Enlarged Prostate and a little scared.

New member. First post.

I recently had a CT w/ contrast of my abdomen that my urologist ordered while investigating 6-9 months ongoing symptoms such as increased urinary frequency (12-16 times a day), urinary urgency, dribbling and so on.
I'm 36 years old. When I saw my urologist, she did the DRE and said my prostate felt slightly enlarged. She did the normal urinalysis which came back normal. She then asked me to complete a 4 day voiding diary and ordered the CT.
My results came back for the CT. I haven't been able to get back in to see my urologist yet, but when I viewed my results online the abdomen all came back normal except for my prostate which stated "The prostate is enlarged measuring 6.0-cm in transverse diameter. Impression: Enlarged prostate as may be seen in the setting of prostatitis; however, neoplasm is not excluded. Recommend correlation with symptoms, physical exam findings, and laboratory analysis." I do have a follow up appointment scheduled.
Naturally, I'm quite concerned with the findings. My father died of PC just a few years ago, he was in his late 50's.
I've looked all over trying o find as much info as I can, but there just isn't much out there concerning enlarged prostate in my age.

I guess I came here hoping for some direction, encouragement, and education.

Is 6 cm big? Really anything to worry about? Most likely some infection or early onset BPH?

Zomglawlz,

Welcome to the forum. Sorry you have worries but glad you found us.

Usually, when we get guys in their thirties here we tell them it is unlikely that they have prostate cancer and that they should talk to their urologist about treating a prostate infection. I can't remember a time when we have been proven wrong. I have no doubt that that is the same advice we will give to you. With your family history you should keep an eye on things from here on out, but it remains very likely that you have a prostate infection that is causing your symptoms. Prostate cancer hardly ever presents any symptoms until is is quite advanced and that would be surprising in a guy your age.

Prostate infections can be hard to treat and have an annoying tendency to come back but with patience and the right antibiotics they can usually be cleared up. Do that first and then worry about your PSA -- prostatitis can cause enough PSA elevation to make the test nearly useless.

Z,
From the Ct scan they should be able to express the size of your prostate in cc. A normal prostate is about 25cc and larger prostates are usually due to benign BPH or prostate enlargement, which is very common. You psa should be equal to the size of your prostate in cc divided by 10, so a prostate size of 40 cc should have a psa of 4. Anything higher would be a concern. There are many drugs available to shrink the prostate, such as Adovart or Proscar.

If anyone has suggested Prostate Cancer without having asked for a PSA, ... well,

The comments so far have been spot-on. Welcome to HW, and I hope you'll not need to sign on long term.

Z,

The American Urological Association recently came out with a set of "guidelines" for PSA testing and they do not recommend screening men under 40 years old. I think your first urologist took those guidelines too much to heart. The intent is to stop urologists from routinely testing young men who are unlikely to have significant cancers to keep them from seeking out over-eager surgeons if their PSA result is a bit high.

But I don't think the AUA intended to rule out PSA testing for a patient who obviously has something going on and his doctors are trying to figure out what that might be.

If you PSA does come back high, be sure to talk to your doctor about other possible causes that might be ruled out before doing a biopsy. Often an elevated PSA in a young man will be caused by an occult infection. This is detected by a round of antibiotics and then a PSA retest. If the antibiotics make the PSA go down then an infection is the likely cause and a biopsy can be avoided.

Good luck. Keep us posted.

Zomglawlz,

You certainly have a lot to contend with. Have they ruled out an autoimmune disease?

I'm not a doctor, but I agree with your first urologist but for a different reason. A PSA will tell you nothing right now. With impeded urine flow, an enlarged prostate, and possible prostatitis, your PSA has got to be elevated - perhaps hugely. That will give you neither a useful baseline nor indicate risk of prostate cancer. So what use is that information to you right now, other than to give you yet another thing to worry about?

If your prostate is that large that it is impeding urine flow, your urologist may suggest a TURP to give you some relief. A TURP is when they ream out your urethra to widen it.

Have they started you on antibiotics against prostatitis? You may be fluoroquinoline-resistant (e.g., Cipro) if you've had antibiotic treatment for some of your other symptoms. Most often, prostatitis is not responsive to antibiotics, but they may want to give it a shot anyway. On the other hand, if you're having an autoimmune reaction, a cortisone shot may prove more useful.

It sounds like you need an expert diagnostician, like a Dr. House. Are you being seen at a tertiary care facility?

- Allen

I doubt you have PCa. It' possible of course, but extremely unlikely.

Glad you found the 2nd urologist. My brother in law (43) just fired his urologist because he refused to give him a PSA test after he requested it.

I doubt you'd be asked to do a biopsy right away even if your PSA is high. They probably run you through a course of antibiotics and then redo your PSA.

I had a cystoscopy years before my PCa. Frankly as far as I was concerned that was worse than anything I was subjected to while having surgery for PCa.

[quote]@HighlanderCFH thanks for relating your situation. The urologist is concerned about my prostate causing me worse symptoms. Currently I'm able to empty my bladder, I just have hesitation, and a weak sometimes split stream with a little leakage. I guess I was lucky in a way with developing sleep apnea after my injury. When I'm using my CPAP machine I don't have to get up in the middle of the night to take a leak. I'm not sure why it is like that, but according to the urologist it is common for the machine t prevent folks from the midnight head calls. Heck, I go 12-16 times during the day, it would drive me nuts if that continued through the night. Not to mention, I think I'd be pretty dehydrated.[quote]

Hey, before I post my new reply, please allow me to THANK YOU!!! for your service to our country.

