Low PSA but cancer??

I'm in my early 40's and have had 2 MRIs of the prostate (not endo-rectal), the first of which I had approx 2 years ago, which was normal and the last of which in May 2014. To sum it up, this one stated "There are diffuse regions of reduced signal intensity throughout the peripheral zone with ADC values in the benign range measuring in the order of 1200. There is predominantly mild patchy enhancement throughout the peripheral zone." Prostate is estimated at 19cc (so small). It concludes by stating it is suggestive of prostatitis (PIRADS 2).

My PSA has been low for a number of years (0.36 a month ago) despite strange symptoms such as pain in the pelvic region after urination that lasted for hours, ED, a somewhat flat urine stream that sprays (2 cystoscopies found nothing) & a CT scan last year that found 'shotty lymph nodes.' I have been to 6 urologists over the past few years, all of which told me that my DRE and PSA are normal. The fact is that reliance on PSA and DRE means nothing. Strangely enough, my testosterone and free testosterone levels have been quite low, all along. I have read though that excess oestrogen can also drive PCa.

Lately I have been having pain in my tailbone and also pain further up in my spine. I had a bone scan 3 months ago, which focused on the pelvis but came back negative. I have been feeling weak on my legs for the past few months, along with having aching in various parts. What would you recommend for my scenario? I live in Oz, but am willing to travel to get answers asap. Thanks for your help.

You have all the symptoms of chronic prostatitis, and perhaps inflammation further up the urinary tract as well. It is notoriously hard to treat, and antibiotics often don't touch it. I have a friend who deals with it as a chronic condition and takes an antidepressant that, oddly enough, seems to help with the pain.

There is something called a "4 cup test" where they massage the prostate and catch the urine stream at different points as you pee. Sometimes it can find the pathogen responsible so that they can tailor medication for it. Often it comes up with nothing though.

- Allen