Prostate Flare Up

[cjdriver]

I have been tested with slightly high PSA (2.5, 2.36, 2.48) age 44. Tests at age 32 and 40 were 1.8 and 1.6 respectively. I have recently had bouts of nocturia with urgency and a continuous feeling of needing to urinate, even after just voiding. Some twinges of pain in my prostate. These last about 12 hours and then go away. I may go a couple days and then another episode. I've tried Leviquin for 30 days with no effect.  I'm scheduled back in with a urologist in a month for another psa test. The question is, should I wait that long, or go in sooner, and also, should I have a biopsy, or is there a chance this is prostatitis?

[cjdriver]

In regards to my symptom flare ups, I seem to go a day feeling fine, then a day of symptoms( freq urination, urgency, burning, feeling full bladder immediately after voiding), then a day feeling fine again. Is this typical of prostatitis? Hot baths seem to help a lot. I have been on Cipro now for 7 days, and the cycle seems to continue. Also, should I stay on Cipro for a full month, or stop after the ten day prescription I have?

[HeinrikMD]

Hi,

The PSA would be able to provide some additional information that may help decide when to perform the biopsy. I doubt if the value would be so significant so as to convince everyone that the biopsy is mandatory. The risk for the disease is really a continuous value, so there is no normal value of PSA in which the disease has not been documented. The tests will not guarantee that a cancer does not exist, it will only dictate threshold values at which there are more cancers (but since it is a continuum, the actual value at which the biopsy is worth doing could be debated). At the end of the day, any test you do, there would be a value judgment needed on your part in which your personal preference comes to play. The answer is really up to you. Perhaps if you are almost convinced that you need the biopsy, then the test may help you decide. If you are far from convinced, the test may not turn things around.  

[cjdriver]

Thank you for your input. My inclination is to treat for prostatitis (Cipro), and monitor PSA. Would a free psa be worthwhile at this point?

[HeinrikMD]

Hi,

The family history may only mean a sporadic form of the cancer, not really an inherited cancer syndrome, as it seems the disease is diagnosed after 60 years old.

The tests you mentioned tend to be most useful in selecting which men to biopsy. The PSA levels of 4 to 10 is a gray area, so some doctors would use such tests to try and separate who would really benefit from the biopsy. There is no clear winner though as which method is best. Hence, looking at your PSA, these tests may not really be that discriminating.

The fact that the PSA fluctuates is a good sign that it may be swelling only or prostatitis.

At the end of it, your doctor would estimate your risk for cancer, and you would need to set a threshold acceptability for the biopsy.  

[cjdriver]

Thanks for your reply, and your time in this forum. I have a maternal uncle with pca, dx after 60, and a maternal grandfather died from pca, also dx after 60. I forgot to mention that my urologist said the dre was normal for someone my age; slightly enlarged. Should I request a free psa test, or pca3 test? I obviously want to avoid a biopsy, but should I have one done?

[HeinrikMD]

Hi,

At your age the chances are that it could still be prostatitis. The treatment you had of a month is typical, but some men may take longer to treat especially if the problem is no longer new. You could discuss the need for cultures, to make sure that the antibiotics you are receiving are adequate. You could also talk about considering doing some other interventions if the main problem really is obstruction due to an enlarging prostate. Do you have any family history of early prostatism? At age less than 50?