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    Old 02-24-2022, 03:26 PM   #1
    IADT3since2000
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    Lightbulb The Role of Antibiotics in Assessing Causes of PSA Elevation

    All of us regular participants on this Board believe that early detection of prostate cancer is important for improving our odds of a good outcome.

    However, there is a sharp, ongoing disagreement on this Board regarding the role and value of antibiotics for some yet-undiagnosed patients who have unexplained elevation of PSA and a suggestion of infection. Some on this Board believe that antibiotics should play no role in assessing the causes of a patient's PSA elevation - "bad medicine," "a great, old myth", a tactic that just delays discovery of prostate cancer while adding no value. There are urologists who seem to agree as they do not try even a single antibiotic to explore an elevated PSA despite evidence of infection/inflammation.

    On the other hand, I, and some experts I have followed, are convinced this is an important matter because infection/inflammation, often bacterial based, frequently elevates PSA, and we are convinced that antibiotics are one way that doctors can sometimes sort out whether or not an elevation of PSA is due to cancer - often worth a try, depending on the circumstances. Naturally, I think I'm right - pretty confident. But sometimes I've been surprised to be wrong about things I thought I knew well. I suspect that's true of all of us. I want to nail this down, one way or the other.

    I hope none of us wants to encourage our fellow patients to undergo unnecessary procedures and treatment, and wise use of antibiotic testing is, I believe, one tool to cut down on such tactics. Who among us would advocate scalping to cure dandruff?

    Let's try to sort out which of these views is right, or to find a sound middle ground. I'm inviting anyone who has facts and insights to contribute. Please feel free to add significant issues.

    Here are some relevant issues to start with:

    Issue 1: How often is infection/inflammation the cause of PSA elevation?

    Issue 2: What is the proportion of PSA elevation due to infection/inflammation compared to elevation due to prostate cancer? (BPH, benign prostatic hypertrophy, should probably also be part of this discussion.)

    Issue 3: What, if anything, should a urologist due early on that might bear on infection for a patient with an elevated PSA?

    Issue 4: Is a fluctuating PSA (up, down, maybe repeated ups and downs) strong evidence of infection? Do other PSA result patterns suggest infection?

    Issue 5: How effective are urine samples at detecting infection?

    Issue 6: Does multiparametric MRI detect infection/inflammation if it exists?

    Issue 7: How challenging is it to use antibiotics to determine whether and how much infection/inflammation are elevating PSA?

    Issue 8: Are there better ways than antibiotics to discover whether patients with elevated PSAs and suspicion of infection actually have significant infection?

    Issue 9: Do antibiotics help to discover whether elevated PSA is due to inflammation that is not caused by infection?

    Issue 10: How often are antibiotics effective at alleviating infection/inflammation overall?

    Issue 11: Does clearing up infection improve the use of PSA to detect prostate cancer?

    Issue 12: Is there much research on these issues?

    Issue 13: Is trying antibiotics a wise course for urologists, and under what circumstances?

    Issue 14: If trying antibiotic therapy for an elevated PSA and suspicion of infection is wise, how should it be done?

    Issue 15: What proportion of urologists often uses antibiotics when a patient has a PSA elevation and a suggestion of infection/inflammation?

    Issue 16: What guidelines from authoritative groups are there for use of antibiotics to check for/counter infections?

    Issue 17: What do experts say about using antibiotics to find out why PSA is elevated? (Dr. JC Nickel, from Ontario, Canada, is a highly regarded expert in prostatitis and has been an author/co-author on many research articiles; he has also presented on prostatitis at an annual conference sponsored by the Prostate Cancer Research Institute, in 2017 if memory serves me right. I believe he was invited not because prostatitis is prostate cancer - it is not - but because prostatitis is of interest to the prostate cancer patient community.)

    Issue 18: Are there advantages from skipping antibiotics when circumstances suggest an infection as a cause of elevated PSA?

    Issue 19: Are those who advocate skipping appropriate antibiotic therapy actually discouraging PSA screening? (Actually, this is a rhetorical question as I already believe I know the right answer. Hint: for starters, check what the 2012 US Preventive Services Task Force, or Richard Ablin in his book "The Great Prostate Hoax", said about screening, PSA elevation and infections. This is kind of like a double banked pool shot.)

