Needing sdvice from a specialist

I am a 54 year old man with prostate problems. In June a routine physical showed a PSA of 3.14, and high levels of white and red blood cells in urine. In late July, urine sample still same result. PSA now 5.4, free PSA <10%. Doctor put me on 1 month of antibiotics. Saw urologist mid August, who requested semen culture. Was told no prostrate infection or enlargement, but needed a biopsy.
Received biopsy results today all negative from 12 samples, but all reported chronic inflammation and mild atrophy.
Urologist states this biopsy is more accurate than PSA tests, and he wants to see me in 6 months.

I am concerned as PSA is rising, have moderate pain in buttocks and lower back, plus in groin and testicles, lots of discomfort. Father had problems before he died.

Should I listen to urologist or seek a second opinion. I go to toilet frequently day and night.

[Ash Tewari, MD, M.Ch.]

PSA can be elevated from prostate inflammation (either acute or chronic).  Chronic prostatitis needs to be treated with longer courses of antibiotics and may not show bacterial presence in cultlures.  Talk to you urologist about cystoscopy (camera inside bladder), urine cytology, and upper tract imaging (CT scan of kidneys, ureter, bladder).  The pain from chronic prostatitis can be relieved by NSAIDS (ibuprofen, naproxen) or alpha-blockers (flomax, terazosin).  Have your PSA followed regularly and have your urologist follow PSA velocity, PSA density, and free PSA.

[blueskyabq]

Hi, Dr:

What is PSA density?  To diagnosis, PSA+ free PSA is enough or cPSA+PSA is needed?  

Thank you in advance for your time and advise.

[blueskyabq]

Dr Tewari

If 2 PSA tests apart of 5 weeks, 1st one is 9.6 and the 2nd one is 3.8.  Are those accurate? why data showed so much difference, what that mean? Is it worth to retest again?  If yes, how long from the last test?

Even a free PSA tested, but if those PSA data seems untrusted then what will be free PSA data tested at the same lab being trusted?

BTW, what is PSA density?

If you can response soon, it will be greatly appreciated.  Thank you in advance for your time and advise!