PSA and CT

[spencoid2]

After internal and external radiation my PSA was very low for a while. There was a recent spike which might have been partly caused by a UTI. I am on cipro now which will hopefully finally get rid of the UTI. I have an appointment in a couple of days for both a CT (uroscan) and cystoscopy. Hopefully the UTI will be over and I can get a representative PSA test at the same time. My PSA was 5 when last tested but I apparently still had a UTI then. Not sure what the CT scan is for? Urologist also want to do another protate biopsy but this is not scheduled so maybe the CT scan results can eliminate that need if negative? Any ideas on the purpose of the CT. I forgot to ask the doctor what the exact reason for the CT scan was.

[Tall_Allen]

UTIs are common after invasive procedures like brachytherapy and biopsies. They are often relapsing and remitting - they come back to wreak havoc with PSA tests, and then go away on their own. They seldom respond to antibiotics.

A CT can show if there are any enlarged nodules. But lymph nodes can be enlarged from infection or cancer.

Intrusive procedures like cystoscopy may damage the friable irradiated tissue of the urethra. It can take several years for all the cancer cells to die from the radiation - meanwhile, those cells are still in place, but incapable of activity. So a biopsy may be alarming but non-informative. I strongly suggest you consult with your radiation oncologist before engaging in any of these procedures. Urologists may be woefully ignorant about all this.

[spencoid2 in reply to Tall_Allen]

I had a Foley catheter jammed through my urethra and inflated in my prostate a year or two after the radiation. I had a TURP to fix the damage and for almost two years was having bleeding, shedding clumps of tissue and having just about every urinary symptom possible. This has finally cleared up and I am peeing normally with no blood, no clots no need for cath. This is all pretty recent. So I think I am actually in good condition in terms of tissue strength, at least better than for the last two years. The doctor who wants to do the cystoscopy is the one who did the TURP. I am going along with it because I would like to confirm that things are better and hopefully going to stay that way. I have had two cystoscopies by my former (moved from WA to CA) urologist at which time there was so much going on that he could see noting but an indistinguishable mess. So what I am hoping to find is that this has cleared up. I,ll ask him to be careful He wanted to do the CT and I figure I might as well have that information too?

Would like to see the PSA go down but if the UTI doesn't clear up who knows what the PSA means. At least it is not going up at an alarming rate. Even with the UTI is is high but pretty much stable, no fast doubling.

[Tall_Allen in reply to spencoid2]

I doubt you will learn anything useful. I strongly recommend you consult with your RO before you allow another invasive procedure.

[spencoid2 in reply to Tall_Allen]

i don't really have an RO. we moved from WA to CA full time. there was an RO overseeing my case but i forget who and he is not locally available. the guy who did the Brachytherapy and who was coordinating things has died. i am definitely going to pass on another biopsy unless there is a very clear indication that it is necessary. things in the uro area finally seem to be improving other than the elevated PSA and i do not want to fuck things up. i think the cystoscopy will be minimally invasive and might confirm that i have finally healed after the TURP.

[Tall_Allen in reply to spencoid2]

Where in CA are you?

[spencoid2 in reply to Tall_Allen]

Northern Mendocino County, mountain road. The new Uro is 3.5 hours away in Santa Rosa. He is a young smart guy who specializes in robot surgery. Does not have a lot of experience but is not a know it all asshole.

[Tall_Allen in reply to spencoid2]

There are lots of good ROs at UCSF. Maybe Joe Hsu, who has experience with men who have had brachytherapy.

[spencoid2 in reply to Tall_Allen]

if anything gets more complicated we intend to see what UCSF has to offer. we get especially good rates at UCSF since hubby was an employee unfortunately it is almost 5 hours away and staying in SF over night costs $350 these days. hopefully this is all an over reaction and nothing that needs to be acted upon.