Infection or Cancer?

[Thomas3857]

Hi everyone - Thanks for reading this. So grateful for the ability to share my story and learn from others.

57, with history of kidney stone disease and diagnosed BPH with very mild symptoms.

Timetable

2/22 PSA is 1.23 a rise from .9 a year earlier but 10 years of PSA tests before that are all under 1.

8/22 PSA is 1.23 Health anxiety explains the 6 month re-recheck no symptoms

2/23 - blood in urine i think due to possible stone but no stone passed and symptoms progressed to painful urination, frequent urination, cloudy, smelly urine and bouts of fever. Looking back seems like an obvious UTI.

3/23 - Go to GP and urine test shows trace leukocytes, large blood and pus in urine. GP says go to urologist but looks like an infection.

3/23 - a few days later at uro with normal ultrasound but enlarged prostate and prescribed antibiotics. No PSA levels checked. Start antibiotics and flomax.

4/23 - symptoms improve but still blood - gross sometimes but always show up on urine test strips and frequent weak urination still there. I go to shot nurse and get a PSA test and level is 18.2. Freak out. Never should have got a test not ordered by doctor!

4/23 - a week later. Back at uro. DRE normal and PSA drops to 12. And free PSA is just over 10% which uro says is common with infection. Uro still thinks infection puts me on a 30 day course of doxycycline.

Present - symptoms improved slightly as far as pain goes but still weak, frequent urination and still blood. Anxiety at all-time high.

Have another uro appointment in 2 days where I assume I’ll have another PSA test.

Questions:

is an increase in PSA from 1.23 to 18.2 in 8 months better explained by infection or cancer?

can PSA related to cancer go down? Is it unusual for PSA to drop from 18 to 12 in a week and still be cancer?

Can an infection cause PSA to be elevated even after onset of symptoms was over 90 days ago?

If infection, shouldn’t the antibiotics have significantly reduced my symptoms - especially the blood in urine?

what should I ask the uro at my appointment?

Thanks for any comments or advice. Feeling a bit lost.

[Tall_Allen]

Prostatitis is a bitch!

"is an increase in PSA from 1.23 to 18.2 in 8 months better explained by infection or cancer?" infection- cancer almost never rises that quickly, blockage almost always does.

"can PSA related to cancer go down? No.- only minor fluctuations with cancer- and then because of underlying benign disease.

"Is it unusual for PSA to drop from 18 to 12 in a week and still be cancer?" Prostatitis almost always follows that zig-zag pattern.

"Can an infection cause PSA to be elevated even after onset of symptoms was over 90 days ago?" Prostatitis is usually asymptomatic, but may occasionally exhibit symptoms. It relapses and remits on its own. I don't think that one ever gets rid of it completely.

"If infection, shouldn’t the antibiotics have significantly reduced my symptoms - especially the blood in urine?" Prostatitis is usually unresponsive to antibiotics. In fact, the AUA guidelines are for doctors to not prescribe them.

"what should I ask the uro at my appointment?"

1. stop taking antibiotics for it.

2. if you have a painful relapse, try Elavil (prescription). No one knows why it works, but it seems to be the only thing that does.

3. If it hurts when you pee, try Pyridium (available over-the-counter). Be careful, it stains everything.

4. Cialis may also help with lower urinary tract symptoms. If you use it with Flomax, be careful when you get up. They both lower blood pressure, so if you arise too quickly, you can faint.

[Thomas3857 in reply to Tall_Allen]

Thanks very much for your response. You’ve given me more information in this one response than I’ve received from my urologist in three months. He just keeps prescribing different antibiotics. Guess it’s time to educate myself. Thanks again!

[Tall_Allen in reply to Thomas3857]

You might find this useful:

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

[Thomas3857 in reply to Tall_Allen]

Thanks. Very interesting. Don’t know if you saw scout4answers response and profile but his rapidly declining PSA turned out to be cancer. The more I learn the less I understand!

[Tall_Allen in reply to Thomas3857]

I don’t have time to read others’ replies But this is a public forum and you have to decide if anecdotes should drive you.

[Thomas3857 in reply to Tall_Allen]

Good point. My health anxiety leads me to catastrophize and seek reassurance when I process information and I tend to focus on the negative. Working on it. Thanks again for the information you provided. I found it very useful.

[Scout4answers in reply to Tall_Allen]

See my profile for my history with anti biotics and PSA/ cancer. I had a similar experience but it is only anecdotal info

[Thomas3857 in reply to Scout4answers]

Thanks for the response. Seems the more I research the issue of rapidly declining PSA the more I get confused. Most sources indicate cancer-causing PSA doesn’t decline rapidly and that such a decline is likely due to infection as the cause but like you stated your experience is different. Wish you good luck in your fight.

[Tall_Allen in reply to Scout4answers]

As I said, underlying benign disease.

[Daveofnj]

As someone who has had both, it sounds more like an infection.

[cpcohen]

What TA says . . .

Prostate cancer is a progressive disease. It doesn't ebb and flow, and the kind of quick-growing PCa that would cause your PSA to go from 1 to 18 (or 12) in a year, doesn't suddenly disappear, or stop producing PSA.

I don't see any evidence for PCa in what you've presented.

. Charles

[LUMC_Survivor]

You have had some great replies here Thomas, so hope that has helped. All I would question is whether you have been seeing the same urologist throughout the period since you noticed the problem. If so, maybe it is time to find someone else and at a different institution, even if it's for a second opinion. Good luck, keep everyone her updated, as it will help to know how your recovery goes.

[Thomas3857]

yes, very helpful and grateful for anyone who takes time to respond. Same uro from the beginning. Very experienced but not very good at relaying information. I’ll update as things develop. Thx

[Thomas3857 in reply to Thomas3857]

hi all - just wanted to post an update hoping that anyone with similar fact pattern can benefit.

My uro continued to test my psa and changed antibiotics seemingly ever 30 days for the next 6 months after my last post here. My psa zig zagged as did my free psa % going over 7 months from rounding off the numbers) 18 to 10 to 9 to 6 to 5 back up to 8 and then 3 with free PSA not bouncing around as much staying around the 15% range. I wasn’t happy with my doc as I thought he was just feeding me antibiotics so I switched uros.

When a psa ordered by new Uro showed psa back up to 4 he ordered an MRI which showed a large area of prostatitis and a PIRADS 3 which radiologist said could be inflammation but wasn’t sure I opted for a mri fusion trus biopsy and all cores came back negative

Fast forward 6 months and my latest psa shows 1.5 and 35% free psa

Anyway, hope some good people here can learn something from what has been an 18 month process Thanks to everyone who responded especially to Tall Allen who nailed the prostatitis diagnosis Thinking of you guys often