Can epididymitis cause a tiny PSA rise?

User

Posted 26 Jan 2018 at 10:00

I know I’m clutching at a tiny straw here but as I’ve posted elsewhere, I have been wondering if I might have a slight hernia because over past year I’ve experienced pain and discomfort in my pubic area, but especially in my testicles - different ones at different times

I went to the GP who examined me and thinks I have epididymitis and has prescribed me antibiotics

After I left the surgery I began thinking about this, and wondering if my post-operative PSA rise to 0.2 might not be recurrence, but PSA rise related to the inflammation in my testicles?

Like I said - probably huge magical thinking process in the hope that I don’t have cancer again, but it did seem to kinda fit that this problem has developed in 2017 and my PSA went up to 0.2

Ps
My “desperate theory” would only have any credence IF epididymitis in any way could affect PSA levels

(Probably more to do with my dread of 6 weeks radiation therapy which starts in 2 weeks)

Edited by member 26 Jan 2018 at 14:08 | Reason: Not specified

User

Posted 26 Jan 2018 at 18:37

The better way of looking at it is this - St James and some other centres of excellence have been running a trial whereby all men are offered adjuvant RT if they opt for surgery, on the basis that recurrence is then much, much less likely. So don’t see it as unnecessary treatment ... see it as putting your seatbelt on.

Edited by member 26 Jan 2018 at 21:09 | Reason: Not specified

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

User

Posted 27 Jan 2018 at 12:38

Originally Posted by: Online Community Member

Hi Lyn, do you know why men in the UK have worse outcomes than in the US?
I have also used the nomogram to look at the stats for me.
Ian

There are theories that US outcomes are better than in the UK because:
- American men are more likely to seek medical advice when they are ill or have symptoms (of any illness not just prostate related)
- many have their 'physician' who may have been the same one for years and often has cared for the whole family so history is not lost
- majority have private health insurance which requires regular health checks
- all of these factors mean that men are diagnosed earlier than British men
- suggestion that once diagnosed, over treatment is much more of an issue in the U.S. than in the UK

Even in the UK, outcomes are variable. Leeds men do worse statistically than in some other regions so the urology/oncology peeps have downgraded their outcomes on their version of the MSK nomogram. This could be explained by:
- Leeds is a centre of excellence so patients needing radical treatment will be referred from other trusts such as Harrogate, York, and the wider West Yorkshire region
- Leeds / West Yorks has a higher than average proportion of black men
- it also has high deprivation factors - men living in poverty or with poor educational outcomes are less likely to seek medical advice than professional people
- another example - outcomes are worse than average in the North East ... lots of working class blokey type blokes who might be more inhibited about 'private parts' and embarrassing bodily functions
- men living in some areas are statistically more likely to have heart disease, to be obese, to have grown up with poor diet, etc and are known to be at higher risk of all sorts of health problems so prostate cancer is just another example
- all combined, men referred to Leeds trust are more likely to have been diagnosed late, to be upgraded, and/or to have recurrence.

However, these are all generalisations or indicative factors and it doesn't mean that treatment in Leeds is worse or that a specific patient would have done better if they moved to another area. I guess you could find out fairly easily what the general health stats are for your own area (for example, is it one of the priority areas for obesity, diabetes, heart disease?)

Well, that's what I have gleaned from Mr P and Mr B over the years, anyway :-/

Edited by member 27 Jan 2018 at 12:40 | Reason: Not specified

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

User

Posted 26 Jan 2018 at 13:25

There is research to show that PSA is present in heathy breast tissue, breast milk, the adrenal gland and the epididymis among others but in very tiny amounts. Breast cancer, adrenal gland tumours, etc can produce slightly higher anounts but not as much as a healthy prostate. So presumably infection could also cause a small increase?

