Biopsy time

Q

QuickSilver

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A while back, I posted about PSA elevation. My husband has been seeing a urologist for a jump in his PSA from 3.7 to 5.4 over a 2 year period. The Urologist put him on a two week course of Cipro to address the possibility of prostatitis. However, his PSA which was drawn 2 weeks ago made a whopping jump to 8.4! So today he is going back to begin the process of a prostate biopsy.. beginning with a rectal culture and then 3 days of antibiotics before and after. Needless to say I am VERY worried.. Need some talking from you guys who have been through this.. what to expect.. what happens with a new dx of prostate CA.. Or what do they do for prostatitis New territory here for both of us.
 

QS. Can't be to much help here, but I have suffered with prostitius for years. When it gets bad, I have to take a antibiotic for up to 3-4 weeks. I have what the dr. call chronic prostitius. Sometime a type of shot is given. Don't know the name of the shot. Oh, and take Flomax twice a day. It never really gets better, just manageable most of the time.

PSA count has never been as high as your husbands, so can't help beyond this.
Wish him well for me. It's not a fun time for a man. Pappy
 
QS, I hope the tests turn out well. I know you're very worried.
 

Pappy said:
QS. Can't be to much help here, but I have suffered with prostitius for years. When it gets bad, I have to take a antibiotic for up to 3-4 weeks. I have what the dr. call chronic prostitius. Sometime a type of shot is given. Don't know the name of the shot. Oh, and take Flomax twice a day. It never really gets better, just manageable most of the time.

PSA count has never been as high as your husbands, so can't help beyond this.
Wish him well for me. It's not a fun time for a man. Pappy
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Several weeks ago he had a cystoscopy for what we thought was blood in his urine.. they were looking for bladder tumors.. his bladder is clean... However, the doc said his prostate is very inflamed. Don't know what to think about that. I did ask if prostate ca looked like that and he said NO.. so perhaps it is prostatitis.. there is a type of prostatitis that is called nonbacterial prostatitis.. so it's hard to treat.. and then of course there is BPH which also causes a jump in PSA.. Needless to say, both of us spend our evenings checking with "Dr.Google"... sometimes I think that is a waste of time as there is so much conflicting information out there.

For example... one study says that PSA velocity. (how fast it is rising) is an indication of an aggressive cancer. Another study says that a rapid rise in PSA does NOT mean cancer, but means prostatitis.. very confusing and worrying.
 
It sounds like your urologists is being super careful. I don't recall the rectal culture step as part of the work up prior to a biopsy. As you may recall my prostate history is a long one with an initial high PSA at least 30 years ago, then a series of five prostate biopsies over the ensuing 15 years all negative. Early on I had pretty much accepted that I must have cancer, but as time went on I became quite less concerned reasoning that even if I did have cancer it must be a very slow growing kind. Finally The VA concluded that my fluctuating PSA just didn't mean anything and so now I get a twice yearly rectal examination. Frankly I never found any of the procedures particularly painful. OK my experience may not be all that typical, but it seems to me QS that the fact that your husband's urologist can't feel an abnormality with a digital examine suggests that even if the biopsy comes back positive it will be the case that the cancer will be entirely treatable and the prognosis GOOD.
 
I've never heard of an inflamed prostate being diagnosed during a cystoscopy. As the scope passes through the part of the urethra which is surrounded by the prostate it's hard to see how the doctor can see inflammation, but I'm not a urologist.
 
Josiah said:
It sounds like your urologists is being super careful. I don't recall the rectal culture step as part of the work up prior to a biopsy. As you may recall my prostate history is a long one with an initial high PSA at least 30 years ago, then a series of five prostate biopsies over the ensuing 15 years all negative. Early on I had pretty much accepted that I must have cancer, but as time went on I became quite less concerned reasoning that even if I did have cancer it must be a very slow growing kind. Finally The VA concluded that my fluctuating PSA just didn't mean anything and so now I get a twice yearly rectal examination. Frankly I never found any of the procedures particularly painful. OK my experience may not be all that typical, but it seems to me QS that the fact that your husband's urologist can't feel an abnormality with a digital examine suggests that even if the biopsy comes back positive it will be the case that the cancer will be entirely treatable and the prognosis GOOD.
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The rectal culture is a precaution against developing sepsis from an antibiotic resistant form of ecoli bacteria. If that bacteria is found to be present, the biopsy will be taken in another manner, under sedation. Perhaps when you had your biopsies, that concern wasn't around.

It is true that when he did the initial exam.. he didn't feel anything abnormal.. In fact, his prostate is not all that large, and he hasn't had any real problems urinating or getting up many times at night.. It's basically the PSA.. and depending on what article you read.. it either does.. or doesn't indicate cancer.. or it could, but it's not reliable. I guess the only thing to do is get the definitive answer... with the biopsy.
 
Josiah said:
I've never heard of an inflamed prostate being diagnosed during a cystoscopy. As the scope passes through the part of the urethra which is surrounded by the prostate it's hard to see how the doctor can see inflammation, but I'm not a urologist.
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The openings in the urethra leading from the prostate were reddened.
 
I never had a Rectal Culture as a part of my procedures, just a Rectal Digital exam and then biopsies which in my case confirmed prostate cancer, but that was over 20 years ago. PSA'S can rise after having sex, after a rectal digital exam or any disturbance of the gland, Jumps in PSA in itself does not mean prostate cancer. Sounds like your husbands Uro is OK and hope it's just treatable Prostatitus.
 
