PSA Velocity over 4 months since UTI

Hi David, Because i could not get into seeing a urologist for 2 months, I arranged for a mpMRI on a T3 machine, so that at least i could see if I had a obvious PCa. Reading was conducted by chief radiologist who specialises in PCa MRI. The result was nothing evident other than a typical onset of BPH and an overal PIRAD2 score. Also no mass etc in my bladder. For 12 years average of 2.4, then after a UTI, my annual PSA spiked to 7.4, then month later 8.2 then 4 weeks later, 12, then 6 weeks later(now) 13. So, the PSA is still climbing. Hopefully, a visit with the urologist may sort out how to determine the cause of the PSA rise. Maybe the BPH that is developing in my prostate is the cause. Prostate is not too large at 37cc, hence why I have no other symptoms other than PSA rise.

Geoff

Antibiotics would rule out infection.

Have you undergone any STD checks?

Regardless of the above results, with such PSA readings, I would urge you undergo a MRI to be reported on by a radiologist experienced in prostate imaging.

Many urologists would ask you to undergo a biopsy without a MRI beforehand, but I feel that the MRI beforehand can only improve the biopsy's outcome.

UPDATE:

After finished 30-day Cipro anti-biotics, i had a followup with my Uro today Oct 4. My PSA dropped to 4.00 from 6.96. My Uro thinks it is likely an infection that caused initial PSA spike. So my PSA was 1.77 then 6.96 and now 4.00. See below. Although the drop is

good news, I don't feel i'm out of the woods yet. I read some men have their PSA goes

down after antibiotics then only to see PSA elevate again in 3 or 6 or 12 months. So i will see my Uro again in 3 months. Also my free PSA is 18% which means there is still a 20% chance can can be found which is a concern.

My PSA results

04/2013 - 1.69

06/2014 - 1.43

06/2015 - 1.77

08/2016 - 6.96

10/2016 - 4.00 (free PSA is 18%)

UPDATE

My Uro also said that my PSA can

still come down even lower if the infection begins to settle down and resolves.

I forgot to add that I also asked for 3T MRI and my Uro agreed that it is a good idea. So i'm going to have a 3T MRI done soon.

Hi David,

Get the 3T mpMRI as soon as possible. Cost me $500, but well worth the information and a marker going forward. The images and report will indicate to you what the Prostate is doing and if there are any issues that warrant further examination. I see my urologist tomorrow to try and track down my PSA spike now that the MRI said BPH only and maybe the cause??

Geoff 

Good luck tomorrow Geoff. Let us know how it goes.

Thanks David, Will do. Considereing the "good" MRI result I have, I do not expect too much bad news; hopefully a remedy for my vertical PSA(now 13).

A reminder from the good doctor just appeared on my computer 2 seconds ago.

Geoff 

I agree with Geoff.

You must have a MRI ideally 3t which will be reported on by an expert in probate imaging. And soon.

My reason is simple. Your PSA from 0/15 to 10/16 more than doubled. That is a very good reason to have the MRI ASAP. 

Don't wait for the next MRI three months away.

I have a 3T mp-MRI scheduled for Oct 26. Will update.

Usually the report is sent to the specialist who referred you for the MRI. Ask for a copy of ten report to be sent to your family doctor as getting a copy form the latter will be easier and quicker than from the urologist.

Of course the best thing is to get a copy sent to you directly.

In Australia, we have to get our general doctor to write a letter of 'referal' to a specialist Urologist. Who in turn, if we request it, will refer us to a radiologist for the MRI. The report from the radiologist goes to the Urologist and the general doctor(both have access to the MRI images online). Me, as the patient, (when I pay the fees) get given a DVD with the images at the time of the MRI. The report is usually prepared 1 or 2 days later when the radiologist specialist in prostate MRI images is available. I went to see my general doctor a few days later for my report, as he always gives me copies of my reports and pathology results for my files. We can not get the report sent to us directly by the radiologist.  

Geoff

Geoff,

Trying a course of Cipro can be a good thing to resolve any UTI bacteria lurking around. I agree the steep PSA spike in such a short duration is not likely to be PCa. I just finished 4 weeks of Cipro. Side effects were minimal. The first few days i had some very bad achings on my left testicle but achings went away in a week or so. I think maybe because the Cipro was working and killing off the bacteria. Other side effects is fatigue and tinnitus but not too bad that didn't really interfere with my daily routine. Trying the Cipro will definitely rule out any infection to see if your PSA comes down. Then you know that the PSA spike is most likely connected to the infection. You should Google Dr. William J. Catalona, a very known research Urologist, he has very good info on his site on rapid rising PSAs and causes. He did mention that any PSA increase of +2 ng/ml PSA is likely to be inflammation rather than PCa and suggests trying a round of Cipro to resolve.

