elevate PSA, in addition to prostate cancer.
If it were prostitis, would my DRE feel normal?
Hope this helps.