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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Hi Ted,

You know quite a bit more about prostate cancer and its diagnosis than I did back in 1999 when I was diagnosed with a challenging case. However, a little knowledge can cause a lot of needless anxiety, which I believe is your situation, along with the benefit of motivating us to get things checked out, as you have. While I knew very little at the beginning and have never had any enrolled medical education, I’ve been through the School of Hard Knocks for prostate cancer for nearly seventeen years now, which resulted in my paying a lot of attention to the disease. (I am now apparently cured with the aid of radiation and hormonal therapy in 2013.) Here are some selected key facts you mentioned in your initial post:

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…. 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…. 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….
I am afraid I have mets already.”

All of these facts are consistent with [B][I]not[/I][/B] having prostate cancer, :) let alone metastasis, though they do not absolutely rule out one of the exceedingly rare cases – a fraction of a percent – where such a presentation is for a patient with statistics like yours whose prostate cancer does not depend much for androgens (testosterone and dihydrotestosterone mainly) as fuel for the cancer.

That’s from my now savvy layman’s standpoint. I suspect an expert prostate cancer doctor, many of them practicing at the highly regarded prostate cancer unit at the Mayo Clinic in Rochester (e.g. Dr. Eugene Kwon, MD), would be convinced that the extensive, highly sophisticated and effective work-up you have had for the prostate itself [B][I]does rule out[/I][/B] prostate cancer. After all, that highly effective 3 Tesla endo-rectal MRI found no prostate cancer but did find evidence of inflammation in the prostate, and that is in conjunction with a highly favorable profile/pattern of PSA and free-PSA results.

You may not be aware that healthy prostate cells produce about .1 unit of PSA for every 10 cc of prostate tissue; since your prostate is 35 cc, the rule of thumb suggests that a PSA of 3.5 – well above your current PSA level - would be quite consistent with a prostate with no cancer, with the added consideration that infection and inflammation sometimes really boost the PSA even when cancer is totally absent, and even with that possible “handicap” your level looks good. Therefore, your recent PSAs are well within the range associated with a prostate with no cancer. (Another competing rule of thumb, with both based on research, suggests that a cc of non-cancerous PSA tissue produces .066 units of PSA, so 35 cc X .066 = 2.31, which is so close to your current value.) Moreover, your free PSA values rather strongly suggest the absence of cancer.

Regarding your pain, I would be shocked and amazed if it turned out to be due to metastases from prostate cancer! :) Actually, I would be surprised if you turn out to have even mild prostate cancer in the near future. :) That said, there may be other causes that are important to figure out. I’m glad that some of your hip and rib pain has gone away.

Chronic prostatitis can be hard to nail down and treat. Usually Cipro is used early in a try at knocking out the particular bacterium that is causing the problem. However, Cipro does not work on many of the bacteria that can cause prostatitis, so it may be necessary to try other antibiotics. I don’t feel I know enough about prostatitis to provide leads about whether and how long to take Cipro, or the side effects about which Jack has already commented and are worth some thought. I do know that many medications have long lists of side effects which in reality will only manifest in a small minority of patients as one or several more side effects, usually quite mild, with still fewer patients experiencing a particular side effect at a bothersome level, often with the option of discontinuing the problem medication and reversing the effect, and perhaps switching to an alternate tactic.

I wish you luck with this, but I envy your treatment at the Mayo Clinic: you are in good hands. :)

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