New member's husband has elevated PSA after two rounds of antibiotics and a negative biopsy.

I'm no doctor, but it's quite possible that your husband has prostatitis. Typically, antibiotics are prescribed first, but as I understand it they're not always effective. In general, a sharp rise in PSA like your husband's is a symptom of infection, as opposed to PCa, which typically ramps up steadily, but slowly over a period a period of time. (There are exceptions to this, of course.)

I think your uro's plan makes sense--this is something that you definitely want to monitor, but you've taken all the typical actions at this point. And while I think it's more likely than not than your husband does not have cancer, keep in mind that even if he did PCa is generally very slow growing and waiting a matter of months for your next steps wouldn't really matter.

Hang in there and enjoy the New Year!

Thank you, Michael T. We pretty much ruled out this being an infection after the first antibiotic didn’t lower J’s PSA. Also, the urologist told us most people with an infection have symptoms. My husband has no symptoms. We got more concerned when the second PSA test came back 7 (1 point higher than the previous test). Your words are reassuring, however. Hopefully this is only an infection & not PC. You have a good new year as well.

I did not know that, Allen. Thank you. We were under the impression this wasn’t an infection because the PSA number is still high. Also, to answer your question, no signs of inflammation were noted, hence the concern. There is so much conflicting info online, you don’t know what to believe. Thanks again.

Thank you, Peter. Everyone has been so gracious here. I’m glad I found this site. I’ll try not to complain too much. Just to clarify, our PCP was the one who initially thought this was an infection. It was the urologist who was leaning toward PC because of the big jump in J’s PSA. I researched, and from what I understand, there are 3 things that can cause PSA levels to rise: infection, BPH, & PC. We ruled out infection after the urologist told us that most men with Prostatitis have symptoms. He also said there’s usually inflammation, neither of which my husband has. The urologist told us the same for BPH. Of course when your mind is racing, you think the worst. Add the rise in PSA from 6 to 7 in a matter of 2 weeks, you panick. Then, because of the holidays, we had to wait over 2 weeks for the biopsy results, & at the office because the computers were down, we waited over an hour to see the dr to get the results which were on the computer. The waiting was the hardest part, & now the unknown, but I’m sure you can all relate to some degree. I truly appreciate everyone’s words of encouragement. Peter, I will take your suggestion & research Chronic Nonbacterial Prostatitis & PHI. Isn’t there also something called Free PSA? I know I came across that term somewhere in my reading.

Allen, thank you for breaking this down for me. What you said makes a lot more sense now. Peter, I skimmed through the article you sent me, & I’ll make sure to show my husband when he gets home. This info is very helpful. Thank you also to the person who titled my post. Somehow I overlooked that. Much appreciated.

Funnest video clip of 2018 so far! (And nice analogy Peter. I might have to borrow that some time...)

Thanks for the laugh, Peter.

I don't know if you saw my post from earlier today J's wife, but it sounds like your husband is where I was about 2 years ago. I'm no closer to knowing what is causing my PSA to rise, but I also feel fine and live every day like nothing is wrong.

Hi J's wife and J-
I post only to relate my experience, and I say at the outset, my case is very atypical (or as my URO said ".... we never see that..."). He also said "...some guys just run hot on PSA..." as we were trying to figure out my high PSA values over a period of about 2-3 years. So my path in the early days parallels the one you travel now.

My story below is not meant to scare, but I do want to emphasize one point- DO NOT PASS on the MRI of the prostate (and do not get another biopsy without benefit of an MRI to guide the process).

It was about 2012-13 that my PSA came back at 6+. I always got a PSA in a lab draw for an annual wellness check at work. I was referred to a URO, got a standard 12-core biopsy (was negative), and then I was followed every 6-8 months by a visit to the URO and a PSA check. about 1 year later, PSA up to 14!- time for a second biopsy, this time with 19 cores, and this too was negative. Unfortunately, the use of MRI to detect PC lesions was not standard of care then- but it was apparent that I did have BPH as well, so the URO put me on finasteride (Proscar) which should shrink the prostate.

After a few months on Proscar, my PSA should go down with the shrinking prostate, but if it remains high, that would be a suggestive red flag-

next visit (6-8 months between visits), PSA = 11+
next visit, PSA = 6+ (in the summertime of 2015)
going in right direction, DREs are all normal, no symptoms to speak of....

except going into fall and winter, I have occasional hypotension episodes, generally not feeling well, some sense of episodic abdominal discomfort, occasional chest tightness on exertion-

Early March 2016- chest thoracic/abdominal discomfort + hypotension + stress drives me to the ER; a full cardiac work-up, stress test and angiocath, shows no reason for my symptoms.

