Hi and let me say I appreciate any and all help with the following.
I am 54 years old and have had PSA levels from 1.3 to 2.7 over the last 10 years. Last August it was 2.0.
April 12 , 2012- Woke up @ 2:00AM and could barely pee. Never had anything like this before! Fever, shaking, overall very sick. Dr. called in 3 weeks of Bactrim. He did a PSA after 3 weeks and PSA was 20.5. Wanted me back in one week for another PSA but I decided to try another DR. This one put me on 6 weeks of Cipro. After I was off the Cipro for 4 weeks he did a PSA and it was down to 8.8. Feeling fine now but he wants me to see a Urologist. I do not want to have a biopsy! Is it most likely that the PSA will continue to drop? I have heard that it can take many months for it to go down following a case of acute prostatitis. Any ideas from you folks? How should I tell the DR. I want to approach this? This episode came on like gangbusters. Could I still have an infection and be unaware of it? Since the PSA dropped 20.5 to 8.8 does this indicate an infection or cancer? Would the PSA drop with antibiotics if it were cancer? Thanks in advance!!
I applaud your disinclination to have a biopsy -- it's often the start of a slippery slope, and I think it's a great idea to rule out other causes of an elevated PSA first. You are right that the Cipro reduces the portion of PSA that came from bacterial causes. One indicator of residual bacterial prostatitis would be an elevated white blood cell (neutrophil) count, which involves only a simple blood test. They can also look for bacteria in the urine.
There are several other biomarkers that are more specific to prostate cancer than PSA is. These include % free PSA, PCA3 and -2ProPSA, which entail a blood test and a urine test after prostate massage. Was your DRE negative? Did it indicate enlargement of your prostate? If it did, you may have BPH as well, which can be treated with finasteride and rapaflo. The finasteride will reduce any of the PSA that is due to BPH.
If you've ruled out prostatitis and BPH as sources of elevated PSA, and it's still rising, a biopsy may be in order.
Many men your age (including my DH) can have Benign hypertrophy, which can cause high PSA's. If you have no other indications of cancer I would forgo the biopsy. There are meds that can reduce the inflammation, and thus lower the PSA. I would see a urologist as they will be more familiar with them.
My PSA stayed around 2-3 for many years (I’m 72) – last fall it was 2.9. But in Feb. I experienced a Urinary Tract Infection, had chills and fever for 3-4 days, and many increased “prostate problems”. My Urologist put me on Cipro for only 5 days, but I seemed “better”. But 2 months later my PSA test was 11!
After another 2 months, my PSA had dropped to 6.9. He suggested a biopsy and I declined (like you, I’m very leery of a biopsy for all its proven downsides, and in my mind, all the other possible problems it could cause that the medical community denies).
So for now I’m waiting another 2 months to see what the PSA does. This PSA thing is confusing beyond belief. Many books I’ve read (and many sources) state that for a guy my age, 0 – 6.5 is “normal”…(The charts say up to 3.5 / 3.8 for men in their 50’s is normal). When one considers that a PSA test can vary by up to 20%-30%, it is very difficult to know what to believe.
You pose a great question, (Would the PSA drop with antibiotics if it were cancer?) – I am also interested in hearing an answer! (Perhaps Tall Allen can address that specific question)?
I can tell you this, when I was investigating some imaging technologies on-line, I happened to tell a urologist that my PSA was recently 11, and is still “high” at 6.9, and perhaps I should have a biopsy – in his reply to me, he said … that if your PSA is not steadily rising, then you may be able to hold off for now on the biopsy. Seems to make sense to me.
You're right that many things affect the PSA test, including age, size of the prostate, the kind of assay used (use the same lab), if one has had sex or ridden a bicycle recently, or if one has been unusually sedentary (like a hospital stay). PSA density >.15ng/ml per gram of prostate tissue is sometimes used as a biopsy trigger. PSA velocity >.75ng/ml per year is sometimes used, and PSA doubling time of less than 3 years is sometimes used.
Acute bacterial prostatitis can increase PSA many times over its normal value. BPH can increase it too, but it is usually reflected in a slower increase. I believe that both of these should be ruled out before biopsy, unless there are other adverse signs like a hard, lumpy DRE or something suspicious is seen with imaging. If finasteride is used for BPH, a new more accurate baseline can be reestablished and tracked over time. As I said in post #2 above, Cipro (or other antibiotic) reduces the portion of PSA that came from bacterial causes.