    Issue 20: Should we seek other medical opinion, change doctors, if the doctor chooses on the one hand to avoid antibiotic testing, or on the other hand to perform antibiotic testing when infection is suspected?

    So this looks complicated. But if we can sort it out, the recommendations to our fellow patients can be boiled down into a simple sentence or two, or, if looking into infection proves meaningless, which I very much doubt, omitted altogether.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    22 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 02-24-2022, 05:29 PM   #2
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    Good topic, Jim.

    I have read that 90 percent of prostate inflammation is due to chronic nonbacterial prostatitis. As that malady is not responsive to antibiotics, the benefit of a course of meds is further thrown into question. But, most urologists seem to prescribe them as an initial screening step.

    Our current diagnostic tools can use a lot of improvement.

     
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    Old 02-25-2022, 04:40 AM   #3
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    Studies have shown the PSA movement after a course of antibiotics is no different than the control group

     
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    Old 02-25-2022, 08:44 AM   #4
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    Quote:
    Originally Posted by Prostatefree View Post
    Studies have shown the PSA movement after a course of antibiotics is no different than the control group
    If such studies exist, I believe they must have been poorly done. Please give us citations of the studies.

    Jim

     
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    Old 02-25-2022, 11:13 AM   #5
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    Here is a PubMed (www.pubmed.gov) search that produced 28 results, which I've begun to look at: (PSA[Title]) AND (prostatitis[Title]) .

    Jim

     
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    Old 02-25-2022, 11:29 AM   #6
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    Do antibiotics decrease prostate-specific antigen levels and reduce the need for prostate biopsy in type IV prostatitis? A systematic literature review (2018)

    https://pubmed.ncbi.nlm.nih.gov/29173276/

    "Conclusions: The available evidence does not support antibiotic therapy for differentiation between benign and malignant cause of elevated PSA in men with type IV [asymptomatic] prostatitis."
    __________________
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    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
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    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
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    Old 02-25-2022, 05:22 PM   #7
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    Thanks very much, Djin.

    I have scanned the paper, and it provides a helpful list of references relevant to this thread. That is going to help.

    As for the study itself, a favorable impact of antibiotics fell just short of "statistical significance", meaning there is not greater than a 95% probability that the results are not due to chance (yes, double negatives are common in statistics), and that is reason enough for the authors to state that that the study does not support use of antibiotics. (Here, the probability was only 94.5% that the results were real and not due to chance.) Even if the results did reach "significance", I would have been suspicious because this is a meta study. Unfortunately, I've heard hard pressed doctors state that they often look just at the conclusions of studies, if they even have time to read relevant studies at all.

    Moreover, this is a meta study that winnows published studies per criteria and then sums results. I like that kind of study for providing leads, but I don't like that kind for results, favorable or unfavorable, because you so often get a serious apples versus oranges problem. Also, a handful of the referenced studies I checked used only one antibiotic or one class of antibiotic - fine for the particular study, and often with a favorable impact, but, given the difficulty of finding the right antibiotic, or even if the prostatitis is bacterially based, not at all definitive.

    I hope to find time to look into this study and its component studies more thoroughly.

    Jim

     
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    Old 02-26-2022, 12:57 PM   #8
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    Not the issue for this thread, but interesting: No Significant Impact on PSA for ALL Incoming Patients When Treated with Antibiotics
    (Contrast with focus of this thread: antibiotics for patients where infection/inflammation is suspected.)

    As stated in Post #1, the objective of this thread is to explore "the role and value of antibiotics for some yet-undiagnosed patients who have unexplained elevation of PSA and a suggestion of infection". In contrast to this less certain area, there seems to be a consensus among experts that treating all patients with newly elevated PSAs is not wise, not worth it.

    The following meta study paper provides pretty good evidence that treating all patients is not effective. While the results the study records and associated statistics do suggest that some patients are benefiting, overall the benefit washes out, and antibiotics do have some side effects - mild when properly managed, and cost (not just the medications but also the medical management cost and lost time/added effort for the patient).

