I am 49, and I am looking for help. I had PSA 3.7 11/14 after DRE at Mayo Clinic. Doctor said it is elevated, and rechecked again on 05/15 PSA 3.1. Both these times I did not know I must have no ejaculation for 48 hours. January 2016, I went to a local urologist, he did DRE and said normal, PSA 2.47 (after DRE?) Three weeks of Cipro PSA 2.5 Free PSA 29.2.
Two month later January 2016 I started to have pain under my right rib, and in my left hip. I went to ER and the X-rays did not see anything suspicious. Three weeks later 03/28/2016 I went to Mayo Clinic to see gastroenterologist for scheduled procedures (endoscopy and colonoscopy) and asked to be referred to urologist. Urologist did DRE (nothing suspicious, but boggy) and checked for infection by prostate massage, all negative. Did not order PSA, because of the colonoscopy test it would not give an accurate number. Ordered 3T MRI with rectal coil., which basically said some diffuse changes, most likely prostatitis.
I was told to take warm baths and ibuprofen to reduce inflammation and recheck in six month. Five months later I stated to have back pain, so I contacted the Mayo doctor and was told to come for follow up 3T MRI test. My PSA is 2.5 10/2016 and Free PSA 25.6. So I went to Mayo in Rochester, MN and saw urologist after 3T MRI with contrast and endorectal coil second time
EXAM: MRI Prostate w&wo IV contrast using endorectal coil.
COMPARISON: MRI prostate 03/30/2016.
IMPRESSION: Increased diffuse hyperenhancement and only mild
diffusion restriction primarily seen throughout the peripheral zone
and bilateral seminal vesicles, which most likely represents diffuse
prostatitis and seminal vesiculitis in the setting of a decreasing
serum PSA.
PROSTATE: The prostate gland is again mildly enlarged and measures 35
cc in volume. Mild nodular enlargement of the central gland consistent
with benign prostatic hyperplasia.
As correlated with exam of 03/30/2016, again seen is scattered T2
hypointensities throughout the peripheral zone in both sides, most
pronounced from the apex to the mid gland. Corresponding
hyperperfusion and mild diffusion restriction are slightly more
prominent than previously (series 801 image 57; series 31002 image 23;
series 31200 image 21-23). These findings again most likely represent
chronic prostatitis, although any underlying low grade tumor cannot be
excluded.
LOCAL STAGING: Extracapsular extension is absent. Mild symmetric wall
thickening of the seminal vesicles with corresponding hyperperfusion,
likely inflammatory. Seminal vesicle invasion is likely absent.
LYMPH NODES: Nothing for suspicious nodes.
BONES: Nothing for suspicious bone lesions. Degenerative changes of
the spine.
OTHER: Tiny presumed right renal cysts. Trabeculated urinary bladder
wall. Colonic diverticulosis. Small fat-containing umbilical hernia.
Electronically signed by:
Mayo urologist told me to take Cipro for six weeks and let them know how I feel. I did not start Cipro yet.
At this time I have pain in my shoulder and some weird warm feeling in my left ear, no pain under my right rib, and no pain in left hip. I am afraid I have mets already. No family history.
What do you think about my situation, and what would you recommend I do next?
I understand you probably already read my post on another forum, but so far I hear it is not PC, somehow I do need some advice on what is the best to do next.
I read from some people who are dealing with their own struggles,yet, kind enough to help, to advice the worrisome person.
Thank you very much.
Ted.
Written by
lumix
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I had one 3T MRI in march 2016 and second one in the end of October 2016. Both with contrast and endorectal coil at Mayo Clinic Rochester MN. No biopsy was recommended both times. No nuclear scans ( pet scan?)
If I were you I would want to put my mind at rest therefore I would schedule a biopsy of my prostate even though it's not recommended by your doctor(s). You can ask the doctor to put you under sedation for the test. If you handled two endorectal MRIs (I've had two also) then the biopsy will be a piece of cake. I know it's easy for me to say but that's my opinion.
At some point in their lives, most men are going to have to come to terms with the prostate, because this little gland is the source of three of the major, common health problems that affect men.
1. Benign prostatic hyperplasia ( BPH ), also known as enlargement of the prostate, one of the most common health problems that affect men.
2. Prostatitis, a painful inflammation of the prostate and the most common cause of urinary tract infections in men.
3. Prostate cancer, the most common cancer in men and the real worry.
According to to the clinical tests : PSA, Free PSA, DRE, 3 T- MRI and the symptoms you have, your urologist should be able to place you in one of the three above categories. Your age is also a material factor as the incidence of prostate cancer is high but you are on the border line.
It is quite possible to contract PCa even if your PSA is within the normal range ( 0.0ng/ml - 4.0ng/ml ) and a possible indication would be the PSA velocity of increase within this range. ( symptomatic or asymptomatic ) to suspect PCa. Rarely, a PCa can grow silently without showing any elevation in the PSA.
Before you become paranoid about your bone pains etc. and a possible PCa, the best way to rule out the "real worry" as mentioned above is to go for at least a 12- core trans rectal needle biopsy.
