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Prostatitis or Prostate Cancer?

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Posted 8/10/2018 8:09 PM (GMT 0)
Hello this is my first post here after getting a standard PSA of 8.6 and having a free PSA come back pretty low (not good) at 8.4% last month. I'm 48 years old. My father died of prostate cancer at 60 and I mention this any time I see a doctor. I do have a very healthy diet and exercise often (including biking a lot). I also have a history of what I am almost certain has been prostatitis going back to my late 20s. This has left me wondering if I'm having a recurrence of prostatitis or this is prostate cancer. I'm posting here to share what happens next and to hopefully hear from other chronic prostatitis sufferers about where that led them.

When I have had flareups of prostatitis in the past it would be a nuisance but I was younger and so I wouldn't get too worried. Now at 48 I'm concerned because I'm more in the prostate cancer age range and the 8.6 PSA is pretty high. Ever since my 20s, when I have had prostatitis flareups it manifests itself in one way - frequent urination, sometimes every hour. It will seem to be worse when I sit a lot which is unfortunately what I do for work. Some other things that seemed to make it worse were frequent masturbat1on and alcohol consumption. When I was in my 20s and 30s I would "spank the monkey" pretty often. It was cheap, stress busting and I wasn't married.

At 29 I saw a urologist. He wound up doing a cystoscopy (everything was normal) and putting me on Ciprofloxacin. He also gave me another medication (can't recall the name) but I do recall it caused retrograde ejaculation (no semen comes out) while on it. I'm a little fuzzy on what happened back then, but I think I forgot about the prostatitis for a little while after that so it seemed like the combination of meds helped. It would recur again though, quite a bit.

Another possibly related thing is about 2.5 years ago I had a stretch where I wound up having several sexual relationships with different female partners. Quite a few times I did not use protection. Very stupid, I know, but I wonder if this could be connected to where I am at now. I have done the full gamut of STD tests every year and they have all been negative.

about 6 months after that promiscuous stretch, I had my first PSA test and it was 3.28. My regular doctor said that was a little high for my age but nothing to get too alarmed by and also there was no baseline. I should have taken another PSA test sooner but I got busy and I didn't have another one done until last month, July 2018.

Starting around April 2018, for a few months I had been having a rise in frequent urination and also a feeling that I can best describe as inflammation in the prostate area. There has also been some dribbling. For the prior 2 years I had been noticing an increase in frequent urination but not as much as in these few months. I took my second PSA test in July 2018 and the results were PSA: 8.6 and PSA Free: 8.4%.

As a result of these tests I am now doing a 4 week run of Cipro. After that another PSA will be done to see if it drops before making any further decisions.

My general doctor said at this point there is a 50% chance of prostate cancer. I am not panicking as I realize this is related to one of the problems with PSA. It can spike for a variety of different reasons. I am on high alert though and looking to be as proactive as possible.

Anyone else out there have a prostatitis history and getting high PSA scores? Good or bad, I would love to hear how things have gone from others with similar situations or just from anyone with thoughts on my situation.
Posted 8/10/2018 8:51 PM (GMT 0)
Welcome to HW.

You should ask for the new PHI test (prostate health index). That might give you more information that you could use. A retest of the PSA is a good idea. You need to confirm that number.

Prostatitis can cause wild swings in PSA. It's unlikely that cipro will make any difference as prostatitis often doesn't respond to antibiotics. Still if you see any drop in PSA, that moves the needle more towards prostatitis than PC.

If it's the same or higher, the needle swings the other way towards PC. Your free PSA is low so I can see why your doc gave you those odds.

You're stuck in a tough place and just have to wait and see what further tests show. At some point you may have to have the conversation with a Uro about doing a biopsy.

Even if the worst is true, you've caught it at an early stage and you have a ton of treatment options and every reason to expect a positive outcome. Likely it will just be a big bump in the road and you'll get to move on with life.

Hang in there and keep us updated on your testing,
Andrew
Posted 8/10/2018 8:55 PM (GMT 0)
First of all, welcome to the forum, hope you are just passing through, and never earn membership in our club
Second of all, i wish i was you, 2 1/2 years ago. smile

Big jumps are often associated with Prostatitis, which is sometimes hard to control, even with antibiotics (from what i've read here). Burning on urination, pain when sitting, big jump in psa over 2 years? Sounds like it could be prostatitis to me. But i'm not a doctor.