Lon said:
I never had a Rectal Culture as a part of my procedures, just a Rectal Digital exam and then biopsies which in my case confirmed prostate cancer, but that was over 20 years ago. PSA'S can rise after having sex, after a rectal digital exam or any disturbance of the gland, Jumps in PSA in itself does not mean prostate cancer. Sounds like your husbands Uro is OK and hope it's just treatable Prostatitus.
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Probably because in the last 20 years, many bacteria have developed resistance to antibiotics. Particularly ecoli which makes up a large portion of normal intestinal flora. A particularly nasty strain of ecoli is now causing problems. It's fluoroquinolone resistant. A rectal biopsy can introduce bacteria to your blood stream. Therefore, it's dangerous if this particular strain of ecoli is present. So now they do rectal cultures.

http://www.ncbi.nlm.nih.gov/pubmed/22386395

[h=1]Rectal cultures before transrectal ultrasound-guided prostate biopsy reduce post-prostatic biopsy infection rates.[/h]Duplessis CA[SUP]1[/SUP], Bavaro M, Simons MP, Marguet C, Santomauro M, Auge B, Collard DA, Fierer J, Lesperance J.
[h=3]Author information[/h]
  • [SUP]1[/SUP]Infectious Disease Division, Naval Hospital San Diego, San Diego, California 92134-1005, USA. Chris.duplessis@waldenu.edu


[h=3]Abstract[/h][h=4]OBJECTIVE:[/h]To test our hypothesis that a targeted rectal screening protocol before transrectal ultrasound (TRUS)-guided biopsy would potentiate streamlined prophylaxis, thereby reducing postbiopsy infectious rates while minimizing unnecessary broad-spectrum antibiotic use. To this end, we instituted preprocedure rectal cultures in an effort to identify fluoroquinolone (FQ)- resistant flora using selective media to optimally direct targeted prophylactic antibiotic administration. The inexorably increasing prevalence of multidrug-resistant microorganisms, notably extended spectrum beta lactamase (ESBL)-producing and FQ-resistant Enterobacteriaceae has increased the post-TRUS prostatic biopsy infection rates, including life-threatening sepsis.
[h=4]METHODS:[/h]A total of 235 rectal swabs were obtained and plated directly onto MacConkey agar plates containing 10-ÎĽg/mL ciprofloxacin. Following the screening procedure, antimicrobial susceptibility results were used to develop a customized antibiotic prophylaxis regimen to be administered before biopsy. Following the biopsy procedure, the patients were seen in follow-up within 7 days, and information was gathered on potential adverse effects, clinical appointments for infections, and potential antibiotics received.
[h=4]RESULTS:[/h]Thirty-two-patients (14%) had FQ-resistant isolates (most Escherichia coli), and 3 (1.3%) were ESBL-producing isolates. There were no infectious complications identified in this period, (compared with 3 septic complications among 103 biopsies in the 4 months preceding the study).
[h=4]CONCLUSION:[/h]Rectal cultures obtained before TRUS biopsy, using selective media to identify FQ-resistant Enterobacteriaceae, facilitate targeted antibiotic prophylaxis, and appear to be highly efficacious in reducing infectious complications.


 
I had a friend that had his physical and a prostate exam included. As part of his blood work he had a PSA test, which came back at 5000. That's 5000, not 5.0. In the following days and a visit to some specialists (urologist for one), he was found to have prostate cancer. That was about 5-7 years ago. Today, he leads a normal life.

Has anyone ever heard of a PSA of being 5000? That had to be a mistake, right?
 
QS, this is a most serious time for your guy. I can relate to it, having almost been there. My own PSA has come back <1.0 for years. Awhile back, I sought help for a bladder infection, had tried Cipro which I had on hand, it failed to help after several days, at which time I went to my new Dr. He gave me a vial of Bactrim (Trimethoprim/Sulfamethoxylate). He said Cipro would have been his first choice. So there ARE bacteria having resistance. Two tablets and 24 hours later, the symptoms were gone.

However, it was time for a CBC, so that was drawn during the visit. PSA requested, came back 6.1! Frightening. I spoke to the Dr., who agreed the PSA probably was not a good idea while a bladder infection was present. PSA done over a week or so later, came back 0.4. I was most definitely relieved! imp
 
imp said:
QS, this is a most serious time for your guy. I can relate to it, having almost been there. My own PSA has come back <1.0 for years. Awhile back, I sought help for a bladder infection, had tried Cipro which I had on hand, it failed to help after several days, at which time I went to my new Dr. He gave me a vial of Bactrim (Trimethoprim/Sulfamethoxylate). He said Cipro would have been his first choice. So there ARE bacteria having resistance. Two tablets and 24 hours later, the symptoms were gone.

However, it was time for a CBC, so that was drawn during the visit. PSA requested, came back 6.1! Frightening. I spoke to the Dr., who agreed the PSA probably was not a good idea while a bladder infection was present. PSA done over a week or so later, came back 0.4. I was most definitely relieved! imp
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Cipro gives me hives for some reason so cannot take. Bactrim is what I take but need to take it twice a day for up to three weeks to do me any good. My prostate is very large and it is tough to get rid of infection.
 
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Positive thoughts QS. The time to worry is when worry will do some good, like intitiating action.
Now it is time to put worry aside and count your blessings.

I know that this sounds Pollyanna-ish, but this is how you can keep strong while waiting.

My best hopes for you and your husband.
 

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