What infections, etc should be checked for in a prostate semen analysis?
Posted , 5 users are following.
I've had insane prostate/rectal pain for 15 months. In that time PSA has gone from 6 to 3 to 9 to 5 in 3 month intervals. Prostate ultrasound and cystoscopy both unremarkable. Epididymal ultrasound showed a few cysts. PI RADS 3T MRI was 3. Before I got the PSA of 9 the pain was the only issue. Since I'm under the impression that PCa shouldn't cause this kind of pain, I'd like to address the pain issue before I undergo a biopsy, with its inherent risks of infection and sepsis. Biopsy complications on top of the pain I already have would do me in. To that end I finally prevailed upon the urologist to do a semen analysis, which I think should have been done long ago. Does anyone have experience with what they should be checking for, or with anything they should be checking that they might not be? Thanks
0 likes, 18 replies
romneyj rolf61809
Posted
First - from my experience of a TRUS-guided biopsy, it is not a painful procedure and there are rarely complications (though they do exist and sepsis is life-threatening should you be unlucky enough for that to follow).
Second - The most common cause of inflammation in the protate (considered a possible longterm cause of prostate cancer) is E coli. Note of course that E coli can be have multiple antibiotic resistance. Clearly thare are other bacteria that can be the cause of infections (eg chlamydia and gonorrhea) and many viruses may also be present though few are known to cause inflammation (herpes simplex is one that does however). Checking for viral presence is managed specifically (ie a specific test is needed for a specific virus) and other than looking perhaps for herpes would not be done unless it is someone's research project. All bacteria present will be grown up and identified and tested for antibiotic sensitivity so if your pain is due to current bacterial infection it should show up though the cysts may lead to concern that the infection is walled off and won't necessarily show up?
Please note - my experience only relates to that of having a biopsy. My background is vaccine development not urology though I have strangely acquired a deep interest in the subject recently
Good luck Rolf. I do hope you get a useful and rapid diagnosis.
rolf61809 romneyj
Posted
rolf61809
Posted
And the biopsy will be a fusion, as I convinced them that I wanted the 3t prostate MRI which they weren't going to do. Heck, if my pirads had been level 1 instead of 3 I wouldn't even be thinking immediate biopsy. It just makes sense to me to check for all possible causes of infection, within reason. If I knew for sure that yanking the prostate would end the pain I'd be first in line. I'm going to ask for the pca3 test too. I've never been really sick or in prolonged pain in my life before. Thanks again for the info.
romneyj rolf61809
Posted
Whilst PCA3 is interesting, with a 3T MRI you will have a very accurate diagnostic tool for PCa (yes/no and where). The biggest issue though is that PCa is not considered to be a cause of pain (pre-metastatic disease). I suspect that your MRI results should be the most interesting guide - have you had it yet? You need ideally to be taken through it by the imaging specialist (urologists are not likely to be capable of detailed interprestation as it is very specialised).
alfred5 rolf61809
Posted
Please let me know if you have a semen analysis done. My other half has had severe burning and pain ever since his biopsy 2 years ago. He's been on antibiotics for at least a year out of 2 years. They make no difference. He's having a cystoscopy done tomorrow. I've asked if he can have a semen test done to look for an infection. But we were told there is no way to tell if he has an infection. So I'd be interested to hear whether yours is done and whether anything shows up.
No, as far as I know prostate cancer doesn't have those symptoms. My other half was diagnosed with it, he had no symptoms at all.
