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Concern over DRE test, leading to PSA

Posted 31 July 2017 15:28:49(UTC)

Hi everyone, I am confused over recent symptoms and hope you can maybe help? I was fine, if a little constipated. Using such things as Fybogel and All Bran, I managed to clear the problem. However, that lead to sudden, violent diarrhoea and a bit of sickness. The sickness only lasted for the first day, but led to needing an ambulance to be called and three separate visits by out of hours medical staff. The diarrhoea lasted for nearly two weeks, when it suddenly stopped, but not without me feeling drained and worried! Just before it finished I developed what I am sure was a UTI, (intense pain while urinating and all the associated weak flow and many nightly peeing sessions). Seeing my doctor a couple of days later (last Monday), he performed a basic dipstick urine test, saying there was no need to send any away for 'proper' testing. He also performed a DRE (saying my prostate was enlarged), arranged for a PSA blood test in a fortnight and put me on some Tamsulosin Hydrochloride @ 400 mcg daily. I have had hypotension leading to occasional bouts of low blood pressure, but they said to take it anyway. This led to me suffering a side-effect of incredible weakness and a hard heartbeat, (thumping harder, but not raised in any way). This lasted for one hour on day one, then one and a half and finally three hours on the third day. Having read on a Tamsulosin and other drugs forum about other peoples experiences, I tried, like many of them do, stopping the tablets for one day. Meaning to go back on them, I stopped (my flow had already improved after the second day) and waited to see what happened. Friday morning, my flow had returned to normal and all the pain had gone by Saturday morning and not wishing to suffer the very unpleasant side-effects again for a while, thought I would see how long this 'recovery' lasts. So it is now Monday evening, I have not taken any more tablets and I haven't had a return to low flow or any other symptoms, meaning I am positive that this was just a very bad UTI. (I've had them before, but many years ago). Reading on many different informative sites, has led me to wondering whether to have the PSA test or not? One chap said it's OK, but is like opening a can of worms that cannot be easily closed, as it may lead to other, more invasive and probably dangerous tests. Just to add fuel to the fire here, my brother (12 years my senior), says he had prostate cancer at 63 and had it operated on. (I've yet to talk to him about this, to find out how he was sure that he had it etc.) I am left thinking that maybe I should have the test and see what results I get, then decide on where to go from there. Of course I am hoping that I will have a very low reading, with no further action necessary, like everyone does I'm sure. But these other sites seem to say "Ooh, you've got it in the family, bound to be cancer then matey". The information on this test though is SO frustrating, leading to false positives and false negatives etc, that no one can surely be expected to rely upon any results can they? Also the biopsy and other tests lead you to almost certainly going from being a fairly well man, to having tons of problems with incontinence and blood in urine just to begin with. I have a friend in his late 40's, who has had all this. He's had to self-catheterise for many months now and is about to have an op that will end his sex life for sure, though he says the outcome should be far better than all the problems and pain he's had in all that time. He was a lively, out and about sort of man, who is now a pale shadow of his former self. He looks more like 90 than nearly 50! So this is why I worry. If you've managed to stay the course of this waffle which I can only apologise for and with some of you having been through these problems, can I please just ask, if you were me, what would you do? Many thanks for any help you can give.

Posted 31 July 2017 19:22:53(UTC)

Originally Posted by: Online Community Member

if you were me, what would you do?

The genie is already out of the bottle. If you don't have the test you will wonder and worry about what might be going on and whether it's PCa. So there's only one logical answer, take the test.

Posted 31 July 2017 20:03:40(UTC)

Yes I suppose that's the only way to think and to do, what I suppose is right. Thanks for your quick reply!

Posted 01 August 2017 01:21:22(UTC)

Hi Ross,

Firstly, in view of your history, I would suggest you get a proper test of your urine done because a UTI can have repercussions and also lead to a raised PSA. The PSA test is done from a small sample of your blood and as you say it can provide false positives and negatives and also be raised somewhat by an enlarged Prostate and also sex within a day or two before the test or even some strenuous exercise such as riding a bicycle shortly before the test. So if you have a PSA test and the results are high for your age, your GP will probably refer you to a urologist who may do another DRE and PSA test. Depending on results and assessment you might have an MRI scan and or a biopsy.

