PSA MRI and pain

I am 49, and I am looking for help. I had PSA 3.7 11/14 after DRE at Mayo Clinic. Doctor said it is elevated, and rechecked again on 05/15 PSA 3.1. Both these times I did not know I must have no ejaculation for 48 hours. January 2016, I went to a local urologist, he did DRE and said normal, PSA 2.47 (after DRE?) Three weeks of Cipro PSA 2.5 Free PSA 29.2.
Two months later I started to have pain under my right rib, and in my left hip. I went to ER and the X-rays did not see anything suspicious. Three weeks later I went to Mayo Clinic to see gastroenterologist for scheduled procedures (endoscopy and colonoscopy) and asked to be referred to urologist. Urologist did DRE (nothing suspicious, but boggy) and checked for infection by prostate massage, all negative. Did not order PSA, because of the colonoscopy test it would not give an accurate number. Ordered 3T MRI with rectal coil., which basically said some diffuse changes, most likely prostatitis. I was told to take warm baths and ibuprofen to reduce inflammation and recheck in six month. Five months later I stated to have back pain, so I contacted the Mayo doctor and was told to come for MRI test. My PSA is 2.5 10/2016 and Free PSA 25.6.
Here is my MRI report.
24-Oct-2016 07:58:00 Exam: MRI Prostate w&wo
Indications: Elevated Prostate-Specific Antigen (PSA);Frequency
Urinary
ORIGINAL REPORT - 24-Oct-2016 10:54:00 GONDA
EXAM: MRI Prostate w&wo IV contrast using endorectal coil.
COMPARISON: MRI prostate 03/30/2016.
IMPRESSION: Increased diffuse hyperenhancement and only mild
diffusion restriction primarily seen throughout the peripheral zone
and bilateral seminal vesicles, which most likely represents diffuse
prostatitis and seminal vesiculitis in the setting of a decreasing
serum PSA.
PROSTATE: The prostate gland is again mildly enlarged and measures 35
cc in volume. Mild nodular enlargement of the central gland consistent
with benign prostatic hyperplasia.
As correlated with exam of 03/30/2016, again seen is scattered T2
hypointensities throughout the peripheral zone in both sides, most
pronounced from the apex to the mid gland. Corresponding
hyperperfusion and mild diffusion restriction are slightly more
prominent than previously (series 801 image 57; series 31002 image 23;
series 31200 image 21-23). These findings again most likely represent
chronic prostatitis, although any underlying low grade tumor cannot be
excluded.
LOCAL STAGING: Extracapsular extension is absent. Mild symmetric wall
thickening of the seminal vesicles with corresponding hyperperfusion,
likely inflammatory. Seminal vesicle invasion is likely absent.
LYMPH NODES: Nothing for suspicious nodes.
BONES: Nothing for suspicious bone lesions. Degenerative changes of
the spine.
OTHER: Tiny presumed right renal cysts. Trabeculated urinary bladder
wall. Colonic diverticulosis. Small fat-containing umbilical hernia.
Electronically signed by:

Mayo urologist told me to take Cipro for six weeks and let them know how I feel. I did not start Cipro yet.
At this time I have pain in my shoulder and some weird warm feeling in my left ear, no pain under my right rib, and no pain in left hip. I am afraid I have mets already. No family history.

What do you think about my situation, and what would you recommend I do next?
Thank you very much.

Ted.

Relax, Ted:

I understand your fear but:

YOUR PSA is well below the level that would indicate Mets.

Your scan saw nothing that would indicate METS, and if METS were causing symptoms it would almost certainly show up.

That still doesn't explain your pain -- maybe arthritis or possibly bursitis.

Mel

samster
I did follow the urologist advice, I started to take warm baths and was taking ibuprofen 200X2 two-three times a day. Two weeks later i started to have a huge headache, so I was thinking it could be rebound headaches, so i stopped ibuprofen, and warm baths.

I wonder if I should start six weeks course of CIPRO this time, knowing that all urine and prostate massage liquid were negative, I assume it is a non bacterial. Will it help? Last time I did three weeks, I noticed small improvement.

I am also thinking about doing MRI reading second opinion, but at the same time I wonder if Mayo already has the best radiologists, and would I believe someone else more than those Mayo radiologists?

Thank you Mel, and john T.

ASAdvocate said...
Lumix, Ninety percent of the cases of prostatitis are non-bacterial. Cipro will not help them.

http://www.harvardprostateknowledge.org/treating-prostatitis-any-cause-for-optimism

Moreover, Cipro has side effects and shouldn't be used unless really necessary.