PSA Velocity over 4 months since UTI

Agree barney. While it was a drop of 1/13th, statistically, this is nothing. One good thing though, the rise appears to have have stopped for the last 7 weeks.

The idea when I chose the urologist was a one stop shop. He recommended the Radiologist company as the best for producing clear mpMRI and a couple of experts at reading them. He in turn is a 'good' at reading them, and supports their findings, with resevations. By that I mean, he uses the MRI as an indication, and not the end game. He still see's the biopsy as the ultimate decider as to the agressiveness of the PCa. He said in my case, which is sort of unusual with a very fast rising and persistantantly high PSA, but with a MRI showing nothing.

He thinks it is a combination of PCa,BPH and prostatitus following the acute UTI. He also said he would review my MRI images and try and work out where the problem was before the biopsy. 

Anyway, next week I will confirm with him the biopsy date and we will go from there.

I had a meeting today with my urologist regarding, 'where to from here'... He reviewed the MRI images and we had a good discussion about them.

He reviwed my PSA readings for the last 17 years. He even had drawn up a graph to see where the true % rise was, as well as the PSA Free and the recent PHI and is of the opinion my PSA spike was UTI caused because my UTI was probably centered in or about my prostate, it got both "barrels" and took the brunt of the problem, causing my PSA to rise from a pretty steady 2.4 to 13 in 4 months. It has now started to decline, well, 1 so far...but it is a start. He thought my PSA may not return to high 2 or 3 for 18 months. He said the MRI images indicated to him prostatitus, and he mentioned about lots of lines showing flows of something, also supporting his theory of prostatitus. He said cipro had no further function as it was more a time thing than drugs. He said the spike did not bother him at all, due to it being too steep. He was more concerned about the 2.4 average PSA. He has patients with aggressive PCa, with PSA lower than 2.4. But, the difference was, they had a steady PSA or 0.5 for several years and then it slowly doubled over two years. That incline is the PCa signal. 

So, our plan of action is to sort out my urethra stricture issue which I have had from birth and do some flow measurements and some endoscopy of my bladder and pipe work to determine the best method to reduce or remove the stricture, which in turn should reduce the chance of a further UTI. As this will take several months to achieve, we can then see if the PSA has reduced and take some more PHI and PSA Free tests, and go from there. The prostate biopsy has been put on hold until the PSA has either climbed again, or refuses to reduce over the next several months. 

I have also heard this explanation before several times from several sources including my Uro that my PSA fluctuations (1.77 > 6.96 > 4.00) is due to prostatitis and can take many months (possibly 12-18) to calm down. In this case, time is the most important factor for spiked PSA to come down. So in your case, your Uro's explanation that prostatitis rather than PCa is a very possibility and "timing" might prove just that. In our case, yours and mine 3T MRI is negative as well. I have another 3-month PSA test in Jan 2017 to check my PSA.

You make sense.

The MRI did not show a suspicion for high grade PCa meaning you may have NO cancer or have a low grade cancer.

I agree with your plan: tackle the UTI matter comprehensively. If you're put on meds, I would wait 3 months and at least 14 clear days after stopping the meds before undergoing a PSA test. At 6 mths do another MRI regardless of what the PSA test tells you, just to be safe.

Also ensure ALL yr PSA tests are done by the same lab.

I was quite impressed by the urologist. He (or his staff) had downloaded my entire history of PSA tests. This was helped becuase over the 15+ years I have always used the same lab. He ploted each years movement and subsequent % rise and fall. Then spent another 10 minutes reviewing the MRI images. He said his choices were, if I did have PCa, then it was either the entire prostate, (due to no lesions or actual signals anywhere indicated) and then the PCA would be in the 000's, or that I had a low grade tissue change some where so small, not yet registering, or the prostate was just unwell. He also reminded me that the PSA test was to signify the prostate was unhappy for a variety of reasons, cancer at my age is a common issue. After the bladder/urethra work, we will retackle the prostate. And agree regarding MRI. While expensive, after 12 months, a follow up will allow a comparison of tissue images.

