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User

Posted 16 Sep 2020 at 05:34

HI to all.

I am from Spain (please, sorry if my english is not very good).

I am 50. Five years ago I had a PSA rutine check which came out in 6,26 (free ratio 12.3%). I went to an urologist who prescribed a semen culture. As I was young and on holidays, I did this a month and a half later. I had a new PSA measured at the same time that went down to 2,55 (free psa ratio 10,59%). In the semen culture they detected an infection (Bacteria resistant to almost all antibotics but ampicilin) which was treated.

The following years the PSA fluctuated from 2,23 (2016), 2,44(2017), 2,99(2018), 4,27(last year, with a free psa ratio of 19,20%). Then I went to the urologist, who told me that surely it was due to a prostatis. He prescribed an ultrasound (prostate was 37 c.c.) and a semen culture who came back negative. He told me that we would wait a year. As I was still worried, I went to the lab and asked for a new psa (one month and a half after the one of 4,27) and it came back as 2,68. So I thought the urologist was right.

One year later, a new psa and came back with 4,93 and a free psa ratio of 15,42%. I repeated the test three weeks later, 4,63 and a free psa ratio of 14,69%. I thouught that this time would be like the two previous ones and waited for a month. New psa exam, 4,45 and free psa ratio of 17,75%. At that time, the urologist told me that probably is a prostatitis, but acourding to the procedures we have to check. He did a rectal examination that acording to him came back normal.

He ordered me antibiotics and anti-inflammatory drugs, and after ten days of finishing, a new psa, and a coagulation study (for a biopsy). He told me that if psa is still high, I will have to do a MRI and a biopsy, depending on the results of the MRI.

I have symptoms from many months/years of going to many times to pee (without actually peeing too much). Sometimes I there is not urine (seems) and 15 minutes later I go to pee and the urine is there. I think this could be sympthoms of prostatitis, but as well to Cap.

I am worried to hell, and before taking the drugs I will do a new psa myself, to check if it is like the other two times and it goes down (but little hope, to be sincere).

I started reading things, and the more I read, the more informed, but the more worried. Even I have a pain in my finger of the right hand (the bone) and I started to wonder if it could be a bone methastasis...

Tomorrow I start with the antibiotics and the antiinflamatory drugs.

Anyhow this is my whole story up to now. Sorry for being so long and boring :)...

User

Posted 06 May 2022 at 09:13

With prostate cancer, your PSA steadily increases. The fact that your PSA is fluctuating up and down clearly suggests that you don't have prostate cancer.

Best wishes,

Chris

User

Posted 23 Oct 2020 at 04:27

Lucky old you!

If I were you I would also concur with your usual urologist and avoid any biopsy at this stage, and wait for your next PSA result.

Best of luck.

Cheers, John.

Edited by member 23 Oct 2020 at 05:38 | Reason: Not specified

User

Posted 29 Apr 2021 at 23:02

That's the lowest result you've had for a while, so good news. Just keep taking the tests.

Dave

User

Posted 06 May 2022 at 08:38

It is very difficult but the fact that your PSA goes up and down is perhaps an indication that you do not have prostate cancer. My understanding that if you do your PSA will always go up. My PSA scores over the years always went up ( 3.58 in 2018, 5.32 March 21, 5.76 April 21 & 6.01 Sept 21). Most PSA tests in the UK do not test for free PSA and the only one that did for me showed a free PSA ratio of something like 27%.

My PSA scores made it easy for me & my doctor to decide that further investigation was needed and the rest, as they say, was history. To be honest, if I was in your shoes I would not be sure what to do either and one has in such circumstances put a deal of trust in the doctor's judgement.

Ivan

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User

Posted 16 Sep 2020 at 13:13

To be honest, even if the PSA goes down you have probably hit the point where MRI and biopsy are necessary. If both come back clear, you can carry on with the close monitoring.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 16 Sep 2020 at 18:00

THanks for answering. Yes, the urologist told me the same, that even if now it goes down, at the end we will have to check... because even if it goes down, it will rise again in the future.

I have read your story about your husband. Encouraging. Glad his psa is low.

User

Posted 17 Sep 2020 at 12:32

New results just before taking the antiinflamatory and the antibiotics... received today (sample took yesterday): 4,54. (two weeks after the one of 4,45). Definitely, something is going on... so I will take the drugs, then I'll wait 10 days after taking them, and then I'll check again.