If there is no PCa and you are still worried about possible bone metastasis due to pain you experience ( But this pains can be due to various other reasons ), you may undergo C 11- Choline PET/CT Scan at the Mayo Clinic or do a 68 Gallium PET/CT Scan. Both these scans are capable of identifying very small metastases.
Anyway, I cannot give you better advice than Mayo Clinic experts.
Hi
I am sorry to hear you are so concerned about distant metastasis from prostate cancer.
I would be very very careful about having a 12 core biopsy if you already have an inflamed prostate.
You may want to consider a trip down to Chattanooga, TN and consult with Dr. Joe Busch. Dr. Busch is excellent at diagnosing PC from a MRI and if necessary will perform a MRI guided biopsy but only if he sees an area that looks suspicious. I have not been to him but a good friend of mine went to him and said he was excellent. It turns out my friend did not have PC even though at times his psa was over 10. You may also be able to get a second opinion reading of your MRIs either from Dr. Busch or Johns Hopkins. There was another guy on this site who had a second opinion from JH and said it was done quickly and only required a fee and the correct form Try their website or call them.
Regarding distant metastasis, unless you were to have a very rare type of PC it is highly unlikely that mets would be present at such a low psa level. There are men who are diagnosed with low psa levels so I am not saying not to follow up just providing some information for you.
Regarding psa levels are not 100% accurate predictors of cancer. The use of psa levels to monitor from a baseline is a good idea. One slightly elevated level is not necessarily an indicator of cancer. Elevated levels that later return to normal is likely a good sign. However based on your concern I think a second opinion might help you.
I am not an expert only a patient. I hope this is helpful and I hope that you do not have PC
Yes. One hates to say that "you dont have cancer" because prostatits or BPH do not protect against cancer. You may have it. Biopsies are less able to rule out cancer than modern scans, and you lean towards a biopsy in order to rule cancer out. All you will be able to say is that the slivers that were taken did not hit any cancer. Will this satisfy you?
I am not sure if it will, I am a very nervous person and sometimes need reassuring not by just saying you do not have it. Sometimes I feel like I should assume the worst and if it is better it is a given.
Well more extreme and I don't know if you can get anyone to do it, is to count the CTCs in your blood. It is a test called "CELLSEARCH", and if you do it, please tell us how you arranged it, and what the results were.
It wont tell you if you have cancer confined to the prostate. It will only tell you if they have begun to escape from the prostate, along with the PSA that is being made in your prostate and getting into your blood.
Solid tumors shed cancer cells into the bloodstream. This test uses a computer to analyze the appearance of those cells, said lead researcher Dr. Howard Scher, chief of the Genitourinary Oncology Service at Memorial Sloan Kettering Cancer Center in New York City. This maybe the test your thinking of.
I agree that you get a second opinion. It is not uncommon for those who have an illness OR not to feel pain and automatically associate it with cancer if they are worried about it. Pain comes from quite a few things that are not cancer. PSA is an indicator, not a guarantee of cancer or not cancer. Do what you need to set your mind at ease. But if your tests and 2nd opinion are negative, rest easier. You don't want to walk this road if you don't have to. Blessings, my friend.
Ted - the fact that your PSA is low, DRE is normal, and the MRIs showed no areas of concern are all good news. Most urologists and those with PCa (I have Gleason 6 and have had MRI and biopsy) will tell you that your low PSA and normal DRE would not have prompted an MRI at this point but now that you've had it done, you should send it to other radiologists like Dr. Joe Busch in Chattanooga for a second opinion before you consider a biopsy, which has risks and should be determined by the results of your MRI. Blinded biopsies are highly ineffective compared to MRI guided ones. Also, you didn't state, but I assume your MRI was a multi-parametric one that provides much greater information to the radiologist than just the MRI (it was good that it was a 3T and not 1.5 MRI too.) However, I would be cautious about the endo coil - most advanced radiologists who do mpMRIs no longer use these so you may want to explore other places to have the MRI done. Also, you didn't express any other symptoms related to BPH or prostatitis so the other ailments you're experiencing could be any number of things.
The endo coil is on the GE equipment, and many doctors (in England at least) prefer the Siemens, which does not use a coil. You can look askance at the T99 scintillation scan, but at the MRIs and CT scans, much less so. Pretty sure.
3T MRI is what I think Mayo is currently using, I would assume they use a top notch equipment and knowing their radiology department is doing it all the time, I wonder if they think it is a sufficient and highly informative scanner. Fist time it was done in their hospital, and second time in the clinic. Both with coil. The interesting thing that first MRI report was signed by one radiologist, and second, the most recent, by two radiologists. Who knows why.
As to my symptoms, I do have some painful feeling occasionally which they explain I have inflammation. Everything else is normal as to void and erection.
The report says no bone involvement and degenerative changes of the spine.
My suggestion is to find a competent medical oncologist. A urologist is certainly necessary but I had a negative 12 core biopsy by a urologist and 12 months later biopsy showed a GS 8 prostate cancer. I pray this is not your case and wish the best for you in determining what is the true cause of your experience.
