Psa rising in accordance my use of rectal medication for my proctitis

Hello to all, This is my post from the Ulcerative Colitis Forum and is was suggested to also post here. I can provide more info if needed. Thanks in advance

I have been on this roller coaster of a ride with my psa rising and trying to hold off on a biopsy. This has been going on for about 2 years now. I have lower left uc and proctitis which I manage with lialda and canasa. I am in remission now but had figured out that my proctitis was extremely low in the rectum and while I was taking my canasa nightly at bedtime I could not stop the bleeding. This went on for a year until I thought that maybe the canasa is not getting low enough in the rectum. I then thought maybe I can try taking it in the early evening while still on my feet which would keep the canasa lower. Would you know this work immediately. The problem is that In the past I had used the canasa on a as needed because it was expensive for me.

It will be 2 years this september when I started using canasa nightly. I had started it nightly at that time because I was scheduled for a colonoscopy that november and really wanted to have good results. The problem with my psa started in accordance with my use of the canasa daily. As a matter if fact I cant take it daily now because my body just does like it. Last winter I thought I had a urinary track infection and went to the emergency room and they had given me antibiotics but the urine test found nothing. I had discomfort while urinating and my crotch area ( seat) area was aching along it getting up at night to pee. I had told my gastro and he told me to back off the canasa and sure enough the symptoms of a urinary track infection went away over a few weeks time. Ot would indicate that too much canasa is not good for me. All this was prior to me figuring out that I had to take canasa standing up to get it to stay in the very lower rectum. I had gone back on nightly canasa and since then but has only been 2 weeks since switching to only taking my canasa every other night and things are fine uc and proctitis wise. The issue now is I believe anyways is that the canasa is the reason my psa test showed a rise to 5.8. My urologist of course wants me to get a biopsy done.

With all that said Is it fair for me to say that since I know the canasa can and has caused me urinary issues that it also can be the cause for my psa rising? I am on week 3 of every other night canasa and feel great but do notice the days I do the canasa I may dribble a tiny bit. The days I dont all us fine.

I had a 4kscore test done one year ago and it was 7. I also had a 3 t mri of the prostate which had a score of 3 which is (equivocal) in which they saw a small lesion in the transition zone. 3 meaning out of a score system from 1 to 5 3 being they were unable to say it is ir is not cancer. At that time my psa was 4.1.My urologist still of course recommended a biopsy but said it was not unreasonable to check back in 6 months. 6 months later snd still on daily canasa psa 4.8. 3 weeks ago and was still on daily canasa psa 5.8 and now 4kscore of 19. All the while he finds nothing on a dre. My recent percent free psa is 19 percent and the psa according the 4kscore test was 6.46 up from 3 weeks prior which was 5.8.

While this post is two sided and I will most likely post it also on the prostate cancer forum I would appreciate any feed back in regards to my rectal meds and proctitis and psa concern.

Thanks

Update:

Perhaps some of you can offer my your opinion on my situation which has changed for the better unexpectedly.

I have avoided a biopsy up to this point but I do have one scheduled for Nov 2. To recap my psa was rising over time and was last at around 6.5 this past May. My mpmri was performed in February of 2017 to see what the prostate looked like and to prepare for a potential biopsy. The MRI yielded a Pirads 3 leasion 1.4CM and some evidence of BPH on the base near the urethra.

I had a psa check again a couple months ago and it was still around 6.4. After seeing that I really thought it would be a good idea to have a biopsy. After talking to my urologist he stated that another MP mri would be neeed because they are only good for 6 months when used for biopsy with artemis. I would need another MRI done to get the new image. I had the MP mri done again last week and eagerly awaited the results expecting seeing no improvement and really expecting it to be more of a Pirads 4 now. To my surprise my PA called me and told he he had good news and that the mri came up clean normal. I asked so what what happened to the lesion and the bph they had found when comparing the image from Feb 2017. He said it may of been imflamation.


As a side note All the while and just prior to the last psa rading 2 months ago I had to switch my colitis oral med because it was causing me to many issues along with urinary symptoms. I have since eliminated all my symptoms including my urinary symptoms and feel so much better. I explained all this and of course have been telling my urologist the same thing but all the while he said in his 20 years he had never heard of this. I mentioned to the PA last week when talking about my new great MRI results how I know that the meds we causing me issues including urinary issues. I asked him if with this new MRI reading would now change the doctors decision on needing a biopsy and he stated that they still want me to get a biopsy. I then asked if It would be reasonable to get another Psa done in light of the good results on the mri and my change in meds and how good I have been feeling. He said That would only confuse things and that I came a long way and should just get the biopsy done. I had him confirm that with the urologist and he also said the same thing.


