Does CIC, Clean Intermittent Catheterization, raise PSA

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I started CIC, Clean Intermittent Catheterization May of 2018. The first time I did it was in a Urologist's office. The Urologist himself taught me how to do it. Unfortunately he skipped the hand washing step and I was using a red rubber catheter which requires pushing the catheter in with your fingers. I developed a UTI within a day or two. While on a 10 day course of the antibiotic, Cipro. I went in for a PSA test. The PSA came back at 26 where six months earlier it had been 2.4 before using catheters. The high PSA is to be expected with a UTI. I had another PSA test 4 months later that came in at 6.2 so it had come down but was still high. Another PSA test 6 months after that was 5.3, so lower again, but still high. The whole time I continued using the catheters.

My question is: Can the use of intermittent catheters about 5 to 6 times per day raise PAS level because of the irritation to the prostate ? You people who have been using catheters and have had your PSA tested, what is your experience ?

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  • Posted

    My general concensus is yes. When I first saw the Urologist I had prostititus. I don't remember what the actual PSA number was - as I recall it was around 5. - they just told me it was elevated. As soon as I began cic it dropped as the cipro and doing cic quickly got rid of the infection. I did 2 weeks of cipro. I thought that problem was over. Also my creatine level was elevated but that also began going in the right direction with cic as it was protecting my kidneys.

    About a year later I saw my GP who told me my PSA level was 9. He told me I was going to have to either do more antibiotics to see if that was the cause of the high PSA level. If I didn't want to do the a/b he said he would schedule me a prostate biopsy because, he said, once the psa level gets over 10 they begin to worry about it migrating. So I did the a/b and it or something brought it down to around 7. I was supposed to go in for a follow up but since I am experiencing no other symptoms I've kind of let it go. Its nearly time for my yearly blood tests so I am kind of curious now.

    I have learned from others on this board that your PSA level, especially if you are doing cic, is not a good indicator of prostate cancer. I have been doing cic about 4 - 5 times a day and switched to a coude tip hydrophilic catheter; before I was using a straight tip. There is not a big difference because I don't think my prostate is actually that large (according to my GP), but I'm not poking it as much when inserting the catheter. Any kind of irritation can cause an elevated psa level.

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    • Posted

      Keith,

      Yes, any kind of irritation can cause an elevated PSA. However, the level where most men get tested with a biopsy is 4.0. Mine came back positive in 2012 at a bit over 4. Then, the PSA went to 5.6 and a second biopsy showed "progression" so I had the cancer radiated - now gone. PSA 0.1 to 0.2.

      If there is any way you could get a 3T MRI instead of the biopsy? That would be preferred. You might have to pay a lot out of pocket, but at least the prostate isn't damaged by the little needles taking core samples. If you eventually do get a 12 core biopsy, make sure you take a couple of Tylenol capsules before to dull the pain - makes the whole experience a LOT easier. You can't take aspirin or ibuprofen as that thins the blood and causes more bleeding after the biopsy. As it is, there will be some blood for a while in your semen. If you ignore the elevated PSA level and do nothing you put yourself at some risk.

      Best of luck to you, Tom

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    • Posted

      I chose CIC over surgery, as my HMO urologist only offered TURP. At age 82, I was not going to subject myself to this sledgehammer approach, and CIC has worked out well for me.

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  • Posted

    I am just curious. Why would you want to use CIC when there are many surgical treatments available that are absolutely safe and effective.

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    • Posted

      I guess the short answer is cic seems like the safest and effective option.

      When I had protatitus about two years ago, my GP apparently thought this was what was causing my swollen and painful prostate. He did a DRE and put me through two rounds of antibiotics, one round for two weeks (ineffective) and one for 10 days (cipro) which got rid of the infection. While taking the a/b and for some time after, I was experiencing overflow incontinence. For a couple of months I was wearing absorbent pads to bed and eventually under my street clothes. I had recently lost my job so staying home made this a little more tolerable. I still don't really quite understand why I couldn't get any urine to flow while awake but oftentimes when I would fall asleep some would come out, enough to completely fill the pad. Anyway, the point is I NEVER want to go through that again.

      My GP apparently didn't understand what was going on with me or he just didn't care enough. I didn't realize that I could be retaining @400 ml or more and not feel it. Evidently my bladder had gotten stretched to the point that the nerves were no longer working. Also, around this same time I was seeing a gastroenterologist for another problem and the blood work showed my Psa level and my creatine level were elevated. When I started doing cic both of these levels were "going in the right direction" according to the urologist. The one time I saw him he did another DRE and then scheduled me for surgery in three weeks; gave me a pamphlet and dvd about Green LIght laser surgery, both items which seemed to me like they were produced by an advertising agency, extolling all the virtues of the laser surgery and none of the risks or downsides. He hadn't done a cystoscopy or anything else to even know what was going on in there, and I didn't know enough about it to ask. I don't trust doctors, especially nowadays when the "care" seems to be gone out of health care in the U.S. IMO, its mostly about $$$. I had never tried the BPH drugs or done any kind of testing. I did have a pre-op appointment one week prior to the scheduled surgery but, being in full retention by now, the uro doc had me doing cic while waiting for the surgery appointment and it was giving me so much relief that I just wanted to keep on doing that. The incontinence went away and my blood levels improved. I was reading on the internet about BPH and found this board and JimJames and his posts on self-catheterizing as an alternative to surgery. I adopted a "wait and watch" strategy as none of the surgery options sounded safe to me, that is without side effects - possibly even permanent incontinence! So I cancelled my pre-op appointment and have only been back to see them once to get my cic prescription changed. I now have their blessing to do cic "if thats what I want to do".