Not much to do till you retest. Good luck. Other more knowledgeable members will respond soon.

Oh, regarding your age, you are still at the low end of the curve of prostate cancer patients. Certainly we see lots of guys in their 40's but its way less common that when you hit 60.

Come to think of it, you're 48? Forget 2 1/2 years ago, i wish i was you now. I'd love to be 48 again.
Posted 8/10/2018 10:15 PM (GMT 0)
Let me tell you my experience, which shares some similarities with yours.

My PSA went up to 4.4 in August, 2016.

I assumed it was from inflammation/prostatitis due to heavy biking. That seemed confirmed when I did a 1 week course of Cipro and abstained from biking for a week before the next PSA test in Oct. 2016.

My PSA then dropped down to 3.4. Bingo, that was the answer, or so I thought. Six months later, 3.7. But in the meantime, I was having to urinate every hour or so, and waking up about 75% of nights. Again, I assumed it was inflammation/prostatitis.

Four months later (Aug. 2017), it went up to 5.2, so a few weeks later, I took a 4K test, which is supposed to be a more accurate version of the PSA test using biomarkers. That came in at 5.4, but the test's algorithm calculated only a 17% likelihood of cancer.

Oct. 2017, it went down to 4.4, so all was looking good again, and by January of this year, my nighttime urination had all but disappeared, so I assumed the inflammation had cleared up on its own, and was looking forward to a sub 4 PSA test in March.

It was a shocker when the results came back at 6.1. My uro did a DRE, and said he felt a small hardness on the right side.

Had a biopsy, and the results are as below. It looks like the cancer was there all the time, at least as far back as August 2016.

So given your family history of prostate cancer, and the sometimes confusing and contradictory feedback of PSA tests, I would say cut to the chase and get a biopsy done. It's far more accurate than a PSA test, and if the results come back positive, you may give yourself a lot more options for treatment by catching it early.


Age: 62
PSA, 3/18: 6.1
DRE, 4/18: Stage T2a, right side
Biopsy, 6/18: Left = 2/6 positive, G3+3; Right = 6/6 positive, 3 @ G3+3, 3 @ G3+4; PNI identified in 2 cores
Posted 8/10/2018 10:39 PM (GMT 0)
Keep in mind that bike riding can also cause PSA spike...I'm not saying that's what happened, but it certainly could be in play. I agree with Andrew's comment about PHI.

Glad you're not panicking, but probably good that you're on alert. (And I don't think it even needs to be high alert--regular alert would do.) Good luck and hope this turns out to another bout or prostatitis.

One other thing...very sorry that you lost your dad to PCa, but in the PSA era there aren't many guys that get diagnosed with advanced prostate cancer. Generally, it's very treatable and most of us do fine.
Posted 8/10/2018 10:50 PM (GMT 0)
Bobmars,

Are you seeing a urologist now? In your recent history you only mention your GP. With your personal history of prostatitis, and your family history of PCa, you should be under a urologist’s care. This has nothing to do with your GP’s advice, which seems sound. And I’m not predicting PCa — this could well be another benign flareup. It’s just time to bring in a specialist.

I didn’t start seeing a urologist till it was time for a biopsy. That didn’t give me time to shop—I had to go with whoever was available. As it happens, I liked the guy and came to trust in him. But trust hadn’t developed yet at our second appointment, when he delivered the news. That was suboptimal, for both of us.
Posted 8/11/2018 12:21 AM (GMT 0)
Unfortunately, prostatitis is extremely hard to get rid of. It is rare that antibiotics can touch it.

All PSA-based tests are at least somewhat affected by it. PHI is better than most other PSA-based tests. There are a few of non-PSA-based tests you can try. It may help you avoid an unnecessary biopsy.

Exo Dx Prostate Intelliscore: (free in clinical trial)
/clinicaltrials.gov/ct2/show/NCT03031418

Select MDx (check with insurance first)
/mdxhealth.com/selectmdx-prostate-cancer

Apifiny (check with insurance first)
/armune.com/wp-content/uploads/apifiny-patient-brochure.pdf
Posted 8/11/2018 12:27 AM (GMT 0)
Wow thanks so much for all the quick great replies. I really appreciate all the words of wisdom as I am stuck in this tough place (just like InTheShop said) and trying to get educated as fast as possible.

