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  • Acute Prostatitis, with recurrent high PSA after several months

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    Old 11-26-2019, 12:17 PM   #1
    Overthinker74
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    Unhappy Acute Prostatitis, with recurrent high PSA after several months

    Hello all,

    This is a terrific board, and I very much appreciate everyone's thoughtful comments and information. I have read so much in the recent weeks about this condition due to my own perplexing and concerning situation.

    To start, I am 45 years old and have likely since my 20's been someone who frequently has to urinate. I've gone to the doctor back in my later 20's and even been referred to a urologist once before without much input beyond practical recommendations about drinking at night and so on. He gave me a DRE back then and that was about it.

    Fast forward then to this summer in June and I came down with a low grade fever (about 100-101) and some even more difficult urination symptoms and went to the nearby clinic when after testing my urine (and identifying an infection), recommended I go to the ER. There, they performed a battery of tests including a CT scan, to assess whether or not there was an infective abcess on my prostate, diagnosed me as having acute bacterial prostatitis. The CT of my pelvic area confirmed inflammation to the prostate (through tissue stranding and trace pelvic fluid), but everything else looked good. After suffering terribly in bed for the next couple days, I felt much better afterwards. After about a 10 day prescription of antibiotics, I went to my primary care doctor for a follow-up. They decided to perform follow-up blood tests including a PSA after 3 weeks from my visit to the ER (about mid July). Those tests showed a very slightly lower RBC and WBC count, but most alarmingly, my PSA was at a 16. So, then they decided to recheck me in another 3 weeks in mid August figuring that my previous infection was still effecting my PSA. On that second test, my blood tests are improved across the board, but by PSA raises to almost 25! (I did realize that I still had some odd symptoms slowing resolving during this time including a heavier feeling in the rectum...)

    Obviously, I'm very concerned and am referred to a urologist. I visit them in a couple of weeks, and she reassures me and believes that I still have infection issues, so she prescribes 2 more 2 weeks of antibiotics, and directs me to return for a follow-up PSA about a week ago. That PSA test showed a reduction, but only back down to a 16. Almost all of my symptoms have resolved from the acute prostatitis issue in June, save for my urinary frequency that I've always had. (it's not terrible, but I probably urinate 6-9 times a day and maybe 1-2 times at night; on the upper end when I'm stressed) I was given a DRE which showed my prostate (and seminal vesicles) felt fine.

    Unfortunately, I've never had a baseline PSA test in my younger years, so I don't know what my PSA should look like, but obviously, even at a PSA which is 16, I'm concerned. I'm scheduled to have an MRI next month with a biopsy to follow. I know there are no answers at the present moment, but it's all just overwhelming at this point. My family on both sides has no history of PCa, and at 45y/o, I guess this took me for a loop.

    I'm trying to be positive and hopeful that maybe the prostatitis is lingering, or alternatively, if I have PCa, maybe I'm lucky that this was perhaps caught early? My mind tends to go in all sorts of directions unfortunately. I just seem in bad shape with a PSA this high. (i.e. 16-25-16)

    Thanks for allowing me to vent a little bit! I realize this can go in either direction at this point, but what a deal.

     
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    Old 11-29-2019, 11:22 AM   #2
    IADT3since2000
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    Re: Acute Prostatitis, with recurrent high PSA after several months

    Hi Overthinker 74 and welcome to the Board!

    It seems to me that you are getting good care, but itís hard to be calm when you are thinking of prostate cancer as a possible explanation for that elevated series of PSA readings.

    First of all, that substantial PSA decline from 25 to 16 pretty much proves, from my laymanís viewpoint, that infection is a major cause of your PSA elevation. There was a really remote chance, "remote" mainly because of the evidence of infection, that the increase from 16 to 25 in about a month could have been a very aggressive prostate cancer with a very short doubling time as cancer cells divided, reflected in the PSA, but cancer does not respond to antibiotics and just keeps increasing at an ďexponentialĒ rate, whereas your PSA fell, and fell substantially. PSA that stems from cancer doesnít fall, unless under treatment or management tactics. Infection/inflammation can easily raise PSA to high levels and do it fast. (The highest Iíve heard of is a PSA of 200, which later recovered to normal after an appropriate antibiotic was found.)

