Question: Hi there

For a male, I had many UTI in my life. For the last 10 years mostly it was OK, but last year I got some bacteria citrobacter koseri. I got amoxiclav and after 10 days I was ok and I had NO SYMPTOMS till beginning of april 2023.

It started with fever 39 celsius for 3 days, terrible headache and muscle pain together with balanitis and burning/frequency/urgency when urinating. Since then I NEVER had systemic symptoms together with urinary symptoms, even that I had much worse UTI's in the past. This UTI was burning but not so much that I would be having tears in my eyes.

I went to doctor and he did urine test, I had leukocytes, nitrites and blood in my urine and CRP 39. He gave me amoxiclav and send urinary culture to sanford. My high fever subsided even before I took antibiotics but even after a week, it was like 80% better but not 100%. Test result came that I had Pseudomonas bacteria in my urine culture and doctor gave me Cipro for 7 days. After 7 days I got balanitis again and my penis was very sore, I still had some urgency and frequency and pain mostly around penis because of balanitis.

After Cipro it didn't go back 100% again, I had some minor frequency and urgency, so I gave urine again (9.5.) and it was borderline. Dipstick test was 1 for leukocytes and sediment had 2 erytrocytes in HPF. Urine culture was 1 meaning bacteria was still present. I was surprised because it was like 40 days after my initial UTI symptoms and 3 weeks after taking cipro.

I also did some blood tests on same day, because I thought urine would be clear. My PSA was 1.33 up from 0.67 year and a half ago and I really panicked of prostate cancer.

So I gave urine again (12.5.) with Sanford test. Urine was ok this time and Sanford came back negative for bacteria. I gave urine again on 15.5. and everything was again clear. On 20.5. I tested for PSA and it was 1.36 this time (after bacterial infection was gone), which is even higher and I panicked a lot more.

I still had some mild symptoms of urinary urgency and frequency so I went to see urologist. I didn't know that I need to have full bladder and that he will make me ultrascan of the abdomen. Because my bladder was empty he couldn't see much, he told me my prostate seems 16,5 cc and my kidneys seem ok except some 1,5 cm cyst which he said is unremarkable. I didn't tell him about frequency and that my symptoms were still 5% there, because we mainly talked about prostate cancer as this is what I feared at the time. Doctor did DRE and he said prostate was not enlarged and it felt totaly normal. The DRE was painful. He also looked at my testicles and this hurt quite a lot, my testicles are very sensitive. He suggested to test PSA again after few months.

This was 6 days ago. Since my visit to urologist my "symptoms" got a little worse. I have kind of wrong feeling down there, some urgency and frequency to urinate, definitely too soon for too little. Weird is the night is usually OK! I also got some testicle pain. First I thought it is because he pressed my testicles so much and prostate exam was painful, but it doesn't go back.

So now I have frequency and some urgency during the day and some testicular pain. I also have diarrhea every morning 1-2 times, maybe because I am in such fear of bladder cancer now and my flora isn't right yet, the cipro wasn't well tolerated by my gut. Now I fear I may have bladder cancer, but weird is I was ok before I got this fever and UTI... Now the symptoms got worse since my urologic exam and I just can not think of any other reason for this except bladder or maybe prostate cancer (but prostate cancer would need to have been big to make me urinate frequently and I guess DRE would not be OK and PSA would be bigger), that leave me with bladder cancer. Even when I pee and after I feel a little little burning on the tip of my penis, but balanitis is gone. I just feel the presence down there, little uncomfortable. It feels like a really mild UTI, but I guess everything is still clear now (didn't do urine test this last 5 days but 2 before were clear). I tried ejaculating today and there is no blood in sperm, but when ejaculating I would say I had mild discomfort, not pain. There is no visible blood in my urine, I am color blind partially but if there would be severe blood, I think I would see it. My urine is a little on the brown side, but it was the same color when I took it to lab and was OK, so I guess either I don't see ok or this is because I have Gilbert syndrome.

The only time I had blood on sediment (4-10) was 4 years ago and it was a routine test and I didn't have any symptoms. 2 successive tests were all ok, so they said further testing was not valid. Now I am thinking if that was the start of the cancer? Would it advance in 4 years or this would be too slow? But everything started with the UTI and the bacteria Pseudomonas was confirmed. And testicular pain, frequency, diarrhea and some pain in my left hamstring that I have for 3 weeks now seems not to be connected by one cancer.

