45 & PSA of 12.2 no diagnosis yet

Hi Everyone

I am 45 and have been having some urinary retention, weak stream and urgency for some time. For a while also quite sensitive in the lower abdomen. A few weeks ago had such a hard time starting urination that I went to see a Urologist. DRE was clear, but flow was very week. PSA test was 12.2. I have had weak stream symptoms coming and going for several years and even went to a Urologist 3 years ago that just told me to practice holding my urine as DRE exam was clear, but he did not do a PSA test back then. My symptoms of a slow stream and then more recently urgency to urinate often came and went and did nto really bother me that much during the last few years, until recently when it has deteriorated quite a lot and does not seem to be getting better on its own like it used to. And by the way, the only reason a PSA test was done on my recent visit to the Uro is because suggested it as I was leaving since I had starting reading a bit about prostate issues and had heard about PSA in the news due to Ben Stiller's PC. So the PSA test was done after a DRE exam and I know this can effect results. But even the DRE exam was over with in a couple of seconds so I don’t know how good this doctor is. Also I lay on my side during DRE and I read in Dr. Walsh book that the DRE are more reliable as Dr.'s can feel more of the prostate if done by the famous "bend over" line.

After I saw how high my PSA was and started reading about this, I also discovered an old full physical check I did just over 3.5 years ago - the only fully physical I have done -and in that check my PSA was 5.2, but I was not told to monitor the PSA or do a check up by the GP who revived the file at the time. I vaguely remember him saying that the PSA was a bit high, but other than that everything looked fine. No mention of a follow up or the importance to keep track of an elevated PSA. At that time I was not aware of what PSA was or the importance of keeping checking elevated PSA, so never followed up as I was in the dark.

On my last visit a few weeks ago the Urologist first gave me Flomax. Then as soon as the test results came in for the PSA , I had suggested, he called me immediately and proscribed me with Anti-biotics and diagnosed me with Prostatitis “until further notice” and subscribed 4 weeks of anti-biotics on top of the Flomax he had already provided. Doctor wants me to come back around 3 weeks after I have finished the 4 weeks of anti-biotics which is sometime in early to mid-December to do another PSA test.

Well I am over 3 weeks into the anti-biotics and I still have some urgency although not as bad as before and it doesn't really bother me that much. Stream much better due to Flomax. Tried yesterday to not take Flomax for one day to see if any change and stream was substantially weaker today and took a while to start a stream this morning. So I am back on the Flomax. Since starting AB’s and Flomax I have had some days where I don’t feel very good and have a lot of sensation in the lower abdominal area. Could be side effects from medicine but I am not sure. My concern is that if this was Prostatitis I was expecting the frequency and weak stream to improve if I stopped Flomax, especially as I am almost finished with the Anti-Biotics. When I take Ibuprofen the discomfort/sensitivity gets much better though, so have been taking that for a few days.

I would be interested to know what you think; should I wait until December to do another PSA or just do it as soon as I finish the 4 weeks of anti-biotics next week? Doctor had told me that if Anti-Biotics work the PSA will slowly come down, but I just want to see if it has come down as soon as possible as I don’t feel much improvement since starting medicine. At the moment I don't have too much confidence in him as he did not test my PSA 3 years ago and was not going to do it on my last visit, until I suggested it. If PSA hasn’t come down I want to do a biopsy right away as don't want to waste time. What is your advice? Wait till early to mid-December for another PSA test or do one as soon as I finish Anti-Biotics next week?

I apologize in advance if this is not a suitable post, as I have not been diagnosed with PC but the signs are worrying. I appreciate very much any feedback and advice from this knowledgeable group.

Welcome to HW, sorry you need to be here.

December isn't that far off and you want to wait till after you've finished your antibiotics. PC generally doesn't have symptoms, even at your PSA. Enlarged prostate and infection are more likely causes.

You might want to consider looking for another doctor. you have to trust your provider and you won't get good care if you can't trust them.

If the next test is high, well, there are worse things than a biopsy.

Hang in there,
Andrew

Good afternoon, And as others have said sorry you are here. I can't help much on your prostate issues since I am relative new here also but I can tell my experiences on antibiotics. Antibiotics are designed to kill bacteria and most of them kill both good and bad. I was prescribed Cipro or Bactrim numerous times over the last few years and they caused me a lot of distress in my intestinal track Cipro being the worst. After much research I started taking Probiotics with the antibiotics and they helped some. Then after more research I found that most Probiotics are not designed to make it thru the acid in the stomach so you only get about half of the effect. I found what works best for me is good old butter milk, Greek yogurt and sauerkraut. Of course not at the same time but any of these really helps me. The butter milk and yogurt also help with the yeast infection you can get in your mouth.
Hopefully this will be of some benefit.
Perry

Thank you again for the feedback. It is very helpful indeed and much appreciated.

Actually, the combination of weak stream, abdominal pain, negative DRE and elevated PSA all point to infection being the problem. Prostatitis is notoriously difficult to knock down with antibiotics. Also, don't be surprised to see your PSA drop dramatically..that's the flowmax working. The thing is, with flowmax, your PSA will drop enough that it can mask the slow steady rise that generally goes with PC.

Hang in there.

I agree with what many said here: given your symptoms and age, the much more likely issue is an infection that cancer. I'd give the antibiotics time to work. And unfortunately, I've read that infections can be stubborn to clear up.

While PC is unlikely and you shouldn't worry yourself needlessly, it's good that you're staying on top of this. Good luck!

Did another PSA test 6 weeks after starting 30 days of anti-biotic (levofloxacin) and taking Flomax. Still on Flomax, which is helping a lot with flow. PSA now 9.35 (was 12.2 when starting AB’s). I am disappointed by this as I had hoped for a bigger drop(don't we all!).

My drop in PSA was about 24% but according to a few studies mean drop in PSA after taking anti-biotics was between 36-42%;
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708243/
https://www.ncbi.nlm.nih.gov/pubmed/11912396

For reference I have days where sensitivity in lower abdomen still flairs up, even after finishing the course of AB’s so possible still inflammation causing this.

URO thinks we can wait until Jan to do another PSA to see if has come down and if not, then do an MRI before moving on to biopsy. Maybe I just do an MRI now? Or ask for more detailed blood tests like fPSA, 4kscore or PHI?