I did suggest to ChrisJ that he get his adrenal gland checked but in his case it seemed not to be an explanation for the big rises he was seeing. Whether inflammation of the epididymis could generate the small amount you have can only be determined by discussing with the onco.

https://www.google.co.uk/url?sa=t&source=web&rct=j&url=http://onlinelibrary.wiley.com/doi/10.1002/ijc.20605/pdf&ved=2ahUKEwiT5KSc2fXYAhUpDMAKHcvgBucQFjAFegQICxAB&usg=AOvVaw2aea2qgnahqVZ0QrbXB2T5

Edited by member 26 Jan 2018 at 13:26 | Reason: Not specified

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

User

Posted 26 Jan 2018 at 19:50

I too agree you really need to discuss this with your oncologist.
I know everyone is different but my husband's stats are nearly the same as yours. i.e 3+4, T2c and PSA 9.2 . He only had his post op results last Saturday and we have been cautiously celebrating as he had clear margins,seminal vesicles etc.and no detectable PSA.
The reason for our optimism was when we put his post op figures into the Memorial Sloane Kettering nomogram it says he only has a 3% risk of recurrence at 2 years and 8% at 5years so your risk would be somewhere in between.

So what I'm thinking is ..if your margins etc were also clear you would need to be very unlucky for a recurrence so maybe you are onto something when you think that you may
not be experiencing a recurrence but your infection perhaps causing the raised PSA.
Another thought of mine after reading Dr Patrick Walsh's book is that if you had clear margins, no extracapsular spread, no lymph node involvement and clear seminal vesicles is how could there be any cancer in the prostate bed which I assume is where they will be irradiatng.
You will of course need to be guided by your oncologist but it certainly wouldn't do any harm to raise it with him/her even at this stage.

Best Wishes
Ann

User

Posted 26 Jan 2018 at 22:59

Originally Posted by: Online Community Member

Hi Lynn
Thank you for your comment. I didn't realise Bill's Gleason had been upgraded to 4+ 3 after his op. ( It wasn't on his profile) however when I have just put this in together with the other stats on his latest posts it comes out now at a 76% risk of being recurrence free at 5 years so not that far out now from his consultant's prediction of 25% risk of recurrence. I think lots of consultants
use the MSK nomograms ( I know ours does) as they are regarded as pretty accurate. I suppose stats are all immaterial though when you are the person experiencing the recurrence ( or not).

Regards

I’ve corrected that on my profile Ann 👍

Show Most Thanked Posts

User

Posted 26 Jan 2018 at 13:25

https://www.google.co.uk/url?sa=t&source=web&rct=j&url=http://onlinelibrary.wiley.com/doi/10.1002/ijc.20605/pdf&ved=2ahUKEwiT5KSc2fXYAhUpDMAKHcvgBucQFjAFegQICxAB&usg=AOvVaw2aea2qgnahqVZ0QrbXB2T5

Edited by member 26 Jan 2018 at 13:26 | Reason: Not specified

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

User

Posted 26 Jan 2018 at 13:55

Thank you again for your knowledge and information Lynn

I have a feeling the Onco won’t entertain the idea as things seem set in motion. I’m on bicalutamide, Radiotherapy starts soon, other than a complete stop and wait and see I don’t see her taking it seriously- and if it wasn’t the case that the inflammation had any role - then the cancer might just grow and get worse. It has certainly got me thinking though because I’ve had this issue chronically over the past year

But I will put it to her and see how she responds

Edited by member 26 Jan 2018 at 14:10 | Reason: Not specified

User

Posted 26 Jan 2018 at 18:06

I'd be very surprised if you have a hernia. Neither of mine felt like what you have described. The timescale and modest change in PSA do suggest an infection. If you retest a week or so after finishing the antibiotics, you should get some reassurance, but if the retest shows no drop in PSA then you will know that your Oncologist's judgement is right and that the fight goes on.

Good Luck

User

Posted 26 Jan 2018 at 18:31

I think that the problem with that is the PSA is likely to drop anyway so we couldn’t know for sure if the drop would be due to the epididymitis

I’m worried about it now and wishing I had been more attentive to it last year instead of just putting it down to everyday aches & pains due to the RP operation

Now I think I’m on the railroad to radiotherapy when there is a very slim chance that it might not have recurred

Damn

User

Posted 26 Jan 2018 at 18:37

Edited by member 26 Jan 2018 at 21:09 | Reason: Not specified

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

User

Posted 26 Jan 2018 at 19:39

Yes I think that is the right way to frame it Lynn

It’s a real long shot for it not to be recurrence and adjuvant treatment is the safest route

Edited by member 26 Jan 2018 at 20:14 | Reason: Not specified

User

Posted 26 Jan 2018 at 19:50

User

Posted 26 Jan 2018 at 20:21

Thank you Ann,

Interesting stats stuff there. After my operation and histology, the surgeon said that statistically there was a 25% chance of recurrence - even though margins/lymph nodes clear. I think this was down to my PSA 8 and Gleason 7 (4+3)

The 4+3 makes it more likely than 3+4 so maybe that’s why?