      The retrograde ejaculation doesn't deter me THAT much, although I'd rather not have my urethra and possibly my bladder neck evicerated on the way to cutting out some prostate tissue and have been hoping something better might be on the horizon.

      I'm on medicare and with

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    • Posted

      I'm on medicare and with my medigap insurance I get the catheters free and with the new types and the hydrophilic type, it is easy and safe to do. I haven't had another UTI since beginning the cic.

      Sorry about the long post. Now that I look at posts above, I guess you (James) weren't replying to me but rather Thomas. Anyway, all my writing may be helpful to someone here.

      It IS time for me to go in and have another check up. Does anyone know if there are other symptoms of prostate cancer that might alert someone to the problem other than having to do a biopsy?

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    • Posted

      Good enough, I am familiar with CIC having done it myself for a short while. I settled on Holmium Laser Enucleation of the Prostate commonly called HoLEP and am completely satisfied with the result.

      Best of health to you.

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  • Posted

    Thomas, you need to know the volume (size) measurements of your prostate to accurately claim you PSA is too high. It has all to do with the size of the gland. A 5.3 for a 150 cc gland may be completely normal. You need a doctor who can and will measure the prostate and calculate what a normal PSA for that size gland actually is. Sorry to tell you if you doctor does not know this, there is an issue. Facts are the facts.

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    • Posted

      I had an MRI of the prostate in 2014. I sent it to Dr Karamanian in Houston Tx when I was looking into FLA. He said it measured 84cc. However the PSA was 2.4 in August of 2017 then went to 5.3 in March of 2019. I am thinking it is because of cathterization, because I don't think the prostate grew that much. Is there anyone who has experienced a rise like that due to cathterization ?

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  • Posted

    The answer toy your question is YES YES!! PSA tests for men doing daily CIC should not be done because it gives falsely elevated PSA values. I've been doing CIC 4 times/day for almost 3 years and have been through this many times with various urologists who keep claiming my elevated PSA is cancer.

    The catheter stimulates the prostate gland similar to how sex stimulates PSA production so if you want a PSA test you need to abstain from sex/CIC for 48 hours before the test - not too likely!

    Also PSA tests are not reliable for men with BPH even if they do not do CIC. That is because PSA is proportional to the size of the prostate. So men with BPH should PSA density for cancer screening which is the PSA value divided by the size of the prostate in cc. This value should be less than 0.1 but ONLY if you do not do CIC.

    For men who CIC daily a good measure is the FREE PSA value measured in the blood. This value should be greater than 18%.

    But the best test for us is to do routine dynamic 3T-MRIs of the prostate which would show up any suspicious lesions that could be targeted in a biopsy. But never ever submit to a blind TRUS biopsy just because your PSA is elevated.

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    • Posted

      Howard,

      Excellent points. My prostate was large (56gm) and PSA went over 4.0, so was sent to urologist for 12 core biopsy (in 2012) and the result came back positive for prostate cancer. A 3T MRI is certainly much less painful and doesn't damage the prostate. The only option I had was the biopsy. My insurance wouldn't cover anything else. At the time I had never heard of a 3T MRI nor was I offered one.

      Tom

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    • Posted

      Yes Tom that is the typical story in prostates. Urologist have a single product SKU in the 12 needle blind biopsy in their practice that is very profitable with an average national price to the patient of $1,150 which is charged to the insurance companies. This procedure takes approximately 15 minutes and is an in office procedure. The lab work done on the biopsy is the only real cost.

      There were approximately 1.3 million 12 needle blind prostate biopsies procedures done in the U.S. last year which makes this high profit single product revenue yield about $1,500,000,000 annually. Yes! That is a billion and a half in procedure revenue at a high profit margin!! And it is an inferior procedure in many ways.

      This biopsy is random in is application and in its sampling of the gland, also it produces a lot of false negitives as well as positives in the process. In fact it is only capable of being applied to possibly as much as 60% of the gland as the other portion of the gland is not exposed though the rectum and cannot be sampled. It causes blood and pain. As you pointed out it takes a while to heal.

      With a 3 TMRI if it is stated to detect prostate cancer in the order written by the doctor, insurance will usually cover this though the urologist will typically not tell you this or support you getting one as they make NO revenue on that procedure. Oddly enough, a 3TMRI if paid out of your pocket is about the same as the needle biopsy or even less. With an MRI if a lesion is visible, a Interventional Radiologist that specializes in Prostate Cancer can then do a single needle focused biopsy of the lesion that is visible. This 3TMRI is very accurate and gives your choices based on the PI-RADs Score and Gleason Grading of the specific lesion on the MRI.