    Urol Oncol. 2015 May;33(5):201.e17-24. doi: 10.1016/j.urolonc.2015.02.001. Epub 2015 Mar 7.
    "Antibiotics may not decrease prostate-specific antigen levels or prevent unnecessary prostate biopsy in patients with moderately increased prostate-specific antigen levels: A meta-analysis" https://pubmed.ncbi.nlm.nih.gov/25752230/

    Jim

     
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    Old 02-27-2022, 08:25 AM   #9
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    A significant side effect of an indiscriminate use of antibiotics is the increased risk of resistant bacteria. Even worse is doing this to men who may need a future biopsy, radiation or surgical treatments to their prostate and bladder.

    And then, the mechanism of confirmation bias, a man who's PSA randomly drops with a course of antibiotics will be tempted to make it mean he is not at risk for cancer in the face of a rising PSA and use it to put off a biopsy.

    Finally, bacterial infections of the prostate are uncommon. Test for it first if you have a concern.

    Drink plenty of water. I drink one hundred ounces a day of non-alcoholic, low/no caffeine, no sugar or dairy beverages.

    One temptation to those dealing with incontinence and/or poor urine flow is to unconsciously, or consciously, drink less causing chronic dehydration and increased risk of the problems that come with it. One of which is urinary tract infection. Another is a mental decline and lethargy.

     
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    Old 02-27-2022, 11:24 AM   #10
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    Type IV Prostatitis AND PSA Elevation: Extent, Location and Aggressiveness of Type IV Prostatitis Affects PSA - Greater Impact When Factors Are Greater

    The bottom line: the title kind of says it - the greater the inflammation, the higher the PSA even when there is no prrostate cancer.

    First some background: Types of Prostatitis. I know a lot about prostate cancer, but I'm closer to being a beginner regarding prostatitis. I have just learned that prostatitis is divided into four types, and Type IV, which means inflammatory prostatitis with no symptoms, is the type probably of greatest interest as related to PSA elevation, at least that's the way it seems to me right now. The other types are Type 1, acute prostatitis, which is painful and requires urgent medical attention in its own right, regardless of prostate cancer. Type II is "chronic bacterial prostatitis, ongoing or recurring bacterial infection usually with less severe symptoms"; it seems to me that this type too would cause a patient to get care to manage the symptoms, and though less frequent than Type IV, would involve elevation of PSA . Type III is "chronic prostatitis/chronic pelvic pain syndrome, ongoing or recurring pelvic pain and urinary tract symptoms with no evidence of infection". Maybe Type III would also be of interest here, though the "no evidence of infection" part of the definition suggests that infection, and therefore antibiotics, would not be involved very often.

    The following medical research paper focuses on PSA elevation in patients with Type IV prostatitis but no prostate cancer: "Aggressiveness and extent of prostatic inflammation relates with serum PSA levels in type IV prostatitis". Actually, their study looks at a combination of prostatitis and BPH but no cancer. While it would be nice to have a view of pure prostatitis on its own, the combination with some BPH is likely the more realistic scenario.

    Here is the source, fortunately translated from Chinese by the staff at the US National Library of Medicine: Zhonghua Nan Ke Xue
    . 2012 Aug;18(8):710-4. [Aggressiveness and extent of prostatic inflammation relates with serum PSA levels in type IV prostatitis][Article in Chinese] Li-Bo Man 1, Gui-Zhong Li, Guang-Lin Huang, Jian-Wei Wang, Bao-Yue LiuT The abstract is available at:https://pubmed.ncbi.nlm.nih.gov/22934516/

    What the authors did was to do a transrectal ultrasound-guided prostate biopsy for each of 120 patients suspected of prostate cancer, I'm guessing "suspected" because of elevated PSA, and they then included in their study only those with benign prostate hyperplasia (BPH) and prostatitis (n = 46), excluding the cases with prostate cancer and those with BPH but no prostatitis. That means there was undoubtedly some contribution to elevated PSA from BPH as well as from prostatitis for these 46 patients, but to the best of their ability they had minimized the contribution from cancer as their biopsy samples revealed no cancer.

    They then observed "We evaluated the relationship between prostatic inflammation and serum PSA levels based on the three-grade pathohistologic criteria for the extent, location and aggressiveness of prostatic inflammation. The serum tPSA levels, fPSA levels, % fPSA, and PSAD were compared among different groups." In other words, they used their biopsy results to determine whether there was cancer, BPH or inflammation, how much, and how aggressive (for inflammation). Their three grades for extent, location and aggressiveness of inflammation are not explained in the abstract; perhaps they are standard grades familiar to urologists.

