Gardnerella? Elevated PSA Prostate Biopsy done

I am writing about my husband who is 47. He had an elevated PSA at 4.67. We are monogamous and I have had several infections of Gardnerella the past couple of years. His DRE was only slightly assymetrical. He has no family history of prostate cancer. Mother, grandmother with breast cancer. He had a biopsy that came back two of twelve with Gleason score of 3+3 on each(bilateral). I am wondering if he should have a second opinion of his biopsy results. Could he have asymptomatic Gardnerella that is causing abnormality of his prostate and recurrence of infection in me?

At this time we have chosen active surveillance. He does not want to have surgery due to risks and side effects and we feel he is too young to undergo radiation which eliminates surgery as an option in the future and runs near the same amount of risk and side effects.

Anyone with thoughts? Experience with gardnerella, or prostatitis. I don't know if a low grade prostatitis could have been missed on exam of the biopsy?

Thanks

Post Edited (Robyn1973) : 11/10/2010 9:25:20 PM (GMT-7)

Hi Robyn,

I too am sorry to hear about the diagnosis, but welcome to the forum.

I agree that it would be difficult for a pathologist to see cancer where there is none, particularly when two cores are positive. While I too am not a doctor or pathologist, I would think that no competent pathologist would mistake cancer for prostatitis. That mistake is sometimes made by urologists prior to biopsy, but a positive biopsy is generally considered pretty definitive. That said, you can get a second opinion on the pathology, and people do sometimes get second opinions, but it's generally to re-confirm grade and not positivity.

You mention that two of your husband's core samples were positive, but you don't mention the extent of the sample that was positive. If it was more than 50 percent in one or both cores, you may wish to reconsider active surveillance. My numbers are similar to your husbands, and that's what drove me to seek treatment for my PCa. The commonly accepted criteria for active surveillance are:

* having a stage T1a tumor
* having a Gleason score of 6 or below
* having a PSA level below 10 ng/mL
* having fewer than 3 positive biopsy cores (with <50% cancer in each)
* having a PSA density below 0.15 ng/mL per gram.

Best of luck to you and your husband. I've found this forum to be an excellent source of support and information, and I hope you'll spend some time here. Also, Dr Patrick Walsh's Guide to Surviving Prostate Cancer is highly recommended. Information is power.

Jonathan

Yes, have the slides analyzed by a second, expert lab..This is especially important with Gleason 6 ..Also don't rely on one 12 core biopsy that came back Gleason 6 to feel comfortable about "Active Surveillance" Many biopsies miss a small spot of high-grade PC that makes relying on one biopsy risky..Further tests to verify the results of your biopsy are needed before "AS" becomes a safe strategy..

As for the Gardnerella, that's a secondary issue to the PC...A simple culture of your husbands semen might provide useful information about any possible infection..

Obtain a copy of Dr. Walsh's book "Guide to surviving prostate cancer" Any library, Amazon, eBay, anywhere..Read and learn what you are dealing with....You want the second, 2007 edition..

