4K score question - Reoccurring Prostatitis - PSA Up and down - looking at maybe needing 2nd Biposis

Brand new to this forum. 50 years old. Have had 2 bad cases of prostatitis. First was in May16. second was in Sep16. On Tamsulosin 4mg daily since May16. 05Sep17 had a PSA done - 6.4. Went on antibiotics for 2 weeks. Redid PSA 28Oct17 after antibiotics - 2.04. DRE - was told nothing noteworthy except that I have a large prostate (36CC-measured with ultrasound).

Previously, In May16... came down with a UTI - was Septic (minor - 6 hour visit to ER). local Hospital (small-local) in Southern AZ diagnosed the UTI - turned out also to be an ESBL resistant E-Coli infection. Had to take a different antibiotic for a month to clear it. Mayo Clinic in Phoenix said it was prostititis. Have taken the flomax since. Apparently, was not emptying bladder completely due to Prostititis. Had almost no symptoms before I got very ill with the septis/UTI. PSA during annual physical in Apr16 was 2.77.

Going back further... AUG 2010, during Army retirement physical. PSA was 8.5. Was given antibiotics. PSa went back to below 3 a month later. Still had biopsis - all 12 cores negative. Looking back - not sure why I agreed to a biopsis. Between 2010 and May2016... no symptoms that I remember.

Symptoms since May 2016.... when things are good.... slightly reduced urine flow. slow start usually. weak stream sometimes - mostly at night when I wake up 2x/night to piss. Slow start after sex (2 min to piss on average afterwards). When things are bad like back in September - i get a low grade feeling all the time like I need to piss but there is nothing or little there when I try to go. No ED ever. Only issue I have now (seems like it's maybe permanent) is slight difficulty urinating at night or when I have to hold it... then I need to piss maybe 2 times within a few minutes to get rid of everything.

QUESTION: The Urologist now wants me to do the new 4K score test after my last PSA went back to 2.04. Only question is - is the test worth it from a diagnostic standpoint? My concern is that - given my history... if I get hit with future episodes of prostititis, or have high PSAs - will I be more apt to need to go and run out for a new biopsis? Biopses are a particular concern for me now, since I had an resistant bacterial infection. I am at a higher risk for resistant infections now given the previous one, and don't want to get cornered into biopses all the time.

Advice?

I am set up to do the 4k score in the next 2 weeks. Am told they'll still do a biopsis (local urologist)... if the 4K comes back over 7 which would indicate I need a biopsis - If I do have to get a biopsis, I plan to go to Mayo for an MRI first. I really want to avoid the biosis when/if I can due to risk of infection.

When my PSA came back 2.04 back in early November after antibiotics - thought I was in the clear.... til my local urologist called and said he wanted to do the 4k?????

I trust the local urologist as much as I trust the one at Mayo... just my gut. Just worried that the 4K will make me live under a shadow.

Any insights would be very very gratefully appreciated!!

Go Army!

Post Edited (InArizona) : 12/16/2017 8:12:22 AM (GMT-7)

Hi InArizona-

None of the PSA-based tests are all that specific for prostate cancer, but some are better than others. Prostate Health Index (PHI) and 4Kscore are the best of the PSA-based tests and are somewhat less skewed by prostatitis. PHI is the less expensive one, and unlike 4Kscore, is usually covered by insurance. You can ask for it instead. (There's a newer test called IsoPSA that I'm pretty sure insurance won't cover.)

There are a couple of non-PSA-based tests that may help prevent an unnecessary biopsy. PCA3 is indicated after a previous negative biopsy and checks for evidence of certain genetic components in the RNA. PCA3 is a urine test after a prostate massage. There's a rather expensive, non-covered test that combines PCA3 with another genetic indicator called TMPRSS2:ERG fusion- it's marketed as My Prostate Score (MiPS).

Select MDx is also a urine test after prostate massage and also looks at RNA. In early trials, it seems to predict aggressive disease very well. Check your insurance for coverage.

There are several other biomarker tests, but the costs can be very high and none are covered by medicare or most insurance.

If you should have another biopsy at some point, I think you should insist that they take a culture from your rectum to check exactly which resistant bacteria you have and select an appropriate antibiotic based on that.

