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PSA 39 ng/ml..scared to death but what should I do?

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Posted 11/12/2019 3:39 PM (GMT 0)
Hello everyone
I am 55 years old in good physical condition and no parents, brothers or cousins ​​with prostate cancer.
Last February I taked my very first PSA test, the result was 12 ng / ml
(I did not know what was the psa it is my doctor who prescribed it)
A second PSA a month later after antibiotic came with the result of 13 ng / ml.
I googled what all those results means and it scared me a lot.
The things become serious so I was directed to a urologist.
He recommended an mri before the biopsy: 3 weeks later the mri came back clear
except a lesion pirads 3 (more or less 1 cm in the mid base left peripheral zone) and some chronic prostatitis.
In April my first biopsy: 16 classics samples were taken plus 3 in the suspected mri area pirads3(10 left side and 9 right side)
Prostate size is 26cc and All 19 cores returned negative, no cancer not pin or highpin but again some inflammatory in the prostatic parenchyma .
No pain during the biopsy but i developped an acute prostatitis one week or a few days later :
urgency, difficulty and pain when/to urinate,fever,...blood in the urine for 6 weeks and
in semen for 2 months !!!!! (more much than average no?)
I was happy with the result and the urologist gave me an appointment in 6 months for a new psa test
So two weeks ago again psa test with the hope that it drops but it came back with 39 ng / ml !!!!!
I was in shock and again waiting for the next mri the urologist prescribed me another 3 weeks of antibiotics
Now I dont feel any symptoms of prostatitis or chronic prostatitis but i know that prostatitis
may be asymptomatic
What is your opinion what should i do ?
Is it possible that the biopsy aggravates the inflammation of the prostate for several months?
Thanks

Message Edité (Gianni) : 11/12/2019 9:07:18 AM (GMT-7)

Posted 11/12/2019 3:54 PM (GMT 0)
Well, it seems that you don't have cancer, so I think you can ratchet the anxiety down. Prostatitis is notoriously hard to treat. Your Urologist seems to be on the ball and he's what he can do. Be patient.
Posted 11/12/2019 3:57 PM (GMT 0)
PS, I don't know much about the Pirads stuff, so if you do have potential issue, the guys knowledgeable towards that will soon comment.
Posted 11/12/2019 4:14 PM (GMT 0)

mattam said...
PS, I don't know much about the Pirads stuff, so if you do have potential issue, the guys knowledgeable towards that will soon comment.


Thank you @mattam , my mri pirads 3 is finally benign but
you're right I do not have to worry but my psa is very high
Posted 11/12/2019 4:34 PM (GMT 0)
The first thing you should do is relax, because you don't have cancer. That is very good news. You do have some other kind of problem, but it will probably go away, either because of treatments or you get well on your own. The high PSA level is due to prostatitis. Not a big deal. Follow your urologist's advice.
Posted 11/12/2019 5:06 PM (GMT 0)
Your PSA is certainly high, but the last big jump up may be due to the biopsy. You need some months to safely take a test again after a biopsy. Although I am not the best example I can add I had a big jump from 5 to 9 six months after my second biopsy in 2013, and 2 months later I got a negative test mpMRI test and PSA estabilized around 5 for 3 more years. On the negative side, mpmri pirads 3 is ambiguous and false negative biopsies are unfortunately common. But, as others say, prostatitis is another possibility. You have been diligent to make every test needed right now so that you can relax for a few months before checking again.
Posted 11/12/2019 6:24 PM (GMT 0)
Your PSA is abnormally high. SOMETHING is causing this. Urologists get paid to find out what the problem is. It took them three biopsies before they found mine.. Ask that your next biopsy be MRI guided..
Posted 11/12/2019 6:47 PM (GMT 0)
Some forms can "burn out" and not show on biopsy yet be metastatic. Actually have a friend of a business acquaintance going through it currently. I would head for a center of excellence to be safe.

https://www.ncbi.nlm.nih.gov/pubmed/30573917
Metastatic prostate cancer (PCa) cases that cannot be detected on repeat prostate biopsy are extremely rare. Our patient was a 51-year-old Japanese man diagnosed as metastatic PCa by histopathological examination of lesions obtained bone biopsy and lymph node dissection. The primary tumor was not detected after repeated prostate biopsy. Metastatic PCa was diagnosed based on immunohistochemical staining: PSA, AR, P504S, and NKX3.1 of bone and lymph node with metastasis. We speculate that the primary PCa was "burned-out," demonstrating remote metastases with no apparent primary tumor in the prostate. Burned-out PCa may be difficult to diagnose and treat due to its rarity.
Posted 11/12/2019 11:16 PM (GMT 0)
Never heard of "burned out" cancer but it's something I'll have to have a look at given my own situation.
Posted 11/12/2019 11:21 PM (GMT 0)
Welcome to HW.

Prostatitis can be very hard to treat and could account for your PSA. PSA due to PC doesn't make wild swings - rather it steadily increases. Also, the biopsy can increase PSA for awhile.

What should you do? Take the meds, wait, retest and get the scans.

If your PSA drops, then you'll know it's not PC.

Andrew
Posted 11/13/2019 4:01 AM (GMT 0)
I agree with most of the comments above. You have a high PSA, which warrants trying to figure out what's going on. But you also have a negative biopsy and an MRI that is better than most PCa guys. I think you likely need to hang in there for another PSA test. Perhaps it would also be helpful to test for free PSA or take a PHI test, which might be able to provide additional information.
Posted 11/13/2019 4:27 AM (GMT 0)
Here's what Walsh says in his "My PSA is elevated: What else could it be?" section.

"In rare cases, BPH can block blood supply to areas of the prostate. This is called a prostate infarction, and the cutoff of blood is much like that in a myocardial infarction, or heart attack. An episode of prostate infarction can trigger urinary retention an cause a temporary jump in PSA, sometimes to starting levels as high as 100 or 200 ng/;ml."

….just sayin'.

If it were me, I think I'd go for a free PSA test as well.
Posted 11/13/2019 4:29 AM (GMT 0)
He also states that not all infections are the same. "Some bacterial infections can cause PSA values to skyrocket". He does not define "skyrocket".
Posted 11/18/2019 1:23 PM (GMT 0)
Thank you everyone
Just receveid my last psa reslt today test after one month antibiotic and it s now rising to 47 ng/ml ...disappointed and worried
So the next step is again another mri in two week to see if something new happend
My urologist said that if the mri back clean then he will do the psma of the prostate for diagnostic and guided biopsy
Is the psma for diagnosis in the case of rising psa beter than template or saturation biopsies?

GuitarHunter said...
Never heard of "burned out" cancer but it's something I'll have to have a look at given my own situation.


@GuitarHunter
Have you ever asked for the psma diagnosis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5458645/#bib1
Posted 11/18/2019 2:05 PM (GMT 0)
Prostate infections are notoriously difficult to resolve with drugs. With that large jump, it is still screaming "infection". The vast majority of the time, cancer is characterized by slow, steady rises over time....a year or more is not uncommon. For example, in my case, annual PSA readings went from <0.1, to 1.1, to 2.0, to 4.2 over a period of 3 years.
Posted 11/18/2019 5:00 PM (GMT 0)
my initial PSA dropped after taking a 3 week crypro. My biopsy showed I had prostities. You should try some strong dosage of antibiotics to see if it brings the PSA down. One thing is for almost sure is that don’t have prostrate cancer. There is some research out there that indicates some evidence that prostitites may lead to prostrate cancer so you should get it treated.
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