      If the score is in a certain range, the IR Doctor that is a prostate specialist in PC can do a specific focused laser ablation of the exact lesion and not damage the remainder of the gland. This is MUCH less invasive and is without sexual side effect damage in most cases. It is also done via the rectum and not through the urethra. It is a day procedure. Lots of men have had this successfully.

      It is FDA approved but insurance will not cover it as the IR associations lobbies are much smaller and have little clout with the insurance providers. The Urological Association Lobby on the other hand is large and very powerful. Urologist do not want IR's playing in their sand box. And men are the ones who suffer. One can go this path without insurance coverage and it is about $20K to go it on your own money. Unfortunately lot of men cannot afford even though it is a much better solution in cases 7 and under in Gleason scores.

      Despite the fact that in a lot of cases, this is the way to go, we are all fighting a big machine that frankly only cares about the money. After all, in the end in a lot of their eyes, we are only a bunch of old men and that is how they think about us. We should not worry about sexual side effects. We are too old. Now BPH is also this way. Only, It will not kill you but sometime you will wish you were dead. (Just Kidding on that point).

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    • Posted

      Absolutely right. My first 12 core was random. I was told by my uro that I had a one in three chance of a positive result. Test did come back positive, but Gleason 6, not a lot of cores positive and percent positive was low. Then, a year and a half later, got a second 12 core. This one produced a LOT of blood. Uro targeted the area that showed positive before, so was more concentrated. The cores showed "progression" - more PCa. However, I will never know if the cancer was really progressing or whether the samples were more targeted. I spoke with several uros and they all suggested I move forward with treatment. If I had gone the 3T MRI route, I might have had a much better idea of what was going on. The uncertainty of knowing that the cancer was "progressing" just got to me, gave me anxiety, and once I got treatment (HD Brachytherapy) psychologically I felt much better. However , between the bloody second 12 core and the radiation, my sex life with my wife went from fantastic to nothing. I am a big fan of advanced imaging.

      Now BPH is also this way. Only, It will not kill you but sometime you will wish you were dead. (Just Kidding on that point). Just went through that issue and had a bipolar TURP Friday. Many men get a TURP, the tissues are sent to the lab, and they find out they have cancer as well. In my case it was the reverse, first the cancer treatment, now the BPH treatment. My prostate issues have been a plague on my life for about 8 years so I know what you are talking about!!

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    • Posted

      Thanks for the info Howard.

      When you say "FREE PSA value measured in the blood should be greater than 18%" do you mean if it is greater than 18% it may indicate cancer ?

      Thomas

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    • Posted

      Hi Thomas,

      When prostate cancer is present the cancer cells like to feed on what is called Free PSA, that is, PSA that is not bound up to other molecules. As a result there is less of this type of PSA to circulate in the blood stream. So a low value, usually taken as 18% serum blood concentration can indicate that prostate cancer is present since there is less to circulate.

      In my case, last Fall, my urologist tested all this. My PSA was 36 but my Free PSA was 30% which is very good. He just scratched his head and said he did not understand but I told him I had done a self-cath 4 hours before the blood test. The following week he wanted to redo the blood test so I agreed and waited 8 hours after my last CIC. In that case my PSA dropped to 26 and my Free PSA was the same at 30%. I also had a 3T-MRI for my prostate a month later and it was clear. He still doesn't get it and always says there must be cancer somewhere in my large prostate! That may be true at the microscopic level but until it becomes clinically signifiacnt at the tumor level not much can be done.

      Also an additional warning: there are genetic tests vailable for prostate cancer screening. these tests use correlations based on men with normal size prostates and not BPH. I went this route too and was told I had a 90% chance of cancer which was what prompted my MRI. These correlations factor in your PSA number which is not releavnt for men with BPH.

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    • Posted

      Hi Tom - I am sorry to hear about your problems. Our urogenital region can certainly cause us problems as we age. I was 50 before all these problems started and now at 70 I wish I had not taken my good health for granted for my first 50 years.

      I've had BPH for 20 years now and in the first 15 my urologists would take routine 12-core TRUS biopsies that left me bleeding and with infections, to say nothing of the problems that Cipro caused me.

      They never found anything but the problem is that even if they did it is at the microscopuc level unless there are large lesions that are visible on the ultrasound and that can be targeted for biopsy. This is where FLA with a good IR comes in. But for low Gleason ( less than 7) the cancer may not become clinically significant for 100 years so what to do?

      I wish you all the best with your Turp and hope the tissue pathology report is negative. Please let us know how you are doing. Howard

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    • Posted

      Howard,

      The problem with taking a 12 core sample is that it can miss a lot, so a Gleason 7 might be missed. I had two 12 cores taken 18 months apart and the second samples showed "progression" - more cores positive and a higher percent in each core. That's when I decided to move forward with treatment (HD Brachytherapy). Since then my PSA reports have been great, 0.1 to 0.2, for five years.

      Tom

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