Prostate Issues Durring Ulcerative Colitis Flare of the Rectum

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I had recently started having trouble urinating. I went to my Urologist who really didn't find anything wrong. I was on Cipro for two weeks for Prostatitis and there was little change, however when she took a sample of prostate fluid durring a DRE I yelled in pain. I startled my doctor and frankly myself as well. A few months later I went in for a colonoscopy and it showed that I had Mild Pancolitis with moderate colitis of the rectum. So that explains the severe pain durring the DRE. So the whole time I have had prostate symptoms I was having a IBD flare in my rectum. So my question is one that no one including my doctor can seem to answer. Can a flare up of Inflammitory Bowel disease of the rectum cause enough pressure in the Prostate to cause symptoms of BPH. I don't know if that is possible, but my doctor wants me to have a PSA test and I am reluctant to do so as my bowel is inflammed and it is difficult to urinate. I don't want to go down biopsy road if my only issue is IBD. Things are so bad in there at this time I doubt I could handle a TRUS biopsy. It would probably cause me to develope a Fistula. I asked my doctor about a PCA3 test and they had never heard of this test. I had to explain to the nurse what it was and I told her that this test has been out since 2004 and that it looks for PC specifically. Here we are in 2017 and they havn't heard of it. My doctor hates informed patients like me asking for fancy tests that they think are a myth. I told them that I would have a PSA test, but I said I don't care if it comes back high or not, I will not have a biopsy based soley on PSA. I said that I would insist upon a PCA3 test before we even talk about a biopsy. I don't understand how a doctor in a major city, at a major clinic has never heard of PCA3. They still use only PSA and they push it. It is a requirement for me as my doctor will not keep giving me Testosterone replacement without it. If it comes back high then the burden of proof lies with me trying to convince my doctor that I don't have PC. I really believe that it is an inflammitory response from my bowel disease. So is there any other men out there in my predicament? Did you have Prostate issues with an IBD flare up? If so please respond so I can get an idea if it is possible.

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  • Posted

    I had nurses and new docs still in residency didn't know what TURP was even after I told them what the letters stood for. Had to explain it to them. Then they knew what I was talking about. Look how long that's been around.

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  • Posted

    Craig, Your concern about PSA tests and biopsies is well handled in other threads; however, since the search function on this website is pretty useless, I'll repeat the short form, here. I'm only addressing the PSA and biopsy issues, not IBD:

    Random TRUS biopsies are essentially obsolete. The process is to first perform a PSA test, including the free PSA test, as well, since that’s also an indicator, although the PCA3 test is better.  And a PSA velocity computation (requiring at least two PSA tests) is also helpful.  However, you may not want to wait for a time interval to determine PSA velocity.  In any case, none of these tests is diagnostic. 

    If, from these test, there is suspicion of PCa, then the next thing to do is to have a Multi-Parametric MRI {mpMRI) performed in a 3T MRI machine.  This requires a specialist radiologist who knows how to interpret, using the PI-RADS methodology, the several MRI images that are produced.

    Using an Internet search engine, if you search for PI-RADS v2 you will find a comprehensive article on this new internationally accepted system for PCa detection.

    PI-RADS computes a grade from 1 to 5.  A grade of 1, which means “clinically significant cancer is highly unlikely to be present” predicts with an accuracy (I’m remembering from reading) in the high 90s% of no significant cancer.  The accuracy, to some extent, depends on the skill and experience of the radiologist.  With PI-RADS = 1 there is nothing more to do.  However, this process will not find indolent cancers.

    If significant cancer is found, then a biopsy must be performed, and the most accurate biopsy that has the best chance of actually sampling the suspicious spot(s) on the MRI images is one done in the bore of the same machine in which the mpMRI was done.  However, there are other, less accurate but more prevalent methods of overlaying the MRI images under software control onto a traditional ultrasound image, permitting the urologist to use his or her traditional method of performing a biopsy, although it is no longer random.  This method is constantly improving with improving overlay software.