It’s certsinly given me a lot to think about. Perhaps Old Codger’s advice is best - see if GP will do a PSA result on Monday, then another in 2 weeks time before the radiotherapy begins - though the timeframe is too tight as I start RT on 7/2/18

User

Posted 26 Jan 2018 at 20:35

Bill - my post-op PSA was 0.014. Four months later it went up to 0.019. One month after that, it went down to 0.014 again. The oncologist told me that if PSA goes up and then down by itself, it wasn't cancer that caused the initial rise. Only cancer related treatment can bring down a cancer related rise in PSA. At that time, I had been on antibiotics for an infection relating to a cyst on one of my testicles. The oncologist said the infection was most likely the cause in the rise and fall of my PSA.

Since then, I have had two more infections in my testicles and my PSA has gone up to 0.023. So I'm going to have radiotherapy. They say that as it isn't coming down, it is cancer now causing the rise.

Of course, as Lyn has explained in a few posts, some hospitals are very sceptical about the sensitive PSA tests and don't do them. After radiotherapy, my oncologist has said she will be looking for a PSA of 0.003. That's the lowest the machine goes.

And my three testicle infections? I'm now having blood tests and scans for testicular cancer. Never rains but it pours.

Ulsterman

User

Posted 26 Jan 2018 at 21:08

I don’t think you have fully understood the nomogram model, Peggles, or how to assess the risk of recurrence. I think Bill should stick with his medical team’s predictions since they have the full stats.

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

User

Posted 26 Jan 2018 at 21:35

User

Posted 26 Jan 2018 at 22:59

Originally Posted by: Online Community Member

I’ve corrected that on my profile Ann 👍

User

Posted 27 Jan 2018 at 00:43

Most UK centres of excellence use a variant of MSK adapted to British data - generally, men in the UK have worse outcomes than those in the USA.

And since Bill is now having salvage RT, his consultant and MSK were rather over-confident.

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

User

Posted 27 Jan 2018 at 10:26

Hi Lyn, do you know why men in the UK have worse outcomes than in the US?
I have also used the nomogram to look at the stats for me.
Ian

Ido4

User

Posted 27 Jan 2018 at 11:25

With my histology report, Gleason 7 (4+3) T2c, clear margins, no lymph node or seminal vesicle cancer found, 30 months of undetectable PSA, I had just started to feel hopeful that the surgery was successful and that a future without PCa was possible

It was devastating and felt worse than the original diagnosis when my PSA went to 0.1 in July, then 0.2 in October

User

Posted 27 Jan 2018 at 12:35

I can totally relate to that. I was initially Gleason 3+4, T3a but with intraductal spread after histology. Negative margins and no seminal vesicle involvement. My PSA was 0.3 just over a year after surgery with a PSA doubling time of 2 months. PSA was 0.7 after three months. Like you I was totally devastated hoping that surgery would be it. I nearly passed out when I was told and for only the second time I don’t mind admitting I cried.
Scanning showed a tumour on the Prostate bed plus cancer in a seminal vesicle remnant so did I have seminal vesicle involvement to begin with? My oncologist is convinced I have microscopic metastasis but I went for RT in the chance he might be wrong.
The nomogram doesn’t provide me with any major reassurance. I find myself thinking quite darkly.
Hopefully for you the recurrence is a local one and RT sorts it out.
As Lyn has said look at the RT as putting your seatbelt on.

Ido4

User

Posted 27 Jan 2018 at 12:38

Originally Posted by: Online Community Member

Hi Lyn, do you know why men in the UK have worse outcomes than in the US?
I have also used the nomogram to look at the stats for me.
Ian

Edited by member 27 Jan 2018 at 12:40 | Reason: Not specified

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

User

Posted 28 Jan 2018 at 12:14

Originally Posted by: Online Community Member

Thanks for the info mate, and hopefully nothing sinister shows up on the tests

Fingers crossed

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