| Hello,
I would like to share with you my own experience with prostatitis and PSA
levels.
I am a 41-year-old physician ( I am not an urologist)k. At the beginning of
January 2004 I was asked to undergo a preventive medical check-up that also
included tumor markers.
I was somewhat disturbed when I found the sedimentation rate to be 19/47 and
my CRP to be 20 (normal values up to 3/8 and less than 5 respectively).
However, the next day I was shocked to see that my PSA was 16(normal value up
to 3.5)!!! I immediately visited an urologist who performed an ultrasound and
rectal examination. He found that my prostate was somewhat enlarged but
fortunately no nodules. He recommended another PSA to be examined next week. I
asked him about a chance to have a prostatitis but was told that this is not
my case. He asked about fever, chills etc. I did not recall any and was told
that chronic prostatitis in fact does not exist. I somewhat calmed down.
Another shock came the next day when I was called form the Nuclear medicine
lab and was told that my ration fPSA/PSA is only 12% and that this is highly
suspicious of malignant tumor.
As a doctor who deals every day with cancer patients and as a father of three
small children and huge mortgage was close to faint. I immediately visited
another (famous) urologist who did another rectal examination with the same
finding. However, he also sent my prostate fluid and urine to the lab. He (in
another hospital) also took another PSA sample (after two days from the first
sample). He assured me that "it is all probably a bullshit...). Being quite
anxious and depressed I was waiting for the next week to visit the famous
urologist again. That day he was in a bad mood. I even did not sit down in his
office and was told, "No positive cultivation in you urine and prostate fluid.
You will stay here in the hospital and tomorrow I will perform a biopsy". I
asked about PSA and was told it was 11. I argued that the value is lower than
the original one but was told that different labs may have different kits and
that there is no comparison between two values.
Being convinced that the diagnosis of prostate cancer is unavoidable I agreed
to stay in the hospital. However, my doctor looked at the results again and
told me that "Chlamydia is positive" and canceled the biopsy. He prescribed
Deoxymycoin and Metronidazol for two weeks. By that time I realized that for
maybe several months I has strange symptoms that I more or less ignored:
frequent urination including the night (Well, I am getting old... I do not
drink the whole day but in the evening...), post-ejaculation pain (What's
going on???), some burning during urination (I cough some cold... or maybe
have some infection...) even sometimes a strong pain irradiating in the rectum
(Oh sh... probably hemorrhoids). Also, for the first time in my life I
suffered from a low-back pain (You are really getting old...). As you can see,
being a physician, I completely ignored or misinterpreted these symptoms!! I
also realized that in December I cured a pharyngitis (as the rest of my
family) with macrolide antibiotics (known to be relatively weak). When after
my morning dose of pills I had to vomit in the dark park (fortunately no
people around at 6AM) on my way to work I decided for a change. I left Europe
with my wife for one week (from ca 20 F) to Caribbean (ca 90 F). I strictly
(almost) obeyed all instructions I got from my urologist: no alcohol, no sex,
no spicy food, no winter sports... After about one week my urination
significantly improved, I was able to pee like a small boy again. I realized
that my urination problems were not caused by age... I also lost my low back
pain and did not have to wake up in the night! At that time I was again almost
sure that I did not have a prostate cancer. I checked my sedimentation rate,
CRP and PSA one month after the first (preventive)sample was taken.
Sedimentation was 3/6, CRP negative and my PSA decreased to
3.37!! Thank God!
Did I have an acute prostatitis and I ignored and misinterpreted the symptoms?
Or did I have a chronic inflammation with gradually more symptoms present that
was so easily cured with antibiotics? Who knows.
However, my case shows that PSA, including the ratio fPSA/PSA, is not
specific for cancer and that very similar values may be present in
acute/chronic prostatitis.
Josef
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