Can a scare mind do all that or is it really cancer? I am 54 male, never smoked, computer programmer all my life.

I am just so scared right now as my problems last for 2 months now. Can urologic examination make things worse (testicle and DRE examination)? I did get 2 very rare bacteria in 1 year (koseri and pseudomonas), is this indicative of cancer?

Yes, last thing I have to tell you I guess... I had urinary problems before as I told you... 30 years ago I had 2 UTI's, one was weird, never found bacteria and after some months I had testis pain and urgency... In 10 years later I made a not, that I have testis pain and something wrong there with urgency and frequency and no UTI and nothing wrong with urine. This symptoms are very similar now, but at 25 and 35 it could have been anything, but at 54 it is likely cancer I guess...

So to sum:

1.4.: UTI with pseudomonas, blood, leukocytes and nitrites in urine, amoxiclav (didn't know yet about bacteria)
10.4. Pseudomonas was found so I got cipro for 7 days
9.5. Still 5-10% symptoms (urgency, frequency, very mild burning on tip of penis after urinating, nights are ok), still leukocytes in urine and urine-culture is positive
12.5. All clear, also Sanford clear, still symptoms
15.5. All clear, still symptoms
20.5. Urologic exam DRE ok, kidney ok
21.5. - now: Some more urgency and frequency, no pain, little weird feeling down there also with ejaculation.

Could you give me your opinion about this weird symptoms please?

Hi again and thank you for your fast answer.

In december 2019 I had Glucose in blood 5.1 nnmol/L and in may 2023 I had 4.6 nnmol/L. So I think I don't have diabetes.

I have some more things I would like to ask you:

1. I did have one time microscopic hematuria WITHOUT SYMPTOMS, 4 years ago I had 4-10 on x400 sediment and 1 on dipstick. Then I only had on sediment when I had UTI's, but on dipstick I had it on some other occasion but doctor told me if sediment is clear, dipstick is false positive. Should I be concerned of this former microhematuria?

2. By visible blood you mean the color you can not ignore and is very different to the urine one normally has? I have light brown urine and I can not see difference when I have 0 erytrocytes in it or 4-10. I never had like shocking urine color without symptoms. I have symptoms of urgency and frquency and weird feeling down there, but no visible blood and last 2 tests were clear.

3. Could overactive bladder came because of UTI I had? Is that possible? This time UTI was not so bad, but leukocytes were there 6 weeks after still, but not last 2 weeks. Can Pseudomonas bacteria be to blame? Is it possible I still have some undetectable bacteria in prostate or somewhere else that makes this symptoms?

4. Can this episode of frequency, urgency go away on its own like it did 10 and 20 years ago?

5. I do not have burning, but after urinating I feel tip of my penis as unpleasant experience, the need to pee is not normal, it feels little weird or unpleasant although I don't have like burning. Testicles do feel too sensitive and I am in a constant little aroused state, but not in a good way. This all can be overactive bladder?

6. Is there something else this could be according to my symptoms? Is there a psychological factor as I am very scared that I may see blood or there will be another burning UTI soon so I am very tensed and scared right now. Can this be a factor in all that?

I won't ask you about my prostate PSA going from 0.66 to 0.136 in year and a half, you already explained this to me in another letter. But can this PSA increase be connected to my problems somehow?

Thank you very much for your time and your kind answers.

Thank you for your answer.

You know that 10 and 20 years ago with similar symptoms I was thinking about chronic prostatitis, that was never detected as it is hard to detect they say...

After ejaculation I have pain in perineal region and testicles a lot of times, yes. But this days I think ejaculating does me good even if it doesn't feel 100% ok, the tension in testicles subside...

I have sex more like once in 14 days.

So you are thinking chronic bacterial or nonbacterial prostatitis? Once I had koseri and once Pseudomonas bacteria that caused UTI that was confirmed (blood, leukocytes, nitrites in urine, severe pain when urinating etc.).

This time with urgency and even after urinating I feel urge to urinate with empty bladder for some time, I felt like things got worse after urological examination, could touching prostate make prostatitis worse?

So it is likely my old problems returned, you still think cancer is not likely?

Is the rise in PSA possible with prostatistis (I know it is not significant but it is 100% from last year).

Thank you.