    Note that results are given in microg/L (micrograms per liter). One microg/L equals one ng/mL, so the PSA levels are the same whichever unit is used and therefore are what we are used to.


    Highlights of what they found were:

    For "extent of inflammation":


    - that just over three quarters (76%, 35 of 46 cases) were the lowest level of extent of inflammation (Grade I) with only 15% being Grade II with the remaining 9% being Grade III; in other words, the vast majority of the cases had the mildest level of extent of inflammation;

    - PSA increased with each grade of extent of inflammation: the average for Grade I was 8.46 microg/L, for Grade II was 15.26 microg/L, and for Grade III was 21.05 microg/L;

    - free PSA increased with each grade of extent of inflammation: Grade I 1.75 microg/L; Grade II 2.54 microg/L; and Grade III 3.19 microg/L;

    - PSA Density (PSAD) increased with each Grade of extent of inflammation: Grade I 0.15; Grade II 0.26; and Grade III 0.42;

    - The foregoing differences between the grades of extent of inflammation were highly statistically significant, with no overlap in ranges for each grade for PSA, minimal overlap for free PSA, and minimal overlap for PSAD.

    For location of inflammation: The meaning of "location" was not clear from the abstract, so I am omitting results.

    For aggressiveness of inflammation:

    - 32 cases (70%) were Grade I, PSA of 8.37, free PSA of 1.76, and PSAD of 0.14;

    - 10 cases (22%) were Grade II, PSA of 13.30, free PSA of 3.27; and PSAD of 0.25;

    - and 4 (9%) cases were Grade III, PSA of 21.05, free PSA of 3.19, and PSAD of 0.42; and

    - and as with the extent of inflammation above, the foregoing differences between the grades of aggressiveness of inflammation were highly statistically significant, with no overlap in ranges for each grade for PSA, some overlap for free PSA, and minimal overlap for PSAD.

    Here is their "Conclusion: The aggressiveness and extent of prostatic inflammation in asymptomatic prostatitis patients are significantly correlated with the level of serum PSA, which may help pathologists to avoid unnecessary repeated biopsies for patients with high-grade prostatitis."

    My conclusion: If the results from this small study are true for all patients, then it's clear that both PSA and PSA Density are substantially influenced by inflammation (with some contribution from BPH in this study). For both extent of inflammation and aggressiveness of inflammation, the average PSA for the vast majority of patients - those with Grade 1 for either extent or aggressiveness, was 8, which would easily trigger a biopsy if infection/inflammation and BPH were not considered. Also, it is clear that infection/inflammation (with some BPH in this study) can greatly elevate PSA in a small minority of patients; 9% of patients with either Grade III extent or Grade III aggressiveness of inflammation (some BPH) had a PSA of 21. I've heard that a PSA of up to 50 due to infection/inflammation is not rare, and Dr. Gabe Merkin, MD, who had a radio show in the Washsington, DC area and a newsletter, reported the highest PSA due to infection/inflammation that he was aware of that was 200 before it returned to normal after treatment with the matching antibiotic.

    We know that not all such inflammation is caused by bacteria; indeed, the proportion that is bacterial may be fairly small, so more information is needed to sort out the proportion that could be targeted by antibiotics. However, because of the high incidence of prostatitis, even a fairly small proportion due to infection would amount to many patients.

    Also, this study is small, though it appears to have been well done. Being small limits our confidence in the results.

    This paper was one in a list of 28 papers resulting from a search of www.pubmed.gov with the string - (prostatitis[Title]) AND (PSA[Title]) .

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    22 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 02-27-2022, 11:42 AM   #11
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    Hi Prostatefree - some ageement, some puzzlement here. You wrote:

    Quote:
    Originally Posted by Prostatefree View Post
    A significant side effect of an indiscriminate use of antibiotics is the increased risk of resistant bacteria. Even worse is doing this to men who may need a future biopsy, radiation or surgical treatments to their prostate and bladder....
    The doctors I follow and I would agree with you that indiscriminant use of antibiotics is poor medical practice. Post #8 is in line with this thought as it shows that treating all patients with antibiotics who are suspected of possibly having prostate cancer is not effective. Indiscriminant use is not the subject of this thread.

