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 PSA Elevation and Prostatitis/BPH [Attn: Madcap et al..] 
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Joined: Thu Jun 28, 2018 9:36 pm
Posts: 43
Post PSA Elevation and Prostatitis/BPH [Attn: Madcap et al..]
Hello:

Over the years,I had managed to get a good handle on my nonbacterial prostatitis, which I've had for decades since my late 30s. Mostly by using stress reduction and exercises. I'd continue to get acute bouts, but learned how to keep them brief. I'd consider myself a success case. Except for the recent crisis I'm sharing now...

A few months ago, it seemed I was getting another bout of the prostatitis, but with some difference in symptoms. Mostly nocturia-
for weeks literally averaging only 2 hours sleep a night because of these wakings. I had some episodes of urinary urgency where I couldn't urinate at all: "urinary retention", I guess. BUT in each of those when I somehow was able to initiated a bowel movement--usually by coffee-- urination would return. I know it seems a odd, but that how it happened. I have IBS -Constipation type, which often comes in tandem with prostatitis bouts.. I went to my GP in an emergency visit that day and he felt this might be mostly an episodic thing..He agreed with my suspicion that BPH was entering into the picture. Hence, some change in symptoms perhaps.. I asked him if he could try to manage this case with me so I could avoid a urologist (for very good reasons). He agreed to do so- but wanted to run a few basic lab tests.. and urinanlysis...He also mentioned a PSA test, which I had never taken before...I asked him to do all the tests EXCEPT the PSA, because I had thought it can be very misleading for those with prostatitis....Apparently he ran it anyhow against my wishes, much to my chagrin. It came out mildly elevated: 6.5. I am 70 years old. So I'm not sure if that cutoff of >4.0 continues to apply at my age...

The GP then referred me to a urologist, because--as he put it-- that's what he does whenever a PSA exceeds 4.0. Though he did feel that the combination of BPH and prostatitis would more likely explain the elevation rather than the dreaded prostate cancer...I have read Richard Ablin's writings on this, as well as those of Dr Stamey, a world renowned urologist. Among other medical/scientific writings. My inclination based on all I've read thus far about the PSA test is to ignore it at this point in time (if not forever)--given the other urinary conditions going on--- which can elevate PSA into that "grey area".

========

I do need the care of either GP or urologist now because of those
"urinary retention" mini-episodes which can be a medical emergency--in case the next time they don't respond to my inducing a bowel movement. My GP feels he can no longer manage this case. on account of that PSA reading, which he requires urological consult..But for the time being is continuing to prescribe the alpha-blocker: Silodosin (Rapaflo)..On the med, my urinary flow is better than I could ever remember it. But having hard time with side-effects, So it appears that I unfortunately do need a urologist to help sort out medication issues after all. Perhaps to use prostate shrinking med instead of alpha blocker?. Hopefully, in long run, i can use complementary medicine for this. But for now..
=========

My immediate concern is:

How to "negotiate" my inclination to set aside that "rogue" PSA reading with the urologist. Or perhaps even better: How to locate a urologist in my area who might be inclined to just drop the PSA issue and deal with the known, not the unknown. Namely the combination of prostatitis and BPH. I might need some medical intervention.. Well, at least for now...While I look into possibilities of alternative modalities

The worst thing for me now would be to add the emotional torment and physical stress of prostate cancer biopsies and all the anguish and dread that entails..Often to little avail of the patient and more often than not, with a negative result anyhow..

Any suggestions on how to convey all that to a urologist?

Thanks:

-~elias~


Thu Jul 12, 2018 3:19 pm
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Joined: Sat Dec 08, 2012 4:30 am
Posts: 756
Post Re: PSA Elevation and Prostatitis/BPH [Attn: Madcap et al..
Elias, to answer your question about how to share your concerns with the urologist, you can pretty much say what you said in this post. As you may or may not be aware, I am not a believer in the PSA test. As you have read up on it you probably know why so no need to go into it here. It’s unfortunate they ran the test against your wishes because once that number breaks 4 it triggers everything else. The medical establishment is a business and assuming you have insurance they know in advance they are free to run whatever test they please and get it paid for because your number on the test broke 4. So this is one of those situations where you may need to be more forceful than you are comfortable with, but remember the final decision always rests with you the patient. It’s your body, your choice.

The first thing you will need to do is ask people in the area you live in about urologists you might see. You don’t want to see just anyone, and my advice is not to see one the GP might recommend. They almost always send you to a friend, and he or she might not be the best choice. You could also explore seeing a different GP who may not share the same opinion about sending you to a Urologist.


Thu Jul 12, 2018 10:56 pm
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Joined: Thu Jun 28, 2018 9:36 pm
Posts: 43
Post Re: PSA Elevation and Prostatitis/BPH [Attn: Madcap et al..
Thanks, Madcap:

It didn't seem my GP had any specific protocol in mind for approaching this. Or so he said. He said he's seen this PSA range "hundreds of times" before, but as to what a urologist might do with it..it's a "black box" for him. IOW he had no idea as to how a urologist would approach it.or so he said... ..He referred me to several urologists based on location and high regard. I set up appt. with the one who was not a urologic surgeon..or at least made no reference to that on his site. The appt. is on Monday. Hence the panic...