Good luck. Hope you get sorted.
rolf61809 alfred5
Posted
Yes I had the 3 t mri done with level 3 in the intermediate zone. I'm probably grasping at straws with the semen analysis, but the pain has taken over my life with no end in sight after 15 months. The possibility of new pain or infection with the biopsy isn't an option. Seeing new PT today. And so far no pain medication. I'd take waterboarding over this.
rolf61809 alfred5
Posted
That's what I'm scared of, that the biopsy could make things worse, and based on your experience it could. Having the semen analysis today. My pain is in the prostate/rectal area, though also to both sides - seminal vesicles or bad deferens or lymph nodes maybe? I'll let you know what they find below or don't find. Good healing to us both.
rolf61809
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vas deferens - auto correct changed it to ' bad'
alfred5 rolf61809
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My other half got an aching in his right testicle, then pain in his prostate feeling like he was sitting on a ball. This was after the biopsy. Then he had brachytherapy for the prostate cancer 6 months later. (Jan 2015) which made symptoms much worse. He is in quite a bit of pain in his buttock and down one leg when he sits for more than about half hour. (As he's a farmer and on the tractor all day this time of year it isn't helpful) the worst problem is every wee burns like mad. From the tip of his penis right up and into the inside of his bottom. He gets a terrible pain when he wants to go too. Severe burning. No infection shows up in the urine sample.
I'm not sure they'll get a camera up there tomorrow as he's in quite a bit of pain. So we'll see. But this has all gradually got worse over 2 years. He taken a lot of antibiotics over that time. With little effect.
rolf61809 alfred5
Posted
Have you heard of the pudendal nerve/pudendal neuropathy? The 'golf ball' is a classic symptom. I've been looking into that on my own the last few months. There's a closed forum ' pudendal neuropathy hope' you could join.
rolf61809
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'Peripheral neuralgia hope' I meant
rolf61809
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alfred5 rolf61809
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Thanks. The sitting on the ball feeling isn't so bad now. That's how it started. Other symptoms are more of a problem.
barney34567 rolf61809
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The transperennial is documented to have a far lower risk of sepsis.
rolf61809 barney34567
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Tell that to my urologists. They both denied it. Trying to find one in Ohio who doesn't.
geoff90305 rolf61809
Posted
I am on cipro for 6 weeks to see if it is an infection in my prostate, rather than reportable PCa. My mri said pirad2, with no evidence of gleason 4 or 5...meaning, it could have gleason 2 or 3, but mri can't get down to this level. My urologist wanted to dive in a do a biopsy straight away. I asked what lesion to target?? He said as non imaged, we have to do a blind transrectal biopsy with 12/13 needles. Now, that does not thrill me at all. IF I was going to get a biopsy, then I too will be looking for a transperineal version, though seem hard to find who will do it. At presnt no pains whatsoever. maybe after biopsy, this could change?
Geoff
rolf61809 geoff90305
Posted
My 3t mri was pirads level 3 in the intermediate zone. They do have lesions to target. Idiots tried to rush me straight into blind rectal biopsy. (Hmmm, make a good name for a punk band). But think I was right in demanding the mri first. And I'm in the same boat with wanting to avoid rectal biopsy. But I'm being a pain in the ass wanting to find out what's causing my pain in the ass first. Excuse the attempts at humor, but I have to decide on the biopsy soon. And it's just pathetic that little effort seems to being made by the urologist towards allowing me to make informed decisions. Thank your lucky stars you're not having to deal with it through a haze of pain. Good health to you.
geoff90305 rolf61809
Posted
Yeah Rolf, when I read this forum, I am indeed lucky. Other than the PSA issue, all my systems work fine. If I had a lesion to target, I "maybe" agree to a single needle, mri guided rectal biopsy, though would still prefer the more expensive, general anesthetic way. I would never agree to the blind method. I can imagine my prostate not being too happy with a dozen needles whacked into every corner of it.
When I had the mpmri done, they did use contrast for the last part of the imaging. Maybe I should ask about coloured dyes to see if this would improve the identification?
I have emailed the Radiologist about his view of a gleason 2-3 being present and what if any other imaging technique can be used to get a more detailed image of 2-3 gleason.
My urologist, who is apparently good at reading mri said the problem was Gleason 2/3 tissue is so similar from a mri point of view to normal tissue, and only a biopsy will get an accurate result for Gleason 2/3.
Geoff