Saipan Paradise said...
Are you seeing a urologist now? In your recent history you only mention your GP. With your personal history of prostatitis, and your family history of PCa, you should be under a urologist’s care...


I am definitely on to the urologist stage. The only reason I went a little longer with my GP is all good urologists seem to have long delays due to summer vacation season. Shortly after I finish the 28 day Ciprofloxacin run and take another PSA, I have an appointment with what I think it a pretty decent urologist. I was in touch with the urologist office and they did concur with the Cipro treatment first.


Michael_T said...
Keep in mind that bike riding can also cause PSA spike...I'm not saying that's what happened, but it certainly could be in play. I agree with Andrew's comment about PHI.


I am aware of this and have banned myself from biking until I get the next PSA test at the end of the month. Plenty of other activities I can do in the meantime.


RichBinSD said...
So given your family history of prostate cancer, and the sometimes confusing and contradictory feedback of PSA tests, I would say cut to the chase and get a biopsy done. It's far more accurate than a PSA test, and if the results come back positive, you may give yourself a lot more options for treatment by catching it early.


I am starting to think of the biopsy option, especially if the next PSA is the same or higher. I don't relish the thought of the biopsy but would appreciate the more definitive information it can bring. I am also reading about and giving some thought to doing the 3T MRI before the biopsy.


I will post more here as I find out more.
Posted 8/11/2018 4:10 AM (GMT 0)
This prostate/PC game can be a slow one. Do your research.

The various blood tests can help decide. the MRI? Not sure how helpful that might be at this stage of if you can get your insurance to pay for it. Still, something to talk with the doc about.

Keep us updated on your progress,
Andrew
Posted 8/11/2018 10:26 AM (GMT 0)
Seems to me with the family history and psa trend you should get a mpmri and then a guided biopsy. The sooner you catch it the better. Denis
Posted 8/12/2018 12:29 AM (GMT 0)

Subdenis said...
Seems to me with the family history and psa trend you should get a mpmri and then a guided biopsy.


Sure wish I had known six years ago what I know about PCa now. My grandfather died from PCa. When my GP informed me that my PSA was over 4 my Uro - whom I'd been seeing for twenty years, simply told me that it was nothing to be concerned about. When it later hit 9.5 he did a biopsy and all he told me that it was negative. Every DRE he did he said my prostate was normal. He never even mentioned anything about cancer.

Dealing with the disease itself has been stressful enough, but the angst over what happened between 2012 and 2016 has been the most difficult part, especially when I read about the guys who get all these special tests, and I got nothing until my Uro retired and his partner ordered an MRI that found my cancer. Then my wife's cancer just a few months later, when I was grappling with ADT and getting the AUS just so I could start SRT.

If only my Uro - whom I had trusted, had been willing to tell me more, I could have Googled "prostate cancer" and everything would have gone much differently. Sorry to vent, but I'm still trying to come to grips with what happened.
Posted 9/11/2018 5:14 PM (GMT 0)
I have an update on my situation and it's got me nervous. After a month of trying to use cipro against a possible prostate infection, I took another PSA test on 9/5/18. Instead of going lower it went higher from 8.6 to 10.1. Also this time the urologist did a digital rectal exam (previously it was general doc) and said he felt a small lump or abnormality (I forgot the exact word because I was already a little shaken at this point.) He said it was on left side of the prostate and expressed some concern that it could have spread because of it's location and my other conditions (rising PSA, frequent urination). The urologist's tone towards the end of the visit was not good or encouraging. Now I will have my first biopsy 9/13/18. I look forward to something potentially more definitive but am worried about the chances of getting very bad news. For now though it's off to buy an enema and figure out how to use it!
Posted 9/11/2018 5:24 PM (GMT 0)
A positive DRE is reason to head for the biopsy.

There are lots of reason for finding a lump. Some good, some bad. It does give the URO something to target. It's uncommon for a GP to miss something like this. URO's do lots of DREs and it's possible that thinks changed between the two exams.

and get two enemas. First time I did it wasn't pretty eventually I needed the second.

Andrew
Posted 9/14/2018 11:33 PM (GMT 0)
I had the biopsy yesterday and I'm glad to report it was not as bad as I thought it would be. Actually it wasn't bad at all, just not fun. They used lidocaine as the anesthetic.

The urologist did another DRE and of course could see my prostate on an ultrasound. While I was there he said my prostate looks normal, small and no abnormalities. The confusing part is 3 days ago he did a DRE and said he felt a small lump or abnormality on the left side.