Robyn1973 said... At this time we have chosen active surveillance.... clocknut is right about being " active ." There was a recent discussion with some guidance which is particularly relevant for men on AS or men concerned about rising or potentially rising PSA after primary treatment; unfortunately some goofiness led to that thread being shut down and can't be added to, but here is some of the noteworthy dialogue about some of the things you can "actively" do to help " stack the odds in your favor ":   diet, stress reduction, exercise...see below =========================================================================== the dialogue below copied/pasted from https://www.healingwell.com/community/default.aspx?f=35&m=1939546 ---------------------------------------------------------------------------------------------------------------------------------------- BobCape said... Dr Samadi, who I understand to be a most respected doctor, should be addressing his conclusions about diet to young children, or their parents (us) - becaus as "patients".... his theory comes a little too late .   I'd like to see a single-factor experiment run to see if it is too late, or not ...       If I were to design the experiment, I would structure it this way:   ·          Start with a group of men with biopsy-verified PC who would agree to forego conventional treatments for at least one year. ·          Check each participant’s PSA…the “ before ” number.   ·          Split the group randomly into two groups.   Ask one group to make significant diet/lifestyle changes, and ask the other group not to make any changes.   ·          Check each participant’s PSA again after one year…the “ after ” number.  Compare to the " before " for trends.   ------------------------------------------------------------------------------       JohnT said... Casey, The UCSF study on AS is doing just that. They haven't published official results yet, but preliminary results are that no one in the diet group has yet to have a progression and there was the normal rate of progresson in the control group...   John, you caught me.  Yes, the experiment has been done (and I knew that), in exactly the way I described above, and the result showed that it is not too late to affect change .   All of the men in the study already had prostate cancer.  The control group that was asked to not make changes in their diet & lifestyle saw their PSA predictably increase.  The PSA of the study group decreased.  Since these men already had prostate cancer, their goal was to control ... it was not too late for their diet & lifestyle changes to be effective .  Is there anyone here at HealingWell who is trying to control their prostate cancer??   You ask, "What diet & lifestyle changes were the study group asked make?"  Cut red meat & dairy, eat lots of fruits vegetables, whole grains.  Stress reduction through yoga-based stretching, meditation and relaxation exercises for an hour per day.  Exercise by walking 30 minutes at a moderate pace 6 days per week.   You ask, "Is it 'all or nothing'?"   No, the study found that there was a direct correlation between the degree of lifestyle change and the inhibition of prostate tumor growth.  The more you do, the better; but it's not "all or nothing."     ... the preponderance of evidence is rising to the top.    

The comments about trial mentioned above, both the theoretical and the actual one, are misleading. For men on Active Surveillance, I am convinced that significant lifestyle changes, particularly in respect to diet, can affect PSA. It may often slow the rise or even cause it to decrease in absolute number. This DOES NOT mean that the tumor is growing less or that the cancer has diminished. It may have converted to a higher G tumor, it may grow while producing less antigen, psa may be responding to changes in testosterone or DHT. It may be an infection that resolves. There are other issues also.
We know that psa is not a cancer marker. It is affected by numerous other bio-chemical issues. It is also not linear. That is, a tumor twice the size may not produce twice the psa. It may produce nearly none.
That said, I am convinced about diet and healthy lifestyle (lower cholesterol) to reduce psa in men who have recurred, and even in men before primary treatment if it will allow them to follow an AS program suitable to their needs and in accord with their medical team.

i agree fully with you jazz, a positive biopsy is evidence of PC, no way to down play that, or to confuse it with any other issue

Someone pointed this out...Cancer is like pregnancy..You can't be "just a little bit pregnant"..

I'm 18 years older than Robyn's husband, and my situation is quite a bit different, but I really should have had my biopsy and surgery at least a year before I did.  My family internist had recommended I see a urologist a year prior.  I wish I had.  Sure, the post-surgery pathology  report  indicates it was organ contained, but by the time I did anything about it, the doc could feel the tumor on the left lobe.  If I never have a recurrence, I'll be a very lucky guy.

My family history has most folks living into their 80's, and I'd like to get there, too.

The biopsy showed all six cores of the left lobe containing cancer, and none of the cores on the right containing cancer.  The pathology AFTER surgery, however, found cancer in the right side as well.  My understanding of PCa is that it usually doesn't present itself as a well defined tumor, as certain other cancers are, but that threads of it can often extend throughout the organ, and that it's a lucky shot if the biopsy needle hits those threads.

So, while I can say my cancer was contained within the capsule, the final path report also mentioned extensive PIN. 

I visualized the cancer as a time bomb in my body, and I didn't know when the fuse was set for it to really explode.  Finding cancer while it's potentially most curable was a blessing which I was never in the least tempted to pass up.

Every situation is different, but I'll deal with my ED after-effects and hope for zeroes on future PSA's.  My beautiful R.N. wife absolutely agrees. 

Good luck, Robyn.  I hope this works out well for you and your husband.  I hope you'll continue to share your experiences here on the forum.

Alegar: How are you feeling since your DaVinci?