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Any correlation between high PSA + hematospermia = extracapsular extension?

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Posted 3/15/2017 4:02 PM (GMT 0)
Any findings on this post surgery that members could share? I have two symptoms - psa at 20 (fairly consistent) and blood in the semen and have a biopsy grade of 3+4=7 much of the left side. Are there members here who have had similar symptoms and found that their cancer had gotten outside the prostate? Attempting to get an idea of probability of such for me. Maybe not enough folks had both symptoms but thought I'd ask.

The hematospermia has been pretty much a constant (some variability) since November. This despite courses of antibiotics. I would guess it could mean the cancer is extracapsular and could be a validator of my 'high risk' category per radiation oncologist. Though MRI didn't show anything.

Most recent psa at 20.5 as of 3/6.
Posted 3/15/2017 11:23 PM (GMT 0)

gene62 said...
Any findings on this post surgery that members could share? I have two symptoms - psa at 20 (fairly consistent) and blood in the semen and have a biopsy grade of 3+4=7 much of the left side.

If you had surgery, how could you have any semen at all? Yes, a PSA post-surgery of 20 probably means it's metastatic - what does the bone scan say? What were the pathology results?
Posted 3/15/2017 11:28 PM (GMT 0)
Sorry, maybe I'm not making sense...what I was asking was for those who had high psa + hematospermia prior to surgery...how often was it found post surgery that they had extracapsular extension. Guess it's not a question worth asking.
Posted 3/15/2017 11:31 PM (GMT 0)
hematospermia always occurs as a result of a biopsy, if that's what you're asking. PSA always increases post-biopsy - they have to wait awhile before doing another one.
Posted 3/16/2017 12:02 AM (GMT 0)
Wait a minute. What was your situation pre-surgery? What is the situation post-surgery?

If you are PSA 20 post-surgery you have some significant issues. If you were PSA pre-surgery, why would you have surgery?

Please make this very simple. What was your diagnoses? What was your treatment? And what is your current status?
Posted 3/16/2017 12:03 AM (GMT 0)

Tall Allen said...
hematospermia always occurs as a result of a biopsy, if that's what you're asking. PSA always increases post-biopsy - they have to wait awhile before doing another one.

No. I have had hematospermia for months. Before, during, and well after biopsy. I have had a pretty constant PSA over that same time - around 20. What I am asking is: for those who have combination of symptoms such as mine (prior to surgery) - has it been common for them to have extracapsular extension found during surgery.

Maybe I am being unclear - anyone else?
Posted 3/16/2017 12:06 AM (GMT 0)
I must be a really poor communicator. mad
Posted 3/16/2017 12:18 AM (GMT 0)
Your post was confusing but I think I understand it now. You're wondering if your post-biopsy hematospermia has any negative prognostic implications. No, it doesn't.

But if it's been going on for months, you may have a blood vessel that requires cauterizing. Is the blood bright red or is it brownish? If bright red, tell your urologist. If brownish, it will disappear - keep master bating to flush it out.
Posted 3/16/2017 12:49 AM (GMT 0)
Let me take a stab at understanding things.

Gene62 is considering surgery at Johns Hopkins but has not had it yet. He has a PSA of 20 now which is approximately the same as his (first?) PSA result 4 months ago. He has been told he is in a higher risk category, probably because of his elevated PSA. He had a biopsy a few months ago which found Gleason 7(3+4) disease, mostly on one side. He has had an MRI which did not seem to show anything outside of the organ.

He also has hemospermia which started four months ago prior to the biopsy and has persisted until the present. Possibly his cancer diagnosis happened because his uro was looking for a cause for his hemospermia. He is worried that the hemospermia might suggest some extracapsular involvement that the MRI simply didn't catch -- possibly, say, something with a seminal vesicle.

So, Gene, how did I do?
Posted 3/16/2017 1:18 AM (GMT 0)

PeterDisAbelard. said...
Let me take a stab at understanding things.