Then today I got the doctor's notes sent to me and another thing threw me for a loop. Everything he wrote sounded normal except:

"Hypoechoic lesions: Extensive hypoechoic lesions involving the left peripheral zone crossing to the right peripheral zone in mid gland and apex.
Median lobe: no"

I definitely don't like the words "extensive" and "lesions" and it's not going to make waiting for the biopsy result next week any easier.
Posted 9/14/2018 11:46 PM (GMT 0)
"lesions" is medical speak for, "something."

Hang in there, waiting is the most difficult part of this PC game.

Andrew
Posted 9/15/2018 12:09 AM (GMT 0)
Given the fact that the uro didn't feel anything abnormal, coupled with your history of prostatitis, I'm thinking that most likely your biopsy will be negative. In fact, I'll bet you an adult beverage of your choice that it be negative. Hang in there and try not to think about it this weekend!
Posted 9/21/2018 1:04 AM (GMT 0)
I got my biopsy results and unfortunately it is prostate cancer and it's aggressive. I'm going to start a new thread as this one was for trying to figure out if it was prostatitis or prostate cancer and now that has been answered.
Posted 11/11/2018 12:28 AM (GMT 0)
My great uncle had PSA 45 ...after one year it came 52...after one more year it came 162...Only symptoms : frequent urination and warmth and pain on sides of testicles. An ultrasound showed mild prostate enlargement with homogeneous texture. No nodule ,mass or fluid in prostate area. No family history of cancer. There is history of unprotected sex in Las Vegas few years ago. He is physically active..runs 4 miles a day in gym.
No abnormality in blood counts. DRE: some boggyness and softness.
A diagnosis of Prostatitis is being considered and he is on Bactrim DS for last 3 weeks. Frequency of urination less, pain is gone. No more swelling or warmth in testicular area.
What are chances of prostate cancer with such high PSA (162) ?
Posted 11/11/2018 12:47 AM (GMT 0)
Has he had a biopsy?

That's a very high PSA. It is possible that it is prostatitis, but PC will drive the numbers that high too.

Quoting odds based on just a PSA number isn't wise, but he should be getting more testing.

Andrew
Posted 11/11/2018 10:01 PM (GMT 0)
NO. He does not want to have biopsy. After being on Bactrim for 7 days, his symptoms have improved greatly.
Only some urinary frequency is left. He wants to finish 3 week course of antibiotic, Bactrim DS and after a month will have ultrasound of prostate. And repeat PSA.
He strongly believes that it is prostatitis because it all started with UTI causing discharge, burning, tender testicles and urinary urgency and frequency. Those symptoms went away 1 year ago after antibiotics. They came back recently so he thinks its the same infection as he has not had any risky behavior as this all freaked him out.
I will update after he finished 3 week of antibiotics
With PSA of 162, he should be having symptoms but the guy is healthy as a horse. No bone pain nothing. So, may be it is prostatitis...time will tell.

Post Edited (Diva2014) : 11/11/2018 3:05:28 PM (GMT-7)

Posted 11/11/2018 10:59 PM (GMT 0)
again, with just that history and a PSA, all we can do is guess.

Is it PC? Is it prostatitis? I don't know and I won't make odds.

PC can only be diagnosed with a biopsy. If he doesn't what that, it's just a guess - I'm not in the guessing game.

Andrew
Posted 11/13/2018 3:56 AM (GMT 0)
Hi Diva2014, I am the one who originally started this thread. Your uncle's situation is a bit different than mine but there are some similarities. It is definitely encouraging that his symptoms have improved greatly after being on Bactrim for 7 days. That PSA sounds quite high though, but I am not a doctor. Hopefully that followup PSA test will be dramatically lower.

My followup PSA after 1 month of ciprofloxacin antibiotic had unfortunately inched up higher from 8.6 to 10.1. So after that, despite my history of prostatitis, it was biopsy time. I was looking for every reason to not do it, but I am glad I did. If I delayed any longer I would have lost valuable time as it did turn out that I had prostate cancer. That certainly doesn't mean that your uncle will have it. However I wanted to share that while I was pretty scared of the prospect of a prostate biopsy, it wasn't painful at all. The whole process is not exactly fun, but I would do it again in a heartbeat if it would give me some important information about the state of my prostate gland.
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