    Quote:
    Originally Posted by Prostatefree View Post
    And then, the mechanism of confirmation bias, a man who's PSA randomly drops with a course of antibiotics will be tempted to make it mean he is not at risk for cancer in the face of a rising PSA and use it to put off a biopsy.
    Aren't the scenarios "randomly drops and "in the face of a rising PSA" inconsistent? They seem lumped together here.

    Quote:
    Originally Posted by Prostatefree View Post
    Finally, bacterial infections of the prostate are uncommon. Test for it first if you have a concern.
    THAT'S IT! YOU GOT IT! This is what this thread is about!

    Quote:
    Originally Posted by Prostatefree View Post
    Drink plenty of water. I drink one hundred ounces a day of non-alcoholic, low/no caffeine, no sugar or dairy beverages.

    One temptation to those dealing with incontinence and/or poor urine flow is to unconsciously, or consciously, drink less causing chronic dehydration and increased risk of the problems that come with it. One of which is urinary tract infection. Another is a mental decline and lethargy.
    I'm not sure whether the decline is temporary or long-term, but I agree with this, though a substantial amount of my 100 ounces is caffeinated green tea at breakfast. I'm not convinced that a modest amount of caffeine or alcohol makes a difference, and I've seen evidence of benefits from both.

    Jim

     
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    Old 03-04-2022, 10:33 AM   #12
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    BPH and Prostatitis

    Dr. JC Nickel, from Ontario, Canada, is one of the foremost experts on prostatitis. He is the lead author of the following paper.

    J C Nickel 1, J Downey, I Young, S Boag
    https://pubmed.ncbi.nlm.nih.gov/10571623/nnnn
    Looked at 80 eligible patients from 100 consecutive patients with BPH but no history or symptoms of prostatitis. The objective was to use tissue from TURPs to explore the extent, pattern and clinical significance of asymptomatic histological inflammation and latent infection (National Institute of Health Category IV prostatitis) in benign prostatic hyperplasia (BPH).

    "Conclusion: Prostatic inflammation is an extremely common histological finding in patients with symptoms of BPH who have no symptoms of prostatitis. There was no correlation between the degree and pattern of inflammation, catheterization, presence of bacteria, serum PSA or PSA density. The clinical significance of asymptomatic Category IV chronic prostatitis associated with BPH has yet to be determined."

    My comment: Many of these patients had some bacterial infection: "Of the prostate specimens, 44% showed bacterial growth (in 67% of the catheterized patients and 28% of those uncatheterized;" However, the extent of prostatitis found was very small on average: " the mean tissue surface area involved was only 1.1% of the total specimen". I suspect this small involvement was the reason for the lack of correlation with PSA and PSA density; any influence from infection would have been far eclipsed by influence from BPH. This suggests to me that using antibiotics to lower PSA and/or try to eliminate infection would not be of much use for men with BPH and an elevated PSA, at least for most patients. Perhaps antibiotics would be useful for men where the pattern of PSA results suggests infection and where the result of PSA divided by 10 is much larger than the size of the prostate, which would indicate that BPH is not accounting for a substantial amount of PSA elevation.

    The abstract at https://pubmed.ncbi.nlm.nih.gov/19936177/ for a 2009 Brazilian study is quite consistent with the foregoing Canadian (JC Nickel) study: a lot of inflammation for BPH patients, but no correlation of infection and PSA. My view: again, the BPH eclipses the amount of inflammation, which is likely very small, based on the Canadian (Nickel) study.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    22 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 03-09-2022, 12:16 PM   #13
    IADT3since2000
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    Join Date: Nov 2007
    Location: Fountain Valley, CA, USA
    Posts: 3,172
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    Re: The Role of Antibiotics in Assessing Causes of PSA Elevation

    Available Research on PSA Fluctuation Pre-Diagnosis

    The following search string on www.pubmed.gov resulted in a list of ten papers that look promising for understanding this topic:

    (PSA [title]) AND ((fluctuating [title]) OR (kinetics [title])) NOT (survival OR prostatectomy OR recurrence OR cryotherapy OR radiation OR radiotherapy OR metastatic OR ADT OR hormone)

    Jim

     
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