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josequake 03-13-2018 06:59 AM

Changes in PSA/PC
Any advice or information will be greatly appreciated. My brother had PC at the age of 56. I'm 61. I've had prostates issues for the last 10 years(had TURP done about 5 years ago).PSA results, 4/1/17 PSA 4.5, 7/12/17 PSA 1.6, 3/12/18 PSA 6.1. Frequent urination and mild pain in lower back and pressure in the pelvic area. I live outside the USA and saw a urologist who told me I don't have PC. I'm confused and would like to go back to the USA for a second opinion. Any help from this forum will be appreciated. Thank you

IADT3since2000 03-14-2018 12:17 PM

Re: Changes in PSA/PC
Hi Jose and welcome to the Board! :)

I’m thinking your urologist strongly suspects infection is causing your fluctuating PSA results as those results are consistent with the classic pattern for prostate infections that wax and wane but [B][I][U][SIZE="4"]not[/SIZE][/U][/I][/B] with prostate cancer. Your symptoms too are consistent with infection, but they are also consistent with prostate cancer that is quite advanced, which is unlikely with your PSA results. However, even though it is very likely that there is some infection, that does not absolutely rule out also having prostate cancer. If you did, it would likely be either mild, or, in extremely rare cases, very aggressive and of a kind that does not make much if any PSA. Personally, I think you can relax, but not completely.

Provided your lab results are reliable, which is extremely probable but not absolutely certain as lab errors that are substantial are occasionally made, that pattern of going from 4.5 to 1.6 just three months later cannot be the result of cancer. That’s because cancer that is unaffected by treatment (which apparently you did not have, or possibly lifestyle changes) consistently doubles in a period of time that is individual for each patient, and for the vast majority of us that tumor growth is reflected in doubling of the PSA result; sometimes infection, benign growth or some other less-likely issues can partly mask the doubling. Prostate cancer is NOT associated with a substantial decline in the PSA score, like the decline that you experienced. On the other hand, infections typically resulted in an up-and-down pattern of PSA as the infection waxes and wanes. If it were me, I would want my PSA measured fairly frequently, such as every three months, for a while; if it continued that up and down pattern, I would concentrate on causes other than cancer.

Did your urologist do anything to try to determine whether you had an infection and to try to cure it? Usually they do some tests to see if they can identify a bacterium that is causing the infection, and/or they sometimes try giving you a course of an antibiotic that works against likely suspects. Fairly often infections are hard to pin down, and this trial and error approach can be repeated for different antibiotics. If it were me suffering the pain and discomfort you describe, I would insist on that approach and find a urologist who would work with me to try to find the cause. Why should you put up with continued pain and discomfort? :(

It is possible that a stealthy or very early prostate cancer could be hiding in the “smoke” created by the infection. That strikes me as quite unlikely, but it is something to keep in mind. Unfortunately, some of the additional tests for prostate cancer, such as the “free PSA” test, also respond to infection and become unreliable in its presence. That can be a problem when we don’t know for certain whether there is an infection. There are a number of tests that can help enhance PSA results, and the test mentioned previously is a good one. However, even it includes two components – total PSA and free PSA – that are strongly influenced by infection. You could have it done, but keep in mind that a positive (meaning unfavorable) result could be caused by infection and not cancer. On the other hand, if it resulted in a low score despite the possibility/likelihood of infection, that should give you great peace of mind. :angel:

Another approach is to take one of the two 5-alpha reductase inhibitor drugs (though not before you do a 4K test as that will rule out the test). The two drugs are finasteride/Proscar® (the earlier drug in this class and now fairly cheap) and dutasteride/Avodart® (the later and somewhat more powerful drug that works for most men who have suitable genetics, with finasteride working for the rest, also now generic and less costly than it once was). These drugs do three major things, and perhaps some others. The main thing is that they shrink the prostate, getting rid of or reducing the benign growth that most men experience as they grow older, which often becomes noticeable in the form of symptoms about your age. In other words, the drugs cause the prostate to shrink a bit. By doing so they eliminate PSA produced by those extra prostate cells, and that leaves just the original prostate cells (after puberty), more or less. That reduced PSA makes it easier to spot changes and trends in the PSA level that are associated with cancer, though infection can still cloud the pattern. Another important thing these drugs do is reduce the blood supply to the prostate, and that includes reducing the supply to any cancer that may be present. A third important thing is that they sharply curtail conversion of testosterone, the best known fuel for prostate cancer, to dihydrotestosterone (DHT), which is a far more potent fuel for prostate cancer; if you do have prostate cancer, that can help, even eliminating low-grade cancer for some men.:angel: For most of us the side effects of either drug are mild and/or favorable, such as helping us grow or regrow more scalp hair (me). For some of us there will be some unwanted side effects that may make it best to stop the drug. (I've been on one or the other of these drugs continuously since the fall of 2000; while I am confident that I have been cured of an aggressive form of prostate cancer, that drug is part of my shield against a recurrence.)

Finally, if competent doctors still are concerned that you may have cancer after looking into infection and benign growth, these days it is becoming common in many areas to have the patient scanned with a "multiparametric MRI" (mpMRI). This advanced scan gives results that help a lot in pushing a decision to biopsy one way or the other. The mpMRI is often quite helpful in deciding on the best therapy and making that therapy more effective. A biopsy is not that big a deal; it is quite but not absolutely safe, and problems can be prevented or resolved, in the few cases where they occur, fairly readily in almost all cases.

Good luck with this! :cool:

josequake 03-15-2018 10:59 AM

Re: Changes in PSA/PC

Thank you so much. Extremely helpful information.

josequake 03-23-2018 06:57 PM

Re: Changes in PSA/PC
Here is an update and again thank you for any advice. My urologist threw a very aggressive treatment to this thing. 10 Ceftriaxon injections(antibiotic),1 every 12 hours, 30 pill of flavoxato,(smooth muscle relaxer), 1 every 8 hours, 10 levofloxin pills(antibiotic), 1 every day for 10 days, 30 tamulson, 1 every night for 30 days. My trips to the bathroom are less than before the treatment, the pain and discomfort in the pelvic is less as well. Finished the 10 days treatment he wants me to get another PSA, Urine test, but not the common urine test. I think the urine is tested like for 3 days or so.And an ultra of the prostate, the type that a probe is inserted in the rectum. But definitely I feel much better. Any thoughts?. Again, thank you so much.

IADT3since2000 03-24-2018 01:41 PM

Re: Changes in PSA/PC
It looks like the doctor is aggressively going after what is likely infection. It's looking more likely because you are getting some relief. I like the doctor's approach.

Good luck on that next PSA test!

josequake 03-24-2018 03:15 PM

Re: Changes in PSA/PC
[QUOTE=IADT3since2000;5479661]It looks like the doctor is aggressively going after what is likely infection. It's looking more likely because you are getting some relief. I like the doctor's approach.

Good luck on that next PSA test![/QUOTE]
Thank you so much.

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