Questions for follow up visit?

[spencoid2]

I have moved and need to set up a local urologist so I have an appointment with the guy who did emergency surgery on me when I was assaulted in the local ER room by a horrible doctor. Recently I had a rather large increase in PSA much higher than after brachy IMRT years ago. Some of the tests were while I had a PSA and others after self catheterization so who know what is responsible for what part of the PSA rise. here is a list of PSA with dates. I am wondering what questions I should ask the doctor that I might not have thought of yet. my first urologist did not seem too concerned about the recent levels but it bothers me. i will probably have another on the 6th hopefully with no UTI and not recent catheterization. should i be concerned and ask about tests such as bone scan, fancy imaging of any sort or ??? i have had a lot of lower back pain but this is hopefully just degenerative disc disease which i do have.

12/28/2018 5.99 no infection no catheterizing

12/05/2018 6.8 with UTI?

10/29/2018 7.31 UTI? UTI and cath right before?

4/3/2018 0.10not sure why there are two on same date but slightly different

4/3/20180.08

11/30/2017 0.82

4/3/2017 0.82 no infection

3/24/2017 0.10

12/1/2016 0.08

12/1/20140.10

[MJCA]

Hi,

What is your PSA?

What was your PSA?

How old are you?

Where did you move to?

Not trying to be nosy, I believe the other members would want to know the same.

Best of luck.

[spencoid2 in reply to MJCA]

PSA was listed in first post with dates. i am just short of 65. i lived half time near Seattle and half in Northern California, now just NorCal.

[Tall_Allen]

So you had brachy boost therapy in 2014 and you've had steady PSA of about 0.1 since them, except for a UTI for which you had to self cath. The UTI and the self cath undoubtedly caused the increase in PSA. Prostatitis is long lasting and can take its own sweet time before all of the inflammation that causes the increased PSA completely resolves. You just have to wait it out. It's going in the right direction.

[spencoid2 in reply to Tall_Allen]

no UTI nor cath for 23 days and the PSA just went down .81 from 6.8. was hoping for more reduction but it might also be that I am still not healed from the ER catheter assault and subsequent TURP of irradiated prostate. after the TURP it only went to .8 so i thought that was typical for being irritated. the TURP was some serious irritation but it only raised the PSA by .79. hopefully PSA will keep going down. is going down even slowly always a good sign?

[Tall_Allen in reply to spencoid2]

That was a lot of prostate irritation - it can take a while.

[spencoid2 in reply to Tall_Allen]

but a year after the TURP it was .8. it was not until almost another year later that it went up to 8 and then 7 and the close to 6. it is going down slowly but it was not until almost 2 years after the TURP that it went up that much. could it have taken two years to go up from the TURP?

[Tall_Allen in reply to spencoid2]

Maybe I'm not understanding - I understood you to say you were catheterizing and have a UTI.

[spencoid2 in reply to Tall_Allen]

i gave the whole history of PSAs with dates and noted on the list if i was catheterizing and if I had a UTI. the most recent PSA 12/28/2019 was 23 days after the last UTI. 10/29/2018 and before i was having to catheterize fairly often. the highest PSA on 10/292018 was right after catheterization and I found later that I had a UTI it seemed to be resistant to antibiotics because when I had the next PSA test on 12/05.2018, i still had a UTI but had not catheterized since the previous PSA. got more antibiotics and when I had the PSA test on 12/28/2019 did not have a UTI and had not catheterized at all since the test on 12/05/2018 this was 23 days. i thought that in that time the PSA should have dropped more than it did. i have no idea how much a UTI and or the trauma of catheterizing can contribute but the last PSA test had neither for 23 days. so what is keeping it so high? i am still having difficulty urinating some times and some times not. i have no idea what causes the difference. i have tried very hard to figure it out but absolutely can not. i am not having the very obvious discharge of tissue and gross hematuria. occasionally a small discharge (very minor) or some blood colored urine but nothing gross. i did have to catheterize once at night in the last couple of weeks. i bought a bladder scanner because i do not want to risk another UTI or unnecessary irritation from the catheter. i had 350 cc late at night and could not urinate at all so i figured i should cath so i could get some sleep. that is the last time about 12 days ago. the bladder scanner is used but i checked the accuracy by voiding completely with a catheter and comparing the measured volume to that indicated by the scanner. it is within 20% every time I checked it. I hope to not have to cath before the appointment on the 6th.

[spencoid2 in reply to spencoid2]

saw more local urologist today. his opinion is that even though the PSA has gone down some that a PSA as high as my last one indicates a problem. that an irradiated prostate should not generate much PSA even with a UTI or other cause of prostatitis. after the TURP it only reached .8 but now it is close to 6. so i am going to have another biopsy, a CT scan and a cystoscopy. also going to have complete metabolic blood test and another PSA. also had urinalysis done today and expect that there is no UTI because urine looks clear. any ideas on whether the proposed tests make sense?