In the mean time I spoke about this to my wife and really thinks there would be no harm in getting another psa done to see what it looks like. I just got a call from my primary doctor and will see him friday and I know I can get him to do a psa test for my yearly checkup. He was the one who refered me to a urologist in the first place. I guess if a psa is still elevated or not coming back to normal then that would justify a biopsy? Or what do you all think?

I really am trying to avoid the biopsy especially now that I just had clean NORMAL mpmri. BTW this was a brand new 3T MRI machine with hardware according to the radiologist. She said this is the latest in MRI that she would be imaging me today with. They had just had this new machine installed only 2 months prior along with new PAD that gets placed over the top of you which was twice as fast and powerful from before. Also since the new MRI image was clean and normal there is nothing to target so the 6 month window is now irrelevant.


Any thoughts would be appreciated.

All the best

I'd get the PSA. If it's lower then the need for a biopsy could be questioned.

However, you do have two medical professionals suggesting you get it. There are worse things than a biopsy.

At the end of the day, it's your call on both points. You might also consider getting a PHI (prostate health index) test as that can provide more information than a simple PSA.

You've got a choice to make and there isn't a clear - "You have to do this" either way.

Andrew

Dx in July 2018, RALP Sept. 2018, 62
Have had Chrohn’s for 30 years, last 10 mostly in remission. My PSA has been all over the place the last three years. The low was 3 and the high was 8.4....with several down moves along the way. Had three sets of biopsy and three MRI, and a 4K test which came back at 9, nothing conclusive.
Finally this July they found it, 2/16 cores 5% 3+3, 10% 4+3. While talking to Dr. Schaeffer at Northwestern and Dr. Zaigaja at Univ. of Chicago, I learned a lot....
......IBD can make your PSA very volatile
...... radiation is not advise because of potential harm to the large intestine
...... Northwestern is finishing up a study that shows IBD patients that are diagnosed with
PC.....you don’t have more of a chance to get PC, but if you do get it, it has a better chance to be more aggressive than the general population. They are not sure if this is caused by the disease or the medication. Not sure when this study will be completed.
Stay vigilant and don’t assume your IBD or medication is the sole reason for your PSA rise.

My Path report....4+3 , 4% of prostate, margins, SV, lymph nodes all negative

Thanks for the input from both of you.

The biopsy would be a fusion image guided biopsy on the Artemis machine. I guess my decision in the next hour will either to wait for 3 months for another PSA or get this done Friday.

My next question is what else can they find out on a biopsy other than the presence of cancer or not? Is there anything else that can be taken from it?

Also what can I expect from this Biopsy? Recovery time? Pain? etc. Will the biopsy cause my prostate to be inflamed and then of course have scar tissue? What is the general recovery like for this procedure? Will I be able to work in a few days? I do recall them saying I will need to rest for a couple days preferably.

Thanks again

All good advise above. The biopsy shouldn't be a big deal, and IMHO you shouldn't delay it. It's more definitive than any other test for prostate cancer. You owe it to yourself to find out what's going on, and the sooner the better. Don't postpone the inevitable.

I've had ulcerative colitis for many decades, and my biopsy was not problem.

Two suggestions....make sure the physician doing the procedure has done a lot of them, and ask for an antibiotic more benign that Cipro, which has been 'black boxed'. It caused me to come down with C-Diff...not pleasant.

Good luck to you.

Talk with the doc who will do the biopsy. Ask him if he uses a peri-prostatic nerve block. This consists of two tiny injections of a numbing medication directly into the nerve bundles that connect to the prostate. If the doc uses this, you will feel only a bit of pressure when the biopsy samples are taken, NO pain. I had my biopsy in the morning, then took my wife out to lunch, then went back to work.

Personally, if a doc told me "We don't use a nerve block. Most patients do fine without it." I would quickly find another doctor. These things do not need to be painful, and any doc who discounts patient comfort can't be my doc.

do let us know what the results are.

and they say 10 days, many times it's earlier than that.

Andrew