Yeah, I had such horrible times with taking a leak. At one point, the nozzle on my garden hoze was getting jealous of the fine spray I was cursed with while standing at the toilet. At the same time, I had an impressive mental map of all the finest restrooms across my entire area because I had to go so often.

I was also haunted by never having that "empty bladder" feeling as I had to go in installments. 15-20 minutes at a time of standing there for several times trying to do what used to take 15-20 seconds. I'm glad to hear that you get a good night's sleep, but sorry to see that you have to go so many times during the day.

A few years ago, before my PC diagnosis, I was simply dealing with the BPH and was on Flomax. This worked great for 4-5 months, but eventually I either developed an immunity to its helpful effect or, most likely, my ever growing prostate simply became too much for the drug to help. So when I was dx'd with the PC, it was almost a blessing.

After the surgery, my doctor said my prostate was slightly over 98 grams -- and the average is around 25 grams. So my particular prostate was about 4x the normal size. It almost felt like that old time movie, "The Blob" was growing inside me.

Hopefully yours will never reach this size.

Good luck!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

Zomglawlz said...
I understand that my PSA test will come back elevated just due to the size of my prostate. The urologist that ordered the test explained that to me also. He wants to get a baseline for me as we'll as see if it is crazy high. He said if it comes back higher than he would expect based on just the size, then we will dig deeper.

There are a lot of causes of high PSA. One of them, and the one that probably has the biggest effect, is when the urine flow is restricted, as it definitely is with you. That can cause your PSA to increase 5-7 fold. If you have prostatitis as well, that will contribute another 5-7 fold increase. Moreover, PSA from these causes fluctuate widely. These large increases will be on top of the smaller increase from your enlarged prostate.

Therefore, any PSA reading you get now is not a baseline, and tells you no additional diagnostic information.

Zomglawlz said...
So far, no one has mentioned the use of antibiotics. I haven't been on antibiotics for quite some time.

This really surprised me. Although there are many kinds of prostatitis that will not respond to antibiotics, some will. Sometimes, one of your white blood cells - neutrophils - will get elevated as well. It certainly seems worth a try to do at least 10 days of Cipro. If that doesn't relieve your symptoms, there is a diagnostic tool called a "4-cup test" for prostatitis where they look at prostatic secretions in various catches of your urine.

I hope you will challenge your doctors and ask them about these things. I've found that being a good little soldier and not questioning doctors may not be a good strategy. Each of us is responsible for his own health. You've shown you understand this by your searching online for answers.

- Allen

Congratulations on those great numbers! I wish we all had them.

Although there are no data for men your age, the odds of PCa with those numbers is very very small, and if it were me, I'd put that completely out of my head.

Are they not looking at prostatitis as a possibility? Did your pathology report mention any chronic inflammation or hyperplasia? Did they examine a core for pathogens? Don't forget to keep a copy of all documents for your own files.

Uroxatrol is a kind of medicine called an alpha blocker. It won't shrink your prostate, but it will reduce the frequency and urgency when you have to pee. Uroxatral may cause "retrograde ejaculations" while you take it. This means you will not experience ejaculation at orgasm.

Good luck on your diagnostic roller coaster!

- Allen

If the Uroxatral doesn't work, try Rapaflo or any of several others - results are individual. Did your urologist say anything about bladder spasms as a possibility? There are drugs for that too.

The odds of having PCa with those numbers are far less than 1%. In fact, in one of the few PSA studies that included men your age, you are in the lowest quarter of PSA. Your 25-year risk of having a metastasis was found to be .1% -- you can pretty much rule out PCa for the rest of your life -- maybe have another PSA test at 65 if you want to. Your high % free PSA is also predictive of PCa-free life.
www.bmj.com/content/346/bmj.f2023?view=long&pmid=23596126

Sorry - I forgot you didn't have a biopsy - but do keep copies of your PSA results and any other tests you have. They become useful down the line.

Just a little follow up.
I had a urodynamic test done to help determine if my LUTS was from my enlarged prostate or possibly neurological in nature from my head injury. The results seem to indicate most of my LUTS is in fact neurological. I'm still taking my Uroxatral and Proscar. My urologist also started me on Detrol LA 4mg. My symptoms really didn't change much at all. My urologist then put me on Viagra 50mg daily. I'm not sure how that works, but my urgency has improved, which is a start.
Unfortunately, things may be a little more complicated as I was also recently diagnosed with POTS (Postural Orthostatic Tachycardia Syndrome) which is an Autonomic disorder that can also cause LUTS as well as many other of my ongoing medical problems, but requires a lot of fluids- so I guess it's a catch 22 on trying to get the LUTS under control.
At any rate, my prostate is still a big concern, it's just on the back burner for now. My urologist wants me to continue my meds indefinitely, and get annual exams and PSAs.

Zomglawlz,

I think if you posted your non-prostate symptoms at this site (http://forum.jackkruse.com/forum.php) in the Beginners Area, you might get some help on them. Most of us there are people with health problems that doctors have been unable to help us with. The doctor who runs the site is a neurosurgeon and he gets down to the cellular level, but the good news is you don't have to understand everything at that low level for his "prescriptions" to work.

His site doesn't replace a great doctor, but supplements them. If you do decide to post there, send me a pm (same name there) and I'll try to get a couple of people to take a look at it. When I read your symptoms, I immediately thought of one of the women on the site that has similar symptoms and has made amazing improvements over the last couple of years. She is now one of the moderators.

Note to mods - there is a pay feature to the site, but it is not required. Most of the information, including the forum, is free. You can buy a membership that gets you a monthly webinar and ability to post in the Ask Jack subforum, but all the other info is free.