PSA Level is 59

Hi, and welcome. Here's hoping your visit here is short and this will all be cleared up to your satisfaction. I had a total of 4 biopsy sessions over the years, but fortunately didn't have infection issues.

Prostate infections can cause elevated PSA, low free PSA, and are hard to cure. I suppose it's possible for your high PSA to still be from residual infection, especially if you had so much trouble with them.

Have you discussed a PCA3 test with your urologist? It's a simple urine test after a little more vigorous than normal DRE. If it comes back with an elevated score it indicates a higher chance of finding cancer on a biopsy. Mine was mildly indicative for biopsy, and I turned out to have a quite significant case. I'm not sure how sensitive that test is.

There is another type of biopsy, the transperineal. Maybe it would be less likely to create infection than going in through the usual route.

jim1rob,

You are not alone in getting infections from biopsies. The latest stats I've seen are at 7% requiring treatment. It is rising due to resistant strains developing. And once those baddies get in there, they are hard to get out. I can't really see the point of having yet another potentially dangerous biopsy when you know you have an angry case of prostatitis that's settled in. Your numbers are very typical for prostatitis. As you've learned, some kinds of prostatitis are very resistant to antibiotics.

Here are a couple of alternatives you can suggest to your Uro.

You might want to ask your Uro if you can have the new PHI test. Here's the link. Unlike PSA, PHI does a better job at distinguishing prostate cancer from prostatitis and may save you an unnecessary biopsy. Another test that involves a urine catch after a prostate massage is called PCA3. If your doctor agrees to give you that test, you can also suggest to him that they test the urine sample for infectious agents that may be causing your prostatitis. A step beyond the PCA3 test is something called the 4KScore, but I'm pretty sure the VA won't cover it. If both PHI and PCA3 are negative, you can feel pretty assured about skipping the biopsy.

If those test positive, there's another step, an imaging study, one can take before a biopsy. It's called a multiparametric MRI (mpMRI). It's pretty good at finding higher grade PC in parts of the prostate that will always be missed in a TRUS-guided biopsy. If you happen to be African-American, this can be particularly important - African-Americans have a disproportionately high rate of anterior tumors that cannot be biopsied with ultrasound guidance. In the hands of an expert radiologist, an mpMRI can be used to guide a subsequent transperineal biopsy. (We already know what happens with a transrectal biopsy for you).

I hope your urologist is open to having this discussion with you.

Thanks everyone for you replies. Some good info and I appreciate it. I did decide to go ahead with my Biopsy. I had it today. For some reason it hurt somewhat this time vs the other 2. Though not that much. I was given some sort of a antibiotic shot in the buttock following the biopsy. This is because I could not stress enough my concern about previous biopsy infections. So so far everything is ok, and I certainly hope my results will be negative.

Good luck on that next biopsy, you definitely need it, despite the risk of infection.

It took 3 of them for me, spread over 18 months before my cancer was dx'd

BTW, you are using the VA, are you a Viet-Nam vet by chance? If so, and if you get dx'd with PC, and were on the ground in Nam, you can qualify for major VA disability money under the Agent Orange provision. Several of us here are 100% VA disabled for that very reason.

Let us know how it goes.

David

Jim,

Don't think I have said hello yet. I can sympathize with your problem of your prostatitis making your PSA hard to interpret. I've been there, too. I spent three days in the hospital on IV antibiotics for a prostate infection before my first PSA test.

Like Bluebird's husband, I too was subsequently diagnosed with prostate cancer. Try not to read too much into that. This is, after all, a prostate cancer forum. Most of the guys here have prostate cancer and some of us had infections before we were diagnosed. But there are lots of guys out there who have infections who don't have cancer -- they just don't usually hang around this site very long. (We are a fun group of guys, don't get me wrong, but not that much fun.) Hopefully you will turn out to be one of those "here for a few weeks and gone" guys, too.

Let us know how your biopsy comes out so we can stop worrying.

Hi Everyone. Just wanted to let everyone know that my results came back today. I am told they are negative. So I'm very thankful for that. I was told I have a rather enlarged and inflamed Prostrate, which is most likely causing this spike in PSA levels. I'm somewhat concerned though that the VA didn't seem to offer further treatments. I had to bring it up just what do I do for this condition now. I was told I could take the Flomax, which I started tonight and I am seeing the Urologist next Friday at the VA. So hopefully he or she will have some answers for me. With all the trouble the VA is having now, with refusing treatment to Vets, I'm somewhat cautious. Just last year I was denied care several times at the Phoenix VA hospital and clinics, because their patient load had overwhelmed them. I'm now back east and having an easier time with the VA here. I'm leaning though towards going to a private urologist, if I find the VA are not forthcoming with treatments or information on this type problem.

Thanks again to everyone for your kind words and the excellent information. I wish everyone hope and the best of luck, with their journey with Prostrate Issues.

Jim, please be aware that the normal Trus biopsy is random jags.
In my case I was on a clinical trial to compare MRI guided biopsy with Trus ( random) biopsy. Once MRI scanning detected possible "significant" aggressive tumour, I was subjected to 4 MRI guided biopsy jags....2 of which found positive! I then had to endure 12 Trus random jags which found nothing! Proving to me beyond doubt Trus biopsy is very hit and miss!!