-david

Thanks David, I will check out Dr. William Catalona site. In "my" opinion, as the mpMRI said no reportable lesions, then I am not too happy about blind biopsy plan if the PSA does not retreat. The infection could be non bacterial? In any case, if cipro does not work, then I need to research how we determine what is wrong with my prostate to cause the rise in PSA and treat PCa as a last resort. As no lesions reported, then what ever is there, if anything, it must be small. If the prostate was similar to gall bladder, it would be out.

Geoff

My other half was diagnosed wit prostate cancer. Gleason 3+3 nothing showed up at all on MRI. Also know a chap with it. Nothing showed on MRI. He went for prostate removal and it had spread to his seminal vesicles AND his bladder. Yet nothing on MRI.

Yes, Alfred, this is a concern. While the MRI indicates no reportable lesions, maybe the PCa is sitting local some how and not clustered sufficient for the MRI to pick it up!

Anyway, will try the cipro for 6 weeks. If still no change, we will have to be a lot more aggressive and see if we can target a biopsy. As my increase in PSA has been 10+ over a 6 month period, this is likely to be too much too quick for PCa !!

Geoff 

I understand you are in Australia. Me too.

Is the urologist you are seeing for a possible infection of the prostate, experienced enough that you would be happy for him to operate on you?

Did you have the MRI in a facility that specialises in prostrate imaging?

 

Hi Barney, The reason it took me 2 months to get an appointment to see the urologist was because he is considered one of the best in Brisbane. On my appointment day/time, he was running 90 minutes late, as he spends most of his time in surgery or at other hospitals, so difficult to get him. And yes, I would trust him as my surgeon. He and two other 'experts' recently ran a Master class for other urologists and radiologists. His 'pedegree'....

"Peter Swindle is a urologist who specialises solely in prostate cancer. His expertise lies in robotic prostatectomy and he has a special interest in MRI of the prostate. He trained in Queensland and subsequently completed a Masters of Surgery at the University of Sydney on magnetic resonance imaging of the prostate. Peter then undertook a 2 year subspecialty Fellowship at Memorial Sloan-Kettering Cancer Center in New York focusing on prostate cancer and undertook two years research on MRI of the prostate. He also completed an American

Brachytherapy Fellowship at the Seattle Prostate Institute". etc etc

The MRI facility I used carries out this procedure for most of the urologists and there are only two of the radiologists out of 51 in the practise that are used by my urologist, and the chief radiologist for the practise, being one of the two, provided my report.

That said, my urologist said the MRI still misses some cancers, due to the nature of the lesion. Often the low score gleeson 2-4 are not found due to them looking like BPH tissue. These of course tend to be the slow indolent cancers that have yet to form into a tumor.

Geoff

Dr Peter Swindle's CV looks good. But I can't see how many surgeries of what type he has performed. Specifically, how many were robot assisted radical prostatectomies?

Assuming that is what you are after if you need surgery.

You need to find this out. The more surgeries of the type that you will require which  he has performed, the better the likely outcome for you. My point was that once you find the surgeon you trust, it is he who should perform the biopsy and any surgery following the biopsy. Most surgeons will not want to operate using someone else's biopsy result.

Where does Swindle operates? I understand that Brisbane's Wesley Hospital has a good name for prostate treatment.

Hi Barney, He does not specifically list how many of each kind of surgery he has carried out. When I asked him, he said several hundred...He works out of the Wesley, Mater Private and Greenslopes.

He was eager to carry out a biopsy on me asap due to the high PSA. But, he also thought it maybe an infection and try the Cipro for 6 weeks. His view was the MRI did not find anything substancial, so, if there is any PCa, it will probably be low grade. Anyway, we shall see in 8 weeks time when I see him again, after getting another PSA/Urine test.

Geoff

I hear you. My point was that most urologists offer an array of treatments: robot assisted radical prostatectomy

open prostatectomy

brachytherapy

brachy & radiation 

wtc

You should find the urologist that has a lot of experience in the treatment you are after. My urologist for instance when I asked how many robot assists surgeries he has performed, told me he has done  I believe 800.

I agree with you to test if you have an infection.if not then you can seek treatment. As the MRI doesnt indicate high grade carcinoma, you may well have an infection or a low grade cancer. both are relatively good news.

He has the usual stable of procedures;

robotic prostatectomy

open prostatectomy

brachytherapy high and low dose

brachy and radiation

turp

green light

mri(runs master classes)

mri guided biopsy

If and when I get to needing some intervention, then I will be really reviewing his experience in detail. It is one thing having lots of experience in a procedure, it is another knowing which procedure gives the best outcome for a given set of circumstances.

If I do have a low grade PCa, then the BIG question will be...what next.

With all the problems with intervention, if possible, watchfull waiting maybe the best option. eg, until the mri indicates a lesion that requres some action...wait.

Geoff

I agree with your decision making process.