    It is good, of course, that the DRE result was fine.

    The MRI is a good next step. Iím thinking it will be a multiparametric MRI (mpMRI), but sometimes a regular MRI is done in your circumstances. I expect that the result of the scan will be continuing evidence of infection but not of prostate cancer. However, there is a possibility that you have both an infection AND prostate cancer. While antibiotic therapy clearly worked, sometimes more than one bacterium is causing the problem, and Iím thinking there is a strong possibility that one or more other bacteria were not eliminated by the antibiotic you were on; another possibility is that you just need to be on the antibiotic regimen for a longer time.

    Even if it turns out that you do have prostate cancer, with the technology we have these days survival prospects are outstanding for almost all patients, though some of us will experience some continuing burden, often quite tolerable, from side effects.

    Good luck!

     
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    Old 11-29-2019, 02:17 PM   #3
    Overthinker74
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    Re: Acute Prostatitis, with recurrent high PSA after several months

    I agree with your assessment and really appreciate your response. Of course Iím hopeful itís just a difficult infection, but after my review of a many studies (primarily on prostatitis and its impacts on PSA with PCa), itís still seems a little high as Iím certainly not in an acute bacterial stage (likely chronic?) and I think it should have fallen more ( or ďnormalizedĒ) after the last PSA 16 about 3 months ago.

    As much as I tell myself to be mentally and emotionally prepared for the PCa diagnosis, itís very hard to wrap my head around it. At this point, I guess Iím just a little hopeful that perhaps the infection has inflated the last PSA score slightly, which could slightly improve my prognosis assuming I do have it.

    My view of this disease is that itís lifelong challenge regardless of how well you responded to initial treatments and subsequent recurrences. Since the chemical recurrence rate appears relatively high (after analyzing likely scenarios with the Sloan Kettering risk calculators), the concept of vigilance hardly captures the situation. And wow, the wait between appointments, testing and results will be excruciating for someone like me, as they already have been.

    My wife and I are certainly anticipating negative news, obviously(probably me more than her). Itís very hard though. I just wish I started PSA testing earlier in my life, I guess, so as to be more personally aggressive in my health approach (like I am with everything else, as I eat almost no processed foods and mostly vegetables and fruit and exercise quite often). Iíll be the poster boy for why eating right, exercising being fit your whole life may not matter as much as some folks may suggest. Sorry for the vent! I do very much appreciate your thoughtful response, positivity, and kind words. Itís very helpful. All your contributions to this board are amazing(as Iíve read quite a bit).

    Thanks again.

     
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    IADT3since2000 (11-30-2019)
    Old 11-30-2019, 03:45 PM   #4
    IADT3since2000
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    Re: Acute Prostatitis, with recurrent high PSA after several months

    Hi again,

    I am a bit puzzled by your statement: "My view of this disease is that itís lifelong challenge regardless of how well you responded to initial treatments and subsequent recurrences. Since the chemical recurrence rate appears relatively high ...."

    These days, with modern management and therapy, my view is that recurrence rates are not relatively high with well-chosen therapy. On the flip side, cure rates strike me as quite high relative to other cancers. It may depend on the phrase "relatively high." For example, "intermediate-" and "high-risk" patients treated with an excellent radiation program can expect their recurrence risk to be "as low as" 20%, with some studies indicating even lower risk. To me, that is really good, though we would like it to go lower, which seems to be gradually happening as technology continues to improve. The context, for me personally, is that I expected for years that recurrence rates for high-risk cases would be well over 50%, so current rates look really good based on that viewing point.

    I am now at the 6 1/2 year point since a curative attempt with radiation, which appears to have been successful. I am now comfortable and relaxed about my situation, not feeling challenged, though I still have labs every three months and an exam every half year, and I employ some mild anti-recurrence tactics daily, now a normal, routine part of my lifestyle. I feel attentive, but not at battle stations, and that is probably how many of us feel after having no recurrence for a number of years after treatment. Should you turn out to have prostate cancer, that good outcome is probably what you will experience in time. It is naturally tough for you and your wife right now with those PSA alarm bells clanging. I expect the vast majority of us "veterans" remember those days well and are very glad to be past them. Hopefully, you will be able to relax soon, or, if necessary, after treatment.

    Again, good luck!

     
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