In Arizona,

I can relate...I just had a 4K score of 7 (low risk group) and one of my Urologists still wants to do a biopsy...as Tall Allen commented...paraphrasing...why did he order it in the first place if he was not going to follow the recommendations of the results (a value below 7.5 "could" forego the biopsy but I guess as we all know...there are no absolutes in test results so he might be leaning on the side of caution because I am close to being in the next group which would be intermediary risk)? Regardless...went on 2 week Cipro regimen and just finished up recently...my urinary complaints have abated and I am feeling better. The urologist above will draw blood for a free and total this week. I needed to go to my general internist for an A1c test (12/7) and he included a total PSA which resulted in a value of 1.7 after the 2 weeks of antibiotic treatment (down from the last value taken and derived from the 4K which was 4.51...have been as high as 5.6...see history below). I have had several labs processing my PSA's since this whole thing started back around September...and...my internists numbers have all been lower then the other 3 labs (including the 4K lab)....so...it was suggested that my internist lab (Quest) may have issues with their results...I am happy with the 1.7 but still not sure about the reliability of the results and what could be a general (accepted) variation in values between labs...I guess I will find out this week when I have the re-test. I will ultimately be sticking with one lab prospectively...

Sept 11, 2016 (Internist...lab 1) 1.6
Sept 11, 2017 (Internist...lab 1)) 2.3…and then 1 month later…
Oct 12, 2017 (First Urologist seen...lab 2)… 5.6…and then 6 days later…
Oct 18, 2017 (Internist…lab 1) 2.5…and then 13 days later…
Oct 31, 2017 (First Urologist...lab 2)…4.68…then 10 days later...
Nov 9, 2017 (Second Opinion Urologist...lab 3)...5.4...then 12 days later
Nov 21, 2017 (Second Opinion Urologist…lab 4…4K lab )…4.51 derived from the 4K results just received…Free PSA %: 18%...then 16 days later...after 2 weeks of antibiotics...
Dec 7, 2017 (Internist...lab 1) 1.7...will be tested for free and total this week

...at this point I am just hoping I am dealing with an infection...I can definitely relate to all of your urinary tract symptoms...are you sure you are not just dealing with a recurrent case of prostatitis or UTI? The problem with this thing is it is hard to be sure...even...as I read...biopsy results can be misleading (false negatives)...you have come to the right place (this forum)...I am totally new to this too so my opinion is not worth much...good luck!

61yo...mpMRI...PI-Rads 2, PSA history above...BPH...DRE...described by one MD as hard and stiff...other MD, large but neg...

FINAL FOLLOW UP TO MY ORIGINAL POST - the first in this string above..............

Originally posted this back in December 17. Procrastinated getting the 4Kscore test done all through JAN and FEB. Had some mild BPH/prostititis symptoms -again- in FEB. Did my annual physical at the VA end of February at the end the month (FEB). PSA back up to 5.2. Had been 2.04 on the last check at the end of October (Down from 6.4 in early SEP after 2 weeks of antibiotics).

Finally did the 4Kscore test. Got the results back verbally yesterday (30MAR). 4KScore was 3. Have not yet seen the report - will go in Monday to speak to the Urologist. He says no biopsies is warranted - and based on all I've read, I agree. He is still suggesting I go to get an MRI.

I don't think I will - If ever I did have an indolent PC, I don't want to know. I'm satisfied with the 4Kscore of 3 - and now just want to put all the crap behind me. Been running up and down anxiety hill now since my military retirement physical in AUG 2010.

Prostititis symptoms are mostly gone - only at night, when my bladder is almost empty and have not had anything to drink in a few hours - then I'll occasionally feel like I am not emptying my bladder 100%. Still have slow start to urinate periodically, but never in the morning.

I'm 50, and my wife is 16 years younger than me. Aside from all this - I am in very good condition for my age... and just want to get back to living my life without worrying about PC. I'll post the actually 4Kscore numbers I guess when I see them Monday.

Bottom Line - felt great relief when I got the news my 4Kscore was a 3 - only 40% of the 7.5 cutoff (2.5x lower).

regards,