1 week later, as an afterthought really, I do my URO checK- my PSA is at 19+!!

time for another biopsy, but now we will precede that with an MRI to guide core sampling if possible.

MRI result: 4 independent zones evaluated as PIRADS 5 (x3) and PIRADS 4 (x1)

30+ cores later, 3 zones of Gleason 10 and one zone of Gleason 8 (5+3) within the prostate.
Scan and CT follow of course, no bone or visceral mets, but retroperitoneal (and pelvic) lymphadenopathy shows clear metastasis-

Diagnosed by May 2016 with de novo metastatic PC, surgery and radiation therapy are not treatment options, I begin ADT and other systemic therapies, but that is another story and still in progress of course.

who knows what my outcome could have been if MRI was used as a diagnostic back when I first hit 14 on the PSA. Timing is everything, especially cancer patients watching new therapies and diagnostics appear on a monthly basis, and realizing, nope- too late for that for me.

trying not to be a downer here for you, just informational; I really am enjoying each day as it comes, BUT-

(1) numbers are in your favor BIG TIME, so try not to stress out; it is like how much do you worry about a place crash every time you fly- mostly you don't, so be happy for now;

(2) your URO plan for the MRI if numbers are high or higher is good practice in my opinion; another biopsy without MRI guidance? well, miss rate on biopsies is significant when lesions are small; hopefully it can eliminate any surprises like mine. And this is a big point for your stress issue I think- know that, if there is a problem (1% or less chance I think) you will very likely catch it early and treatable in the MRI guided biopsy- and you are likely to be in that 99% still alive at 10 yrs; things are good!

good luck to you both- I know very well the stresses of pending diagnostic results in PC; in fact, my stresses were greater and more disruptive over the first year of this journey than they are now. After a while, things just callous over and it is easier to enjoy that which we have access to each day.

keep on fightin'

rf

Thank you, rockyfords & three 5’s & a jack. It helps to read others’ stories & know we’re not alone in this process. I wish you both well. Rockyfords, my husband will definitely have the mri should it be needed. The uro originally thought PC, but after the biopsy results, he said if there is a small lesion, it could take years to develop into something serious. The biggest question I ask myself is, could the biopsy have missed something? I admit, though, once the 12 cores came back negative, we were both hugely relieved. I find comfort in the hope that if this is, or ever turns into, something bad, we caught it early.

I went through 10 years of rising psa 13 biopsies and psa tests every 3 months, so I understand how nerve racking this can be. It sound like prostititis as cancer is reflected by a slow and steady rise in psa. The newer MRIs are much better now and should be able to identify cancer in the transition zone or anterior which may be missed by a normal biopsy.

J’s Wife said...
Hi everyone. I hope you’re all doing well. I wanted to update you on my husband’s current situation. He recently had another PSA test done & the numbers came back lower. They were 7.2 in December, & now in May they’re down to 5.6. Today, my husband saw the urologist for a follow up appt. Originally, the dr said if the numbers are still high, he wanted to do an MRI, but now he wants my husband to wait 4 months & then have a 4 K test done. I’m not really sure how this test differs from a regular PSA test, but that’s the plan. After this, if the numbers are still high, the dr wants to do the MRI. So this is where we’re at now. We made a few changes since my last update. For one, we’re eating healthier & exercising more. To date, my husband has lost 6 pounds. I’m wondering if these changes have contributed to his lower numbers. Also, can anyone please explain the 4 K test to me & how it’s different from a regular PSA test?

This sounds like a reasonable course of action to me. First of all, the PSA has come down instead of continuing a slow. steady rise. Or any instead of any rise at all. This, combined with the original biopsy results, while no guarantee, is certainly a major result in your favor. If possible, you guys might want to just assume the best, relax and continue to keep an eye on it, as you and your doc are doing.

Also keep in mind that, more and more every day, guys that are actually diagnosed with PC take months to decide on what to do about it and many then end up doing nothing other than Active Surveillance, or watching it closely. These are the guys diagnosed with what is known as a low risk case, which is probably the majority of guys with PC. This group of "just watch it for now' do just as well over the next 15 or 20 years as the guys who have treatment. A fairly small % end up getting treated in a year or 2, some more 10 years later, and a bunch never get treated at all. Regardless of whether they end up with future treatment or not, these AS groups as a whole end up doing just as well as the low risk guys who get treatment immediately.

So bottom line for you guys: the above applies to guys actually diagnosed with low risk PC who choose to simply keep a close watch on it, and those results are excellent. You are not yet diagnosed with any PC at all, low risk or otherwise. And yet you are still keeping a close watch on it. Nothing else is needed. Until he is actually diagnosed, there is not anything else that needs to be done. Until proven otherwise, he is in the group with 90+% odds of never dying from PC, if he even actually has it.