I would like to somehow be weaned off this alpha blocker--or a new one tried. I have not yet tried Tamsulosin (Flomax). Except briefly two years ago for help facilitate kidney stone passing. Oddly, I had no side effects, even though i took it for ~8 days...and it did seem to help the stone pass..Silodosin (Rapaflo) is supposed to have the least side-effects . So i asked for that....I don't feel like myself on this and am very fatigued...Maybe it's all the stress now adding to the adverse effects..

I'm almost tempted to just stop the alpha blocker and hope those brief urinary retention episodes just dont happen anymore. Now that I've gotten some sleep..This is kinda risky..But..

As to the PSA

My concern if I insist against biopsy--and perhaps suggest followup retesting in some undefined future-- as a possible option is that--I'd be seen as a "difficult patient" and might not get optimal treatment..Or I might even be dropped (Would that even be legal?)

Another option is to is simply not tell him I even had such a test.When I give the history. He may not order it. Since the protocol now is not do PSA screening for those over 70 at all..Not sure if that applies if one is having symptoms though..I wouldn't feel very comfortable hiding this test result from him..But I do think a prostate biopsy on a patient with prostatitis is medically very unsound. Especially since it very unlikely to effect what I would do with the results..

I did email Professor Richard Ablin over at the University of Arizona several weeks ago asking him if he knows of a urologist in the NY area with similar skepticism about the PSA. I havent heard from him. So I don't expect to...

So, i'm really at a loss whether to keep the appt I have for next Monday. Or try to stall for time to find a more patient-centered urologist--if such a creature even exists..

I have no idea how to go about this...
Thanks

~elias~

=================
PS:

In the list of things which can elevate PSA, there's one that's generally omitted in lay writings. Namely: Urinary Retention. Usually such cases are seen in hospital settings and patients are catheterized. However, in the medical literature, the PSA elevation during urinary retention was in the blood sample PRIOR to the catheterization. and the elevations were quite steep. So it wasnt the catheter that did it. The researchers generally r puzzled by cause of this. Some speculate a very high degree of inflammation driving it. Others invoke something called "micro-infarctions" of the prostate...It cant be due to BPH itself, because the elevated PSA very slowly begins to recede upon relief of retention via catheterization. In any case , I do wonder if those episodes of brief but acute retention on the day of the PSA teat might've skewed the test...Or maybe..Im just scared and grasping at straws here..Suffice it to say, it was a very whacky week or so for me, urologically speaking..


Fri Jul 13, 2018 12:15 am
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Joined: Sat Dec 08, 2012 4:30 am
Posts: 756
Post Re: PSA Elevation and Prostatitis/BPH [Attn: Madcap et al..
Elias, you have numerous options. I’m 63, and personally if I were in your shoes I would wait a few months and run the PSA test myself. You can do it privately without a Dr. This is assuming you feel the time is right to redo it. You mention things which can make it go up, but considering your age it’s going to go up regardless because it’s normal for it to rise as we age. There are just too many variables to start worrying about cancer/biopsy over 1 test. I would expect a good Urologist would already know this without you needing to tell them.

On the alpha blocker I went off Flomax after years on it and noticed no change other than no more bad side effects. You might want to take some time and think this through. There’s no need to rush to a Urologist or anyone else immediately.


Fri Jul 13, 2018 1:37 am
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Joined: Thu Jun 28, 2018 9:36 pm
Posts: 43
Post Re: PSA Elevation and Prostatitis/BPH [Attn: Madcap et al..
Thanks again, Madcap:

The reason for rushing to see a urologist is that I'd like to get started on Finesteride- (Proscar)--which can shrink the prostate. So that i can prevent the urinary retention episodes..But those take a few months for their full effect. So it be best to get started on it ASAP.. That way I can taper or discontinue the alpha blocker.
Though i think that's been around many years and a GP can prescribe it, most would send u to a urologist to get this...And after that PSA, mine would to..

If it were just urinary frequency or discomfort, I'd sweat it out as I have with the prostatitis...and treat it with the same approaches which have worked for me in the past. But acute urinary retention--even if very brief-- does scare me..So I'm reluctant to stop the alpha blocker until I've replaced it with something medical

Anyhow, ill think this thru and decide if to cancel appt. Or alternatively, keep the appt. and take a strong stand on this--as you suggest--but without alluding that I've read any medical research on it. Which they do hate..

=================

I'm looking into other ways to achieve the smooth muscle relaxation that alpha blockers do for urethral and prostate muscles...Something along the lines of "Resperate"..which is a biofeedback device which gradually slows your breathing rate. It's been FDA approved to lower blood pressure, specifically by relaxing smooth muscles inside the blood vessels..Wonder if it works for smooth muscles in the urinary tract as well?..I'll post about this...if I get thru this upcoming ordeal..

Thanks again

~elias~


Fri Jul 13, 2018 2:48 am
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Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1087
Post Re: PSA Elevation and Prostatitis/BPH [Attn: Madcap et al..
Hello Elias, have you thought about a TRUS, or pelvic MRI imaging from the newer 3-Tesla machines? Either of those may save you the agony of having to endure biopsy.


Fri Jul 13, 2018 2:15 pm
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