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    Old 11-17-2016, 10:05 AM   #1
    Lumix48
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    PSA MRI and pain

    I am 49, and I am looking for help. I had PSA 3.7 11/14 after DRE at Mayo Clinic. Doctor said it is elevated, and rechecked again on 05/15 PSA 3.1. Both these times I did not know I must have no ejaculation for 48 hours. January 2016, I went to a local urologist, he did DRE and said normal, PSA 2.47 (after DRE?) Three weeks of Cipro PSA 2.5 Free PSA 29.2.
    Two months later I started to have pain under my right rib, and in my left hip. I went to ER and the X-rays did not see anything suspicious. Three weeks later I went to Mayo Clinic to see gastroenterologist for scheduled procedures (endoscopy and colonoscopy) and asked to be referred to urologist. Urologist did DRE (nothing suspicious, but boggy) and checked for infection by prostate massage, all negative. Did not order PSA, because of the colonoscopy test it would not give an accurate number. Ordered 3T MRI with rectal coil., which basically said some diffuse changes, most likely prostatitis. I was told to take warm baths and ibuprofen to reduce inflammation and recheck in six month. Five months later I stated to have back pain, so I contacted the Mayo doctor and was told to come for MRI test. My PSA is 2.5 10/2016 and Free PSA 25.6.
    Here is my MRI report.
    24-Oct-2016 07:58:00 Exam: MRI Prostate w&wo
    Indications: Elevated Prostate-Specific Antigen (PSA);Frequency
    Urinary
    ORIGINAL REPORT - 24-Oct-2016 10:54:00 GONDA
    EXAM: MRI Prostate w&wo IV contrast using endorectal coil.
    COMPARISON: MRI prostate 03/30/2016.
    IMPRESSION: Increased diffuse hyperenhancement and only mild
    diffusion restriction primarily seen throughout the peripheral zone
    and bilateral seminal vesicles, which most likely represents diffuse
    prostatitis and seminal vesiculitis in the setting of a decreasing
    serum PSA.
    PROSTATE: The prostate gland is again mildly enlarged and measures 35
    cc in volume. Mild nodular enlargement of the central gland consistent
    with benign prostatic hyperplasia.
    As correlated with exam of 03/30/2016, again seen is scattered T2
    hypointensities throughout the peripheral zone in both sides, most
    pronounced from the apex to the mid gland. Corresponding
    hyperperfusion and mild diffusion restriction are slightly more
    prominent than previously (series 801 image 57; series 31002 image 23;
    series 31200 image 21-23). These findings again most likely represent
    chronic prostatitis, although any underlying low grade tumor cannot be
    excluded.
    LOCAL STAGING: Extracapsular extension is absent. Mild symmetric wall
    thickening of the seminal vesicles with corresponding hyperperfusion,
    likely inflammatory. Seminal vesicle invasion is likely absent.
    LYMPH NODES: Nothing for suspicious nodes.
    BONES: Nothing for suspicious bone lesions. Degenerative changes of
    the spine.
    OTHER: Tiny presumed right renal cysts. Trabeculated urinary bladder
    wall. Colonic diverticulosis. Small fat-containing umbilical hernia.
    Electronically signed by:


    Mayo urologist told me to take Cipro for six weeks and let them know how I feel. I did not start Cipro yet.
    At this time I have pain in my shoulder and some weird warm feeling in my left ear, no pain under my right rib, and no pain in left hip. I am afraid I have mets already. No family history.

    What do you think about my situation, and what would you recommend I do next?
    Thank you very much.

    Ted.

     
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    Old 11-18-2016, 08:55 AM   #2
    Lumix48
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    Re: PSA MRI and pain

    I wonder if I should start six weeks course of CIPRO this time, knowing that all urine and prostate massage liquid were negative, I assume it is a non bacterial. Will it help? Last time I did three weeks, I noticed some improvement.

    I am also thinking about doing MRI reading second opinion, but at the same time I wonder if Mayo already has the best radiologists, and would I believe someone else more than those Mayo radiologists?

    Last edited by Lumix48; 11-18-2016 at 09:25 AM.

     
    Old 11-20-2016, 01:33 PM   #3
    IADT3since2000
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    Re: PSA MRI and pain

    Hi Ted,

    You know quite a bit more about prostate cancer and its diagnosis than I did back in 1999 when I was diagnosed with a challenging case. However, a little knowledge can cause a lot of needless anxiety, which I believe is your situation, along with the benefit of motivating us to get things checked out, as you have. While I knew very little at the beginning and have never had any enrolled medical education, I’ve been through the School of Hard Knocks for prostate cancer for nearly seventeen years now, which resulted in my paying a lot of attention to the disease. (I am now apparently cured with the aid of radiation and hormonal therapy in 2013.) Here are some selected key facts you mentioned in your initial post:

    “PSA 3.7 11/14 after DRE at Mayo Clinic. Doctor said it is elevated, and rechecked again on 05/15 PSA 3.1. Both these times I did not know I must have no ejaculation for 48 hours. January 2016, I went to a local urologist, he did DRE and said normal, PSA 2.47 (after DRE?) Three weeks of Cipro PSA 2.5 Free PSA 29.2…. Ordered 3T MRI with rectal coil., which basically said some diffuse changes, most likely prostatitis. I was told to take warm baths and ibuprofen to reduce inflammation and recheck in six month. Five months later I stated to have back pain, so I contacted the Mayo doctor and was told to come for MRI test. My PSA is 2.5 10/2016 and Free PSA 25.6…. PROSTATE: The prostate gland is again mildly enlarged and measures 35
    cc in volume. Mild nodular enlargement of the central gland consistent
    with benign prostatic hyperplasia….
    I am afraid I have mets already.”