    I’ve had every test I discussed here, including the mpMRI.  Fortunately, my mpMRI showed a PI-RADS score of 2, which means: “clinically significant cancer is unlikely to be present.”  There were no identifiable suspicious spots to be biopsied.  My PSA at that time zoomed up to 14, although it dropped back down to 8 a month later, where it’s approximately still at two years later.

    Harvey (in S. Calif.)

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    • Posted

      What you say is logical, but as I said my doctor seems to be living in the dark ages and insurance sometimes will not pay for an 3T MRI unless you have a failed biopsy first. My doctor has never heard of a PCA3 test at all. I will have the PSA test, but I told them I would require a PCA3 test or a 3T MRI to be done before I would allow a biopsy to be done. My urologist does do the in office TRUS biopsy still. Granted it is guided by an ultrasound image, it is still a blind poke and hope. I have active disease at this time and having such a test could be really damaging to me. I think I will just go with the flow for now and have the PSA test to make my doctor happy. I did warn them that if it is high I have no intention of allowing a biopsy. It will have to be proven that I have an issue with a 3T MRI first and that way a guided biopsy can be done, but only if my IBD is under control. I am also on immune suppressants so the chace of sepsis go up, even with antibiotic use.
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    • Posted

      Here in the U.S., Medicare paid for my mpMRI.  I don't recall having to prove I had a previous biopsy; however, I did have two random biopsies, first in 1999 and then in 2005 (the prostate dark ages), both negative, that I reported to the mpMRI radiologist, so I don't know if that fact was reported to Medicare.

      I certainly agree that while on immune suppressants it's a bad idea to have a biopsy.

      There are urologists, lacking the overlay software, who will do what's called (humorously, I think) a cognitive overlay (CO), where the urologist looks at the mpMRI with its suspicious spots outlined, then looks at the US image to guide the biopsy needle in an attempt at landing in the suspicious area.  Needless to say, this is far from an accurate method of locating PCa, if it's there, but better than a blind poke, as you say.  This CO method is obviously easier if the suspicious area(s) are large.

      Do you exercise a lot?  That's an absolute requirement for health, because muscle metabolism generates various products required by other organs.  There's a must-read article that reviews a couple hundred clinical studies relating physical activity and disease prevention'/remission.  Search on:  Waging war on physical inactivity  It was published in 2002 by Booth, et al.

      Good luck!

      Harvey

       

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  • Posted

    Two years ago I ate some bad sushi in Mexico (I know, shouldn't been more careful in Mexico) and had about 6 months of IBS problems.  During that time my bph issues flared up.  Every doctor I asked said there was no known connectiong but my irritated bowel was located so close to my bladder that it didn't seem to be a coincidence.

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    • Posted

      That is something to ponder. I have a lot of inflammation in my rectum and it seems to me like it is causing my urinary symptoms as well. As you said there have been no studies done to see if there is a connection. I don't want to have a PSA test that is high because of an IBD flare up. I couldn't handle a TRUS biopsy at this time. It would cause more harm than good.

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  • Posted

    Craig...... just wanted to comment on the IBS part of your issue(s).  Not sure this is really relevant, but I thought I'd pass it on for what it's worth.

    I had uncontrollable diarrhea a few years back, and it turned out that because I was taking antacids almost everyday (for a very sensitive stomach), they had eliminated the necessary acid in my digestive system, allowing a huge growth in bacteria, which led to the diarrhea.  Once I cut out the antacids, everything pretty much went back to normal.  No more surprise (and I do mean surprise) diarrhea.

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  • Posted

    You are correct. Your Dr is wrong. You need a new doctor.

    Neal

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    • Posted

      Well, that is possible. I may need to get a new doctor. I didn't want to but if he makes me jump through hoops like this to remain on TRT then maybe I should switch. One of my friends from work is also on TRT and his doctor has never ordered a PSA test for him and he is over 50 years old. I am still under the age of 50.

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