 

Hi David,

My urologist said some guys may think the spike in the PSA is very scary. The advantage I had is my PSA history. If you got a one off PSA test and it said 13, ALARM BELLS...In my case I have at least one test a year for 15 years. Sometimes two or more when I had a company medical as well. He said doubling in a 12 month period is a strong indication, while a spike in a few months is usually nothing. He said some guys were not worried when they had a PSA of .04 go to .08 in one year, as they were under the guidelines for say 4. Any constant movement that doubles in 12-24 months is a concern.

t is super important to know your prostate's habits, eg, he said mine has a high PSA average at 2.4 over a number of years, meaning it leaks out the prostate antigen higher than normal. This would be the case then if I got a prostate infection, it would complain loudly and leak out more PSA. As my BPH progresses, it will leak out more PSA again.

The danger is of course, this could mask a PCa hiding in the protatitus PSA leakage.

After we get the urethra issue resolved, which will hopefully reduce the chance of a further UTI(only ever had the one, and it was a terrible 2/3 weeks...never been so sick in my life) Then we will revisit the prostate. He thought 3 monthly PSA/Free, 6 monthly PHI and a further MRI in 12 months. Like the PSA, having a history of MRI images by the same lab is good, as any changes can be spotted quickly.

I said to the urologist I was a beliver in Pareto and can understand his view that 80% of the images that show no PCa, were correct, but for some reason, 20% of people do not show lesions. Assuming you have no symptoms, but a doubling of PSA over a year, means a biopsy is the only answer. Where he can not see a lesion, he mostly does perineal biopsies so he can get access to the entire prostate.

My brother said today his PSA took almost 2 years to return after a bad UTI. So, as you say, time can be a healer, as long as you understand what is going on...otherise, it can be a silent killer

Geoff  

 

Hi Geoff,

You mentioned it took your brother almost 2 years for his PSA to return.

Did his PSA return to normal level (same level before his bad UTI)?

Did he get biopsy done?

Did he get 3T MRI?

Did he take any Cipro antibiotics?

Just curious if he did anything or just wait out time.

thanks,

David

 

Hi David,

My brother's PSA never returned to 'as before' level. His doctor said once you have had a significant UTI that substantially raises your PSA, it will usually not return to as before but be maybe 0.5-1 above previous baseline. His PSA went from his 7 year average baseline of 2.7 to 19.9 over a 3 month period. The high PSA was found when he went to Dr with usual UTI symptoms, who took a urine test and blood test. His PSA was then 8 and rose continually for 3 months, then settled at 19.9 

He did not get a biopsy done. His doctor said the spike in PSA was too much and too quick for PCa.

He did get a mpMRI, which indicated no evidence of PCa. His PIRAD score was 2

When he presented with the UTI, he was prescribed cipro for 2 weeks. Dr said the antibiotic will kill the infection, but the damage it caused to the prostate will take 2+ years to recover and will be very PSA leaky.

My brother chose to wait it out. Following the antibiotics, his UTI symptoms went very quickly, other than a dull ache behind his pubic bone for a few months. Every 3 months he had a PSA test. It remained at 19.0 for 6 months, then came back down over the last 2.5 years to 3.03 last check a few months ago. He is now back to annual PSA tests.

In summary, his doctor said too many people think a 'high' PSA was proof they had prostate cancer, which is not the case in 80% of the time. 

Best of luck David with your issues.

Geoff

 

Hi wiley,

Thanks for the reply. Be good to see more parts of your information. 

What was your PSA increase and average from 45 until 67. 

Had your PSA risen to 4 from what? over this period? Then it rose by a further 2 to reach 6 over what period? When you had the surgery did the pathologist report on the cancer lesion size, Gleason and placement?

As you know, PSA rise is all about increases over time. A steady increase that doubles within 12-24 months or so, spells trouble. An increase that goes up 4-6  times in 5 months, with a PIRAD 3TmpMRI score of 2 usually says prostatitus. 

Did you get a mpMRI done, as it would have been interesting to know what it reported. 

My PSA rose from 1.9 to 2.4 in 22 years.(a 0.023% rise per year) In 5 months, following an acute UTI, it rose from its' 2.4 average to 13. or 540%. 

The urologist said as there is no history of PCa in my family, the "too" rapid PSA increase coupled with the MRI showing no leasons but evident BPH and prostatitus, points to no meaningful PCa. The unfavourable PSA free and PHI test results are saying the prostate is not happy, and there could be a combination of things causing this. Both these tests are designed for a PSA < 10. As my PSA was higher, it throws the results out somewhat. He thought because of my age, I may have a low grade, yet to be detectable PCa going on(as do most blokes at my age)

Anyway, I need to get the urethral stricture resolved to reduce the chances of further UTI occurrences. When this is done in the next few months, I will revisit the PSA/MRI conundrum and monitor the PSA direction. If any doubt, I will have a biopsy.

