Negative Biopsy 6 months ago, F/U PSA spikes

Something's going on there. Good to get it checked out. The doubling time is a bit worrying.

Hang in there,
Andrew

Starr15,

I'm not a Uro-Pro, but I think you make a good assessment about asymptomatic prostatitis. You were humming along fine until after your biopsy. Maybe something got injected into your prostate. There are tests for prostatitis that involve prostate massage (like your PCA3 test). Also, sometimes the neutrophil (WBC) count gets elevated. It's often unresponsive to antibiotics these days. :-(

star15,

No particular advice here; it sounds like you have a pretty good grasp of your situation but, for what it's worth, I've been more-or-less exactly where you are. Here's my trajectory up to the point where my situation most resembles yours:

I met my urologist in the hospital where I was being treated for a prostate infection. My PSA was high, of course, but my urologist assured me that after the antibiotics knocked back the infection it would go way down. It went down some... but not enough. He put me on Avodart saying that would drive it down. Again, it dropped some... but not as much as expected. It started creeping up again. More antibiotics and a retest. It dropped but not enough. First biopsy. Negative. Six months later PSA is up some more. Free PSA is lousy but PCA3 is OK. Checked again in three months. Up again. Free PSA even worse. Second TRUS biopsy -- also negative. Starting to get tired of the process.

I think I may have left out a round of antibiotics and a retest somewhere. On both my negative biopsies the pathologist noted inflammation. I had some mild pelvic floor pain so my prostatitis was not altogether asymptomatic. I clearly has prostatitis that antibiotics didn't get rid of. My free PSA suggested that I might also have prostate cancer (50/50 as I recall) but two biopsies hadn't found it. The prostatitis made my PSA a bit whacky with zigs and zags that made calculating a doubling time difficult although it did seem to be trending upwards.

My signature tells the rest. Do stay on top of things.

Star15,

Re your questions:

What were your PCA3 scores? I dunno. I remember my urologist characterizing them as "OK" but I don't have a copy of those lab reports.

Did you ever have an MRI? Nope. Before surgery I was a very-low-volume GS7 (3+4) with a fairly high PSA (last pre-op PSA 8 something) but also with prostatitis and a huge prostate (shrunk to a mere 81g by Avodart). Higher Gleason tumors produce less PSA per gram of tumor than do Gleason 6 tumors.

Where in the gland was the Gleason 9? Anterior? Apex? The post-op pathology characterized the tumor as "Bilateral" and involving "virtually all of the apical half of the prostate, slides 1-14. There is no carcinoma in the basal half of the prostate (slides 15-38)." Extraprostatic extension was described as "Present, multifocal, left and right, anterior and posterior, apex and mid." The surgical margins were "Positive, Right apex, right mid anterior and posterior. Less than 1mm from left apex margin."

Sometimes anterior tumors are out of the reach of the TRUS biopsy. Maybe yours was, or it could have just occurred quickly. Who knows? I don't. It is hard to believe it wasn't growing briskly between the last (negative) biopsy (December, as I recall) and the surgery (mid June). The cancer that was described in the post-op pathology would have been hard to miss with a biopsy. I suspect it was mostly anterior before its final growth spurt.