User

Posted 18 Sep 2020 at 17:55

Don't think you're being boring. It can be worrying. Once you're on this treadmill it's hard to get off. The tests are fairly inconclusive. Every pain can be thought a symptom, even though it rarely is.

Your psa appears fairly stable at around 4.6 which isn't that high. Your prostate at 37cc was larger than most.

I don't think there's a guarantee it will go up in the future. You could get a lot higher than that and for it to be benign. Even at psa 10 about 1 in 2 won't have it on average.

There are risks of over treatment and finding traces of cancer when many men have traces that will never cause them a problem.

On the other hand if you do have a lesion and it becomes advanced you will be sorry you didn't have better tests. So you could go on that route to put yourself on a more stable footing.

All the best, Peter

User

Posted 20 Sep 2020 at 10:50

Thank you. Yes, it seems stable. The pain in the finger has disapeared. I am taking now the ibuprofen and the antibiotics for ten days, and then after 13 days (the doctor said 10 days, but there are holidays around these dates) I will test psa again.

User

Posted 08 Oct 2020 at 10:31

Puff, I had last measurement on 17/09/20, PSA 4.55

Yesterday, just three weeks later, PSA 5.85

Is it normal a rise of more than 20% in three weeks?

Now, it seems that it is time for the mpRNM...

User

Posted 08 Oct 2020 at 12:15

If there is infection, the rate can jump up and down. If there is cancer, the PSA does not go down, only up. If there is some cancer and also infection, it can jump up and down but perhaps never goes down to normal level.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 08 Oct 2020 at 20:54

Thank you.

I have an appointment for a 3T mpMRI on 21st of October (they say that they will deliver the result in the same date). Crossing fingers, hoping that the result is without lesions...

Edited by member 08 Oct 2020 at 20:55 | Reason: Not specified

User

Posted 22 Oct 2020 at 21:29

Update: mpMRI 3T yesterday. It came back with a small area of old prostatitis (acording to the radiologist) and at the end of the report it says "No suspicious areas found".

In fact, the pirad table in the template report was empty.

The urologist in the place where I did the mpMRI said that the rate of false negatives on the mpMRI can be up to 15%, and recomended a template biopsy for staying in the safe side. Nevertheless, my usual urologist after reading the mpMRI report, recomended to wait six months and check PSA again, which eventually, after thinking about it, is our choice.

Edited by member 22 Oct 2020 at 21:32 | Reason: Not specified

User

Posted 23 Oct 2020 at 04:27

Lucky old you!

If I were you I would also concur with your usual urologist and avoid any biopsy at this stage, and wait for your next PSA result.

Best of luck.

Cheers, John.

Edited by member 23 Oct 2020 at 05:38 | Reason: Not specified

User

Posted 29 Apr 2021 at 22:47

Hi all.

Update: I just have had my psa result, and it is 3,67. The urologist told me to measure it again in six months time.

User

Posted 29 Apr 2021 at 23:02

That's the lowest result you've had for a while, so good news. Just keep taking the tests.

Dave

User

Posted 26 Apr 2022 at 13:34

Update: In november 2021 I had again a PSA analysis and it was 3.59, with a ratio psa/free psa of 23.96%.

The urologyst told me to measure PSA again in six months.

But...

Last year I almost didn't have any sympthom, more than slow and thin stream of urine. But from three weeks ago I have started to have more sympthoms again, tingling and urgency to urinate and strange sensations, like one year and a half ago. I have went to the lab today for the PSA test and I suspect that it will be high.

They promised to deliver me the results next friday and I have my usual appointment with the urologist on monday.

I have found a clinic who does the mears and stamey test and I have an appointment for next wednesday.

Crossing fringers for the PSA not being too high...

Note: The two previous "lower" PSA were in april 2021 and november 2021 last year, and I have had (for other reasons) a course of ampicilin in december 2020 (because I had fever and blood in semen once) and in september 2021 (small surgery not related). I don't know if the antibiotics treatments had anything to do with the lower PSA than when I had the mpMRI.

Edited by member 26 Apr 2022 at 14:12 | Reason: Updating data

User

Posted 27 Apr 2022 at 13:49

UPDATE: I have received the results from the lab.

