Help / advice sought

[Arthur1962]

57 year old, it all started in March with aching painful right testicle which seemed to clear but the left got sore.

Had 3 courses of antibiotics, never worked, then developed the feeling of having to clench as you feel as if your going to leak and wet yourself.

After several months doc finally got me in for blood tests and prostate examination, he thought the prostate was slightly enlarged, Psa returns a reading of 15.

Off to the consultant, his examination of prostate he replied it was enlarged, it had no definition and there was no middle ridge.

He prescribed Tamsulosin to relieve the clenching, it worked for a week but now back as bad as ever and sample results over past 2 weeks are showing blood in my urine.

Consultant said that another Psa would be done and he would see me again in 12 weeks ??. I was amazed and disappointed that a MRI and biopsy wasn’t done.

Looking for thoughts on my Psa reading of 15 and symptoms I have had and are having, please any thoughts comments would be welcome, this is my first post on this subject.

[Tall_Allen]

You are displaying many of the classic symptoms of prostatitis (elevated PSA, testicular pain, enlarged/inflamed prostate, blood in urine w/o bacteria, urinary retention, non-responsive to antibiotics). They are doing exactly the right thing - treating symptomatically. Unfortunately, there is no cure - it relapses and remits on its own. Imaging will tell you nothing (inflammation confounds MRIs). Biopsy may aggravate it. Over time, there will be a typical see-saw pattern as it relapses and remits. If not, they may want to biopsy.

[Arthur1962 in reply to Tall_Allen]

Thank you, much appreciated.

[mike__c in reply to Tall_Allen]

This was not the approach my urologist took. He did not seem interested in my symptoms. My elevated PSA and what he felt was abnormal DRE made him tell me immediately that I needed a biopsy. I got him to refer an MRI, which showed a 2.4x2.6 lesion according to the radiologist. So, i trust i need this biopsy. My urologist did seem to have a distinct bias against the prostatitis diagnosis. He told me that if I had prostatitis, I would be extremely ill with a high fever and flu-like symptoms...otherwise I didn't have it, but maybe potentially had pelvic floor tightness (which he told me that I did not have when he did the exam).

I have been symptomatic with pelvic pain and some LUTS for several months.

[Tall_Allen in reply to mike__c]

It depends on what was abnormal about your DRE. If it is lumpy, that, in itself, is a good reason to biopsy.

Your urologist, however, is wrong about prostatitis. Most of the time it is asymptomatic. Read this:

ncbi.nlm.nih.gov/pmc/articl...

[Magnus1964]

The PSA of 15 is not surprising. PSA can rise because of irritations of inflammations. You probably have both. I get the feeling your doctor is playing the odds that you don't have prostate cancer. You need to demand a biopsy to find out and fast.

[Arthur1962 in reply to Magnus1964]

Thank you, much appreciated.

[Hidden in reply to Arthur1962]

Did you have freePSA also measured? There is a relation of the free to total PSA ratio with the prognosis of benin vs cancerous occurances.

[Arthur1962 in reply to Hidden]

Don’t think I did, something I will look into many thanks appreciated

[Neewor]

I was told by a urology nurse a couple of weeks ago that Tamsulosin takes about 6 weeks to be fully effective, so it might be worth investigating that.

[Arthur1962 in reply to Neewor]

Thank you, it was disappointing that it worked so quickly but then symptoms returned, perseverance I hope will conquer.

[CalBear74]

Please review Tall Allen’s comments and take them to heart, he is by far the most knowledgeable on this site.

[Arthur1962 in reply to CalBear74]

Appreciated thank you.