Gene62 is considering surgery at Johns Hopkins but has not had it yet. He has a PSA of 20 now which is approximately the same as his (first?) PSA result 4 months ago. He has been told he is in a higher risk category, probably because of his elevated PSA. He had a biopsy a few months ago which found Gleason 7(3+4) disease, mostly on one side. He has had an MRI which did not seem to show anything outside of the organ.

He also has hemospermia which started four months ago prior to the biopsy and has persisted until the present. Possibly his cancer diagnosis happened because his uro was looking for a cause for his hemospermia. He is worried that the hemospermia might suggest some extracapsular involvement that the MRI simply didn't catch -- possibly, say, something with a seminal vesicle.

So, Gene, how did I do?


You did great! Perfect. Couldn't have said it better myself tongue You must have been (are) an education professional who has had to interpret a lot of badly written papers.
Posted 3/16/2017 1:53 AM (GMT 0)
PDA- Thanks for interpreting that!

gene62- hematospermia that is not caused by a biopsy is, I think, most often caused by prostatitis or maybe just a broken blood vessel. Is it still bright red? What did your urologist say? Neither predicts for prostate cancer. But prostatitis is a probable cause of elevated PSA. Sometimes the pathologist can find evidence of acute or chronic prostatitis in the biopsy cores.
Posted 3/16/2017 2:11 AM (GMT 0)

Tall Allen said...
PDA- Thanks for interpreting that!

gene62- hematospermia that is not caused by a biopsy is, I think, most often caused by prostatitis or maybe just a broken blood vessel. Is it still bright red? What did your urologist say? Neither predicts for prostate cancer. But prostatitis is a probable cause of elevated PSA. Sometimes the pathologist can find evidence of acute or chronic prostatitis in the biopsy cores.


Pretty red lately but has varied from brownish tinged ejaculate to bright red. Currently more on the red side and a good bit of it. I do have some MRI evidence of chronic prostatitis.

Guess I'm also wondering how much these persistent symptoms might be driven by the prostatitis vs pc. But I'm aware it is pretty much impossible to say. Hence my question as to whether any study or anecdotal evidence to suggest strong link between these symptoms and extent of cancer.
Posted 3/16/2017 6:03 AM (GMT 0)
There is a strong link between those symptoms and prostatitis. I don't understand why you are trying to make a sow's ear out of a purse.
Posted 3/16/2017 3:57 PM (GMT 0)
Tall,

I suspect is goes something like this...

He went to his uro because he had blood in his semen. His uro said "Well, it could be several things. We'll do some tests to see what is causing it." His uro started monitoring his PSA and gave his antibiotics to see if that would drive his PSA down (indicating prostatitis). His PSA didn't particularly respond. His uro did a biopsy and the results came back Gleason 7(3+4) in two cores. His doctor said, "Well, there you go. You have prostate cancer. and appeared to lose interest in the hematospermia.

What the doctor thought he was saying was "You have prostate cancer and whatever is causing the hematospermia doesn't matter since prostate surgery will fix that too, whatever it is."

What Gene62 probably heard was "You have P R O S T A T E C A N C E R and that is what is causing the blood in your semen."

Gene62 may have known that hematospermia is a rather rare symptom of prostate cancer. He may not have known that in its early stages prostate cancer seldom has any symptoms -- all symptoms are rare symptoms.

So all this left him wondering "Is the rare sort of prostate cancer that causes blood in one's semen unusually bad?" It has proven a difficult question for us to answer since it is similar to asking if it hurts to be gored by a unicorn.

Perhaps we can reassure him the other way around. We have lots of guys on the forum who had cancer that had escaped from the capsule -- seminal vesicles, surrounding tissues -- and they don't seem to talk about blood in their semen except for that caused by biopsy.
Posted 3/16/2017 4:26 PM (GMT 0)
PDA-

A very likely explanation - very clearly put. I do miss your postings, which have become less frequent.
Posted 3/16/2017 6:53 PM (GMT 0)

PeterDisAbelard. said...

Perhaps we can reassure him the other way around. We have lots of guys on the forum who had cancer that had escaped from the capsule -- seminal vesicles, surrounding tissues -- and they don't seem to talk about blood in their semen except for that caused by biopsy.

Thanks for this - it is helpful.
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