    All of these facts are consistent with not having prostate cancer, let alone metastasis, though they do not absolutely rule out one of the exceedingly rare cases – a fraction of a percent – where such a presentation is for a patient with statistics like yours whose prostate cancer does not depend much for androgens (testosterone and dihydrotestosterone mainly) as fuel for the cancer.

    That’s from my now savvy layman’s standpoint. I suspect an expert prostate cancer doctor, many of them practicing at the highly regarded prostate cancer unit at the Mayo Clinic in Rochester (e.g. Dr. Eugene Kwon, MD), would be convinced that the extensive, highly sophisticated and effective work-up you have had for the prostate itself does rule out prostate cancer. After all, that highly effective 3 Tesla endo-rectal MRI found no prostate cancer but did find evidence of inflammation in the prostate, and that is in conjunction with a highly favorable profile/pattern of PSA and free-PSA results.

    You may not be aware that healthy prostate cells produce about .1 unit of PSA for every 10 cc of prostate tissue; since your prostate is 35 cc, the rule of thumb suggests that a PSA of 3.5 – well above your current PSA level - would be quite consistent with a prostate with no cancer, with the added consideration that infection and inflammation sometimes really boost the PSA even when cancer is totally absent, and even with that possible “handicap” your level looks good. Therefore, your recent PSAs are well within the range associated with a prostate with no cancer. (Another competing rule of thumb, with both based on research, suggests that a cc of non-cancerous PSA tissue produces .066 units of PSA, so 35 cc X .066 = 2.31, which is so close to your current value.) Moreover, your free PSA values rather strongly suggest the absence of cancer.

    Regarding your pain, I would be shocked and amazed if it turned out to be due to metastases from prostate cancer! Actually, I would be surprised if you turn out to have even mild prostate cancer in the near future. That said, there may be other causes that are important to figure out. I’m glad that some of your hip and rib pain has gone away.

    Chronic prostatitis can be hard to nail down and treat. Usually Cipro is used early in a try at knocking out the particular bacterium that is causing the problem. However, Cipro does not work on many of the bacteria that can cause prostatitis, so it may be necessary to try other antibiotics. I don’t feel I know enough about prostatitis to provide leads about whether and how long to take Cipro, or the side effects about which Jack has already commented and are worth some thought. I do know that many medications have long lists of side effects which in reality will only manifest in a small minority of patients as one or several more side effects, usually quite mild, with still fewer patients experiencing a particular side effect at a bothersome level, often with the option of discontinuing the problem medication and reversing the effect, and perhaps switching to an alternate tactic.

    I wish you luck with this, but I envy your treatment at the Mayo Clinic: you are in good hands.

     
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    Old 12-09-2016, 06:38 AM   #4
    Lumix48
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    Re: PSA MRI and pain

    Thank you to all who responded, I do appreciate your desire to help and share.
    I went to see a local doctor who (of course) did DRE (mildly enlarged, and normal) and sent me to PSA test, I said again, would it be accurate?, he said it will be close. It came back 2.7 with free PSA 22%. I asked him about pains I have in my shoulder, and back, he said we can do X ray of your shoulder, I doubt it will show anything. I asked is I can get a bone scan, and he said I do not have dx for that, and PET scan will not be paid by insurance if there is no dx prior to that. I asked him about 4k test, he said people have to pay like $600.00 and it does not really help. That is another doctor. He said i need to take UROXATRAL and he will see me in three weeks.
    I feel I am getting worse, I started to have pain in my right side under ribs, which goes to the left side as well. I do walking everyday 3-4 miles, eat healthy food, no alcohol, no smoking, no fast food. I take Omega 3 4000, Vitamin D 8000, Milk Thistle 700, pomegranate extract 800 and turmeric occasionally, drink green tea.

    I just do not know if i have mets already all over, or something else is killing me.
    What should I have done i did not, or what to do now?

     
    Old 12-09-2016, 01:13 PM   #5
    IADT3since2000
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    Re: PSA MRI and pain

    In my informed layman's view, your doctor is right about those scans. I would be amazed if an insurer would cover them in your circumstances, and I would be more amazed if they revealed any prostate cancer.

    However, something is causing you problems, and I hope you persist in finding out what it is. It's encouraging that your doctor wants to see you in three weeks to keep close track of how you are doing.

    Again, good luck!

    Last edited by IADT3since2000; 12-09-2016 at 01:17 PM. Reason: Added sentence re doctor keeping track shortly after posting.

     
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