Geoff, my father, grandfather passed from PC and I had two first cousins get it in there late 40s. One of them died at 48. I have always assumed I would probably get it and ate all the right foods and started getting an annual PSA when l was 45. The first was 1.7 in 1994 and remained less than 2 through my test in Feb of 2010. I in Jan of 2010, I experienced the same symptoms you initially listed. I had lab work done last week of monto of Jan and my annual physical on Feb 7,2011.Reported symptoms to my Doctor who said I probably had a UTIAND it had caused my PSA to goto 4.22. Prescribed antibodies an wanted new PSA in a month. Did a digital inspection of prostate but didn't note anything abnormal. Symptoms went away in 3 weeks.in a month, new test was 6.5, he recommended a biopsy and I went to an Urologist first week in April. New test was 7.3 and he detected a bulge in the prostate. I had the biopsy done the last week inApril. Only pain was similar to being popped with rubber band and lasted about 30 minutes. In and out in less than 2 hours. Got report back in 2 days and result was Gleason 7, 3+4,. I had contacts with a Doctor friends who was a Department Head at UT Health Science Center in San Antonio, Tx. Their head of Onocology/Urology, Dr. Dipen Parehk proformed robotic surgery on July 5, 2011.post op PSA was 7.9. Pathology of the gland was Gleason 8, 4+4, the gland was extruded, but he felt that all the cancer was confined to the gland. Went for follow up in 6 weeks and PSA was undectable.. radiation was not recommended unless PSA started to rise. Had quartily test done first year,semi annual tests through 5 and will have an annual test unless there is a change. All test were ultra fine test and all have come back undectectable. I was blessed to catch it early. I saw what my father went through because he wouldn't go the Dr. And his had spread to his bones. I did not have a MRI done and it was never mentioned.

I hope this helps. I really believe in being pro active. For the 4 years, I have consulted newly diagnosed patients on what to expect from surgery and recovery. If I can answer any other questions, let me know.

I have a question about this forum. Do you have to check every day to see if there has been a response or can you be notified of a response? Thanks and good luck.

Wiley

Ummm Wiley, Mate, you were always going to get PCa one day with that pedigree. If the after effects of prostate surgery were not so invasive, I would have had my prostate removed on my 18th birthday....or been having PSA done every 3 months to build up a long history and any increase beyond that of normal incline, whip it out.

Great news that your PCa was intact and seems to have been all removed from the PSA results. With your history, I would now have 6 monthly PSA tests and yearly PET scans.

Agree with being proactive. For many years here the doctors did not agree with PSA tests. I insisted and built up a history to watch my slow incline. Dr was not happy with my PSA at 2.4, but because I had a long PSA history from the same lab showing the rise and fall range was 2.2-2.7, with the latest being 2.4, we assumed that was my base line average and I had a leaky prostate putting out more PSA that the norm. It was only after the UTI that the PSA went vertical, and now 6 months later has started the return journey...we hope.

Males should never ignore the prostate. It will kill you with little warning other than the PSA test as warning No 1 and No 2 mpMRI, No 3 biopsy. So far, I am at No 2. The prostate is on notice and being monitored. As I said earlier, when the urethral stricture is resolved, and my system as less reason for a UTI, then we will address the PSA. Urologist thinks, if I do have some PCa, it will be some very small area that a biopsy may find difficult to find as nothing is evident on the MRI. Though that said, he did warn me that some 20% of prostates tissue does not indicate a signal on the MRI, and all looks clear. If my PSA will not show signs of returning back below 3, then we will go with the blind biopsy...He did warn that this means 10-15 samples of every corner of the prostate.

As for your last question. Go to the top of the forum, and click follow this discussion. Then, again, at the top of the forum, click your name, go to settings and then notifications. You can select to be emailed for any topic you are following.

OK wiley, great you achieved the first task, remove the PCa without it spreading first. That has to be every mans thought. Sure the other problems are not good, but you are able to smell the flowers, until something else creeps up on you....

How long did it take you to get back your continence? did the errections return?

Geoff 

Geoff

I wore pampers for 4 months because of leakage during sudden movement, sneezing, lifting ,etc. Have been OK since

Have had to use vacuum pump for erections