Fluctuating PSA(3-10), 2 Negative Biopsies(TRUS-Guided & MRI-fusion), MRI shows Cystic Lesion. HELP!

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It's been 1.5 years now and it all started back in Feb'2016. I had really high PSA (22), UTI symptoms, nocturia and enlarged prostate. I was put on Antibiotics, alpha-blocks and dutasteride but still, symptoms didn't subside. In June' 2016, I was ordered Pelvis MRI and it showed a cystic lesion and then first biopsy(TRUS-Guided 12 cores) in July'2016. It came out to be negative(sign of relief). PSA dropped to 9-12 range by December'2016, but doctors wanted another MRI screening to look at the lesion. It increased minutely in size and then I was ordered MRI-fusion biopsy in January'2017. Again Negative and then I tried some ayurvedic meds and continued having alfuzosin. All well until june 2017. My PSA dropped for the first time to 3 ug/ml in april'2016. 

Its started again couple of weeks back. I am again facing such symptoms (Nocturia-3 times, spasms while passing urine, etc.). PSA again climbing up. Kindly help!

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  • Posted

    Your history looks so much like mine, with UTIs, bladder stones, two negative biopsies, a "lesion" and fluctuating PSA (between 5 and 10 on average) being my history for almost a decade.  

    With a history of PCa in the family it was inevitable that the doctors would assume prostate cancer along with BPH but after the two negative biopsies I came to the conclusion that "yes" I did most probably have an insignificant tumour but the UTIs were the main cause of my fluctuating PSA and in turn the formation of bladder stones and a lesion that was found in that part of the prostate which forms the bladder neck. Unsurprisingly, when the stones were removed the lesion disappeared but due to the continuing UTIs from retention and a risk of more bladder stone forming I bit the bullet and had a HoLEP procedure which finally rid me of the BPH symptoms and have been free from UTIs since then.

    The only downside is that a Gleason 6 PCa was discovered in the recovered prostate tissue during the HoLEP but that did go to confirm my suspicion of several years yearlier that a believed I had an insignificant tumour had been confirmed and it still remained insignificant.  PSA has remained steady at 1.1 for over a year now after it settled down following the HoLEP carried out in 2015.

    Antibiotics would always result in my PSA dropping significantly after the UTI was cleared up but another infection would soon follow and up it would creep again.

    Does any of this sound familiar (apart from the stones and HoLEP that is)?

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  • Posted

    I forgot to say that I'm living with the PCa for the present as it's not presenting an immediate threat and until it does I'm going to leave it alone other than stick my  decade long dietary regime of dairy free, no red meats, loads of fresh fruit and veg, vitD supplements and pure pomagranate juice.

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    • Posted

      Thanks a lot for getting back to me. I truly appreciate it.

      First, Here is my back ground:

      Indian, 47 years male, No Cancer history in the family.

      I don't have any stones or bladder issues. My MRI Reports says everything is Clean except bladder bottom wall is a bit thickened and a cystic lesion in the prostate. I am so confused on what to do since my troubles subside for few days and then haunts me back.

      My family doctor prescribed me Albendazole and Cipro to clear any parasitic infection. I am planning to see doctors again and probably will go with TURP/HoLEP to get rid of BPH but then doctors think that 47 years is just too young to get any of those invasive treatments.

      Also, there is this unique spasms around my thighs while passing urine along with other LUTS.

       

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    • Posted

      I would suggests you need to be absolutely certain that surgery will be of benefit fior you before you agree to it. Many men have surgery only to find out that it was not effective or even necessary. I have had BPH for several years. During  a recent visit with the urologist, he suggested surgery wouldn't likely help me much because I also have bladder/sleep issues. 

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    • Posted

      I agree with your doctor's opinion that at 47 you are to young to have any invasive treatment.

      Keeping on top of the infections is of prime imortance to avoid wrecking your bladder if allowed to continue for any length of time.

      However, at some point in time you will have to make the choice between having a permanent solution found for your BPH or putting up with years of discomfort and symptoms that will eventually end up ruling your life and that of those around you.

      In some respects I was the master of my own fate when I decided to rely on medication for almost 10 years to relieve BPH symptoms and almost tool the opportunity of having a TURP when it was offered some 7 years ago but nowing how barbaric the procedure was I bided my time until HoLEP became available to me and took it without hesitation.  Good luck with whatever route you choose to take.

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    • Posted

      Thank you so much for your suggestions. I am in absolute dilemma on whether I should take an invasive route. Surgery wont help me if it turns out to be some chronic infection, which it most likely is because in last MRI in december 2016 my prostate volume was 33 cc and my DRE appeared normal in april. My urologist said that by his experience cystic lesions are most likely caused by chronic non bacterial(My culture tests were always normal) infections.

      I dont know what to do at this point.

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  • Posted

    My first thought is UTI. Do you have urinary retention ? What is the average total volume of your 3 night trips ? Hank

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    • Posted

      Thanks for getting back to me. Truly appreciate it.

      I have had a lot of uroflowmetry tests and last one in april was normal with zero void. I am planning to get one again soon.

      For the nocturia volume, I have never measured the volume but I need to get up thrice when the symptoms are really bad else few days its zero times. I have a spasm in my thigh and penis sometimes while passing urine.

      Also, do stinging nettle and saw palmetto of any use?

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    • Posted

      UTI can give spasm to penis, possibly to thigh area (though not common) that is nearby due to nerve issues. If it is not too difficult, try to measure and keep track of your void frequency and volumes of each void for a day or two. The results may narrow down what you have, other than UTI. Hank

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    • Posted

      Thanks for your suggestions. It started getting even worse since a week. I have severe pain around legs and pelvic region with spasms while peeing. It seems like something is pulling my nerves. I am now scared of peeing due to pain. I have an appointment again with my uro, but I dont think so anyone can cure me.
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