It is true that a minority of men who have a biopsy develop a UTI and this can take time for antibiotics to deal with it. However, most men find the procedure not very painful and have only a very small amount of blood in their urine/semen for a few days thereafter with no other complications. If the biopsy is done first it takes about 6 weeks of healing before a good MRI can be obtained.

Sometimes, where cancer is caught at an early stage men are just monitored until radical treatment is considered appropriate. However, where required, early diagnosis/treatment is likely to provide better outcomes. PCa in some men never develops to the extent that treatment becomes necessary and many men die without even knowing they have it. Unfortunately, some men are diagnosed too late for curative treatment and just have various treatments that hold back their cancer for a time.

You don't state your age but many of us feel that men when they reach 50 years of age or a little earlier if they are more at risk - PCa or breast cancer in the family for example, should be offered a PSA test as a matter of course. It then enables them to decide how far along the diagnostic/treatment route they wish to go.

(Wish I had been diagnosed earlier!!)

Posted 01 August 2017 12:02:41(UTC)

Hi Ross Tate,

I think you know the answer get it checked out,If you click on my avatar you can see my journey and i believe i was very lucky as it was only a private medical for a 7.5 ton licence that my doctor picked up my low PSA 2.19 but wanted me to have further tests (I had gone into the doctors with no problems at all).

My Prostate cancer was picked up at mid range and gave me a fair chance of beating it.I am 71 ten months  on from my procedure and very happy with being so lucky it was picked up at that stage, but another year would have been a different choice and maybe a negative outcome.


Posted 01 August 2017 23:27:39(UTC)

I think you are missing the point slightly. Yes the biopsy can sometimes cause temporary after effects and it is true that there are concerns about over treatment of diagnosed men. It is also true that treatment for prostate cancer can cause (temporary or permanent) incontinence, a bit of pain, loss of libido, fatigue and erectile dysfunction. However, if you don't get tested and you do have cancer, you need to understand that as it progresses it will lead to incontinence, erectile dysfunction, pain, fatigue and generally speaking, men with incurable cancer don't have much of a libido either.

Avoiding diagnosis is not going to avoid the things you fear (unless of course you turn out not to have prostate cancer)

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

Posted 27 August 2017 15:10:45(UTC)

Hi all and thanks for your replies. I asked for my urine to be tested properly at my surgery, but they refused. I had another bout of the sickness and diarrhoea, which was worse than the first, including a lot of acid and the doctor actually visiting me twice in one day, but thankfully that only lasted for a couple of days this time. I had the PSA test last Monday and was told to ring for the results tomorrow. Only they rang me on the Wednesday to say that my result was twice the level they thought it should be (5.8). Yet I see that 4.0 is about normal, so not so bad then, I would have thought. My brother, who had a result of 14.0, then went on to have a biopsy and had seven tubes taken, with a 4:3 positive result. So he decided to have the op to have his prostate removed through keyhole surgery. This was helped by his employer having a private medical arrangement for their employees, so he was treated a lot sooner than usual and had a private room! I wouldn't have such an option. But the main thing is, he seems to be back to normal and is having regular PSA's (about six-monthly) and so far they have all been around 0.1. Due to his troubles though, means that I am more likely to have it, but hope that when they redo my test in a couple of weeks, that the reading has gone down a bit, as my doctor thinks the result could be due to the two major bouts of illness that I had. I am keeping my fingers crossed! I thought though, that doctors were meant to sit you down and discuss your options? But my surgery said that, if my result is either the same or higher, that they would send me to a urologist for a biopsy! What ever happened to 'watchful waiting' and all the others?

Posted 27 August 2017 17:11:56(UTC)

Except for a sing!e marginally high PSA reading, there is no reason to think you may have PCa. Do stop worrying and leave the matter in the hands of your GP, who hasn't put a foot wrong in my opinion. Watchful waiting is a possible approach AFTER a diagnosis of PCa. You have not been diagnosed. Even if it turns out after a biopsy that you have it, you will have loads of time to decide on treatments with what very likely would be a very low grade case of PCa. Get on with your life, fella!

Posted 28 August 2017 10:06:32(UTC)

read my profile

and you will see 1st psa 5.2

2nd psa 6mths later 8.0

biopsies taken , all negative

my high psa is due to my very large prostate ( words of the urologists), and BPH

now waiting a further 6mths and retest of psa, to see whats happening


so not all doom and gloom , worrying -yes

but better to know than wish you had later

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