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  • Rising PSA and antibiotics

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    Old 07-21-2006, 07:13 AM   #1
    Kurz
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    Question Rising PSA and antibiotics

    I am 59 and followed at a VA hospital regularly. Lab tests this spring showed rising PSA, it always had been around .5 or less, but this test showed 3.9, a follow-up test a week later showed 7.3 and another test over 8.

    Digital exam and ultrasound were negative. The care giver, a nurse practioner, decided to treat with a course of anti-biotics for 3 weeks. This did drive the PSA back down to 1.46 (not as low as it was) and recent PSA was 1.15.

    The NP said the anti-biotics did the trick and not to worry, I probably had an infection. I still have some mild symptoms (post void dribbling) and she recommended saw palmetto.

    Anyone care to comment on the adequacy of this treatment?

     
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    Old 07-21-2006, 08:01 AM   #2
    All_Sevens
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    Re: Rising PSA and antibiotics

    My recommendation is to get hooked up with a good urologist. First of all, I noticed you did not mention anything about this NP culturing a prostate fluid sample *before* starting you on antibiotics. Second, as I found out the hard way, it is not a matter of having an infection OR having cancer-- in my case I had both. It will be important for you to monitor your PSA closely, like at least every six months, under the care of a urologist, following this antibiotic treatment.

     
    Old 07-21-2006, 08:24 AM   #3
    Kurz
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    Re: Rising PSA and antibiotics

    Thanks, for the good advice. No there was no culture of prostate fluid prior to the antibiotics just a digital exam and ultrasound of bladder.

    I can get frequent PSA tests through the VA. I will monitor closely

     
    Old 07-21-2006, 08:46 AM   #4
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    Re: Rising PSA and antibiotics

    When you test again it might be a good idea to get a "free" PSA - if this is below 25% the cancer is there, they just haven't found it yet.

    Also, there should be no massaging of the prostate area 72 hr before PSA test - no bike riding, no sex, no heavy exercise and the digital exam should be done AFTER the blood is drawn for PSA.

    Good luck,
    Major

     
    Old 07-21-2006, 10:49 AM   #5
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    Re: Rising PSA and antibiotics

    My husband will be 68 in Aug. He had brachytherapy in 1999. He also had 25 external radiation treatments at that time. Last month his PSA went from it's normal 0.6 to 1.87. It has been stable for several years, but all of a sudden tripled. His urologist didn't even want to speak to him - just had his nurse tell him to come back in 6 months for another PSA. We called the oncologist my husband had in 1999 - he suggested it might be a PSA bump and told my husband to have another PSA test in 3 months. My husband told him that he was changing urologists because this one was not interested in his problem. Surprise, surprise, the urologist called the next day and said he understood that my husband had some concerns and had called the oncologist. He said they discussed it and decided to put him on antibiotics for 1 month (Bactrim), then do another PSA and go from there.
    My husband is on day 15 of the antibiotic. He will go back to the urologist to have the PSA test done when the antibiotic is through.
    BUT, we are changing urologists after that - no matter what the results. (see my posting below PSA Tripled in 6 months). My husband also called the Prostate Cancer Institute at the time of the last PSA test, and they have called back twice to check on him and told him to take the antibiotic but to get to a Brachytherapy Specialist no matter what his next PSA test shows.
    So my advice to you is to demand a PSA test every 3 months, and if it jumps again get to a Prostate cancer specialist ASAP. A urologist who is not a cancer specialist will let your rising PSA go too long before he does anything - a specialist will start looking for the cause right away.

     
    Old 07-24-2006, 12:25 PM   #6
    Kurz
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    Re: Rising PSA and antibiotics

    Thanks, more good advice. They won't do a "free" PSA here unless the basic PSA is over 7.0.

     
    Old 07-25-2006, 03:51 PM   #7
    sp11
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    Re: Rising PSA and antibiotics

    Quote:
    Originally Posted by Kurz
    Thanks, more good advice. They won't do a "free" PSA here unless the basic PSA is over 7.0.
    Then I personally would find a doctor who would do a "free" PSA. Just my opinion.

    Major

     
    Old 07-26-2006, 09:44 PM   #8
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    Re: Rising PSA and antibiotics

    My husband's PSA's climbed for a few years and we didn't think anything of it b/c we thought (as the lab values state) that 4 was the limit. (We didn't know a climb was a red flag) Hubby was declined for an insurance physical at age 49 with a PSA 4.7, free PSA 15%.

    Like you, the docs thought maybe a silent infection and gave him a month of antibiotics. The PSA did improve after that month, so they thought that confirmed an inflammation and gave us reassurance.

    A repeat was back up there, so they tried another month long course of antibiotics and even tho this one didn't do anything, we were given reassurance again and option to retest in 4 months. His free PSA's were dropping (which is bad), but docs felt biopsy was unnecessary - b/c still thought it was an inflammation. Said if I (being the wife, not the patient) absolutely insisted they do a biospy, they would, but thought we could wait for another retest and possibly a 3rd course of antibiotics.

    Husband did not have an enlarged prostate or any pain, but he did have occasional episodes of very bloody semen - which is a scary sight, but also thought to be linked to a prostatis /inflammation.

    PSA's went up steadily over a year and free PSA (which as mentioned should be over 25%) dropped from 15%, 11%, 8% to 5% before they agreed it was time for a biopsy.

    He did have cancer. He had a radical prostatectomy in June Gleason 3+4 =7, and cancer was scattered throughout both lobes, but still contained within the prostate. Whew!

    A free PSA test is cheaper than a biopsy. I would insist on the free PSA. Is your prostate enlarged? Don't panic, but do stay on top of it and remember, the doctor works for you. Insurance can get in the way, but your urologist should be able to help you around some glitches. I hope future testing is good news for you.

    Patrick Walsh's book "Surviving Prostate Cancer" is loaded with useful info, for anyone with prostate/ PSA issues. It's an easy read and helps make sense of a lot of the terminolgy, anatomy & physiology.

    You'll be in our prayers.
    LW

    Last edited by Lilacs&Lillies; 07-26-2006 at 09:47 PM.

     
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