PSA up again to 4.28 although Free PSA/PSA ratio is 20.79%. My appointment with the urologist is next monday.

It is very similar to three years ago (in april 2019 I had 4.27 ng/ml and a free PSA/PSA ratio of 19.2%). At this time the urologist asked for a semen culture and an ultrasound, both came back normal.

Edited by member 27 Apr 2022 at 14:18 | Reason: Not specified

User

Posted 04 May 2022 at 19:41

UPDATE: Back from the urologist... he told me to wait six more months and test psa again.

User

Posted 05 May 2022 at 13:11

Are you happy with waiting 6 months for another PSA test or would you feel more comfortable if it was in 3 months time? Personally, knowing what I do now, I would want a 3 month test.

Ivan

User

Posted 05 May 2022 at 18:40

Actually, I don't know... but I hope three months will not make a difference.

I was looking to the statistics about free psa / psa ratio and psa density and I think that it is difficult to decide. In my last resilts I had a psad of about 10.2/10.3 and a free psa/psa ratio of 20%, and acording with https://www.frontiersin.org/articles/10.3389/fonc.2021.693684/full, (quoting) "the optimal cutoffs of PSA density to diagnose csPCa and rule out the presence of prostatic inflammation in patients with an elevated PSA (>4 ng/ml) were 0.10 ng/ml2", which I know doesn't rule out cancer with lower psad. Regarding the free psa/psa ratio the cutoff value is 15%, 20% or 25% depending on different studies... and all of this knowing that there is no guarantees, because there are cases of cancer even with psad lower than 10 and free psa/psa ratio over 25%, But it is true as well that there are positive cases of prostate cancer even with psa of 1, so difficult to be 100% sure.

Several years ago I had a PSA of 6,26 and a free psa/psa ratio of 12% Two months later I had a PSA of 2,6, Three years ago I had more or less the same measurements than my last ones, and one month later the psa went down to 2,67, going up again to 4,95 in the following year. It went eventually up to 5,85, I had a mpMRI (no suspicious lessions detected acording to the report) and then six months later it went down to 3.6.

I don't know if the urologyst is right, but I understand his decision, as it is very difficult to know. What he told me is that it is not recommended to do mpMRIs every year because the contrast fluid is not good for the kidneys, and due to my history of ups and downs he expects that I will need more mpMRIs in the future.

In addition, I have weak stream since an episode last december 2020 of two days of fever and blood in the semen (just two months after the mpmri) which the urologyst atributed to prostathitis.

Nevertheless, tickling and strange sensations have been on and off since more than two years, and when I was free of these symptoms my psa was about 3.6 (one year ago and 6 months ago). Just before my last analysis (two weeks or so) the tickling came back.

According to the mpmri I have a prostate of 41,7 cm3, and there are cases of symptoms like mine that were due to the prostate size. I know that there were other casess with cancer as well.

Another thing to take into account is that when I am close to the date of the measurement I am very stressed, And there are no guarantees if I test more than I am doing know and came back clean, because there are cases even with previous clear template biopsies that eventually had cancer not localized.

So, in summary... I don't know...

Edited by member 05 May 2022 at 19:05 | Reason: Not specified

User

Posted 06 May 2022 at 08:38

Ivan

User

Posted 06 May 2022 at 09:13

With prostate cancer, your PSA steadily increases. The fact that your PSA is fluctuating up and down clearly suggests that you don't have prostate cancer.

Best wishes,

Chris

User

Posted 13 Dec 2022 at 12:30

Hi.

Update: New blood analysis, PSA 4.52, ratio free psa/psa: 24.34%. The urologist told me to do a new lab in six months, as the free psa is high.

In addition, as my stream is very thin, he prescribed me tamulosin. I have been taking it for a few weeks without noticiable results.

What worries me now a bit is that, when my penis is erecting, it goes to the left, and stays like "bended" for a while, and then, the erection is complete and the penis go back to the middle. It happens since a few months, but I didn't pay attention and didn't tell the doctor. She only asked me one year ago that if I had erectile problems and I answered that well, I don't function like when I was 20, but more or less I function. At this time I didn't have the "penis bending" thing.

And it worries me because yesterday night I went to pee and it was bended, like if I would had a not complete erection.

Have you ever heard of something similar to this?

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