Second opinion is call I would make. Just remember, Prostate Cancer is one of the most over treated conditions. Your pain localizing in different areas is kind of strange. If a biopsy is negative watchful waiting would be my advise.
I now understand your concern very well. Much better than before.
You have done various tests including a 3-T MRI and none of the tests clearly indicate you have PCa. You also experience bone pains for reasons unknown but you fear possibilities for metastasis.
So you are facing a dilemma. Under the circumstances, "should I unnecessarily follow aggressive procedures such as biopsies and thereafter similar aggressive treatments if I have PCa? Or I should not miss this early opportunity of diagnosis in case I have PCa". Don't be nervous, you are a very lucky person to have hit your head on this. My advice is to focus fully on the quest for early detection by using all resources available. Because PCa can be cured only when diagnosed early and treated properly before it is too late.
I took my own 3-T MRI report and compared with yours by reading your one very carefully ( Thanks for giving all the details ). Don't take it too lightly. I quote few lines from your report : "T2 hypointensities throughout the peripheral zone in both sides, most pronounced from the apex to the gland.............These findings most likely represent chronic prostatitis , although any underlying low grade tumor cannot be excluded"
This is the pattern.BPH starts in the prostate's transition zone ( mid area ) and grows inward whereas the cancer begins in the peripheral zone and grows outward. And also cancer is more crowded near the apex of the prostate gland ( Joined with the penile urethra ). Please note the fact that low grade tumor cannot be ruled out though the condition has been identified as chronic prostatitis. On the other hand if you have chronic prostatitis for long periods without being treated properly, that itself can be a precursor for developing PCa.
My 3-T MRI report ( 19.12.2014 ) too have the same lines quoted above from your report but it ends up by saying "The appearances are in keeping with stage C1 neoplasm most likely malignant ....." Malignancy as you know means cancer. I did not have any symptoms but at a routine checkup my PSA was 5.11ng/ml. Immediately I went for a biopsy and was diagnosed for GS 9 aggressive PCa. But I was happy to have been diagnosed well in time before my cancer could spread. Without any fear I followed an equally aggressive treatment protocol Surgery ( RP ), Radiation ( IMRT ) and Hormone Therapy (ADT2 ) and my PSA up to date is 0.00ng/ml. Yet ,I am managing my case very carefully because my PCa is GS 9.
Why I am taking my time ( well spent ) to tell you all this is to emphasize on how important it is, not to miss the early opportunities available to you to get a proper diagnosis and start earl treatment. My age was 68 when I was diagnosed and you are just 49 with many more fruitful years to live!
You have received a heap of useful advice from our dear brothers and I read them all as if they are meant for me. I am glad I have one more option to offer you and it is only a blood test for detecting PCa. Probably you may be aware of this test, but I did not see it in any of the posts here. This is an advanced test developed, based on the research done at the Memorial Sloan Kettering Cancer Center famous for developing various cancer predictive tools ( Nomograms )and introduced for use in 2015. Name of the test is "4Kscore"
The 4Kscore combines four prostate specific biomarkers with clinical information to provide men with an accurate and personalized measure of their risk for aggressive prostate cancer. The 4Kscore can be used prior to biopsy or after a negative biopsy and can predict the likelihood of cancer spreading to other parts of the body.
The 4 biomarkers mentioned above are : Total PSA, Free PSA, Intact PSA and Human Kallikrein-2 ( hK2 ) and the related clinical aspects are : Patient's age, Digital rectal exam (DRE ) status, Prior biopsy status if any ( positive or negative ). Percentage risk calculation will be for GS7 and above.
So if you are desirous of avoiding biopsies at this stage or if your biopsies turnout to be negative and still you have some suspicious PCa related symptoms clinically significant, you may consider doing this test in consultation with a good Urologist/Oncologist.
You can get more details regarding this test at opko.com
Thank you Sisira, that was very nice of you to take your time to go over and explain the possible concerns in my report . I hope you will get rewarded for your compassion to people like me. As I mentioned in my post, I went to Mayo Clinic and now I am thinking why they did not offer any of those tests, like 4Kscore or some other ones (urine) more precise to detect the malignancies.
Before I went to Mayo, as I mentioned before, I went to a local urologist, who performed DRE, said normal, and only after I asked for PSA, he agreed. I mentioned if the test should be other way first PSA, he dismissed saying no big deal. I went to see him complaining about a rib and a hip two months later. He dismissed me telling his secretary to send me a reminder to test PSA in 12 months. I do not think this guy will take my request for additional testing, and Mayo would think I am telling them what to do.
Thank you very much for your kind heart. May God bless you.
Lumix you have to be your own support allie. I believe you have sufficient reason to expect these doctors to perform the tests. Be firm but not obnoxious in your discussion with them. Your friends have given you good advice here. I also believe you should get a good medical oncologist. Let su know what happens.
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PSA dropping but pain
PSA after the radical prostatectomy
MRI result after constant pains 
Pain, despite very low PSA
Lower PSA but rib mets pain
