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What Do My Lab Test Reports Indicate?
Question: I noticed in mid-November that I started to urinate a lot and in fact the during the week of around the 17th it got extreme. I saw a Dr. on a 11/21/15 (Saturday) because I did not want to wait for an appointment with my Dr and I needed to get something done. They performed a urine test and did a DRE. He stated I had an enlarged prostate but my urine test initially came back negative. I was provided with a script for Flowmax.
On Monday 11/23/15 I followed up with my Dr and he ordered a full blood and urine test and also started me on Proscar (5mg). I had the test done on Wednesday 11/25/15. That same day I received a call from the previous Dr. and they stated that I had an infection and called in a script for Nitrofurantoin 100 mg (2/day). I continued with that until I got the results of my full blood and urine test which was on 12/1/15. The results of that test were a PSA of 23 and bacteria (few). My regular Dr. then put me on Cefpodoxime 200 mg (2/day) and I finished it on 12/13/15. It was really hard on my stomach. He told me to come back on 12/21/15 and he would give me another PSA test and urine test.
In the meantime, per some pressure from friends I went ahead and made an appointment with a well regarded Urologist/Oncologist . I saw him on 12/17/15. His nurse practitioner took my initial information at the appointment and sent me to the lab to get another urine test. She was really having a hard time understanding my history but eventually figured it out. The Dr. came in the room later and she told him the story. He performed another DRE and said I had an enlarged prostate. The urine test came back negative. He told me that they would do another PSA test and if the results were not good then they would probably do an Ultrasound. If they were alright he would like to see me in 6 months. They also did something that measured how much urine I was retaining and it came out that I was retaining more than average.
That leaves me where I am now on 12/20/15. I received a note from the Dr with the blood test results and it stated that my PSA is still high (11) and that I needed to get and ultrasound and biopsy. This seems strange to me because the PSA is going down and I had an infection. My PSA was 2.4 in August of 2015.
On Monday 11/23/15 I followed up with my Dr and he ordered a full blood and urine test and also started me on Proscar (5mg). I had the test done on Wednesday 11/25/15. That same day I received a call from the previous Dr. and they stated that I had an infection and called in a script for Nitrofurantoin 100 mg (2/day). I continued with that until I got the results of my full blood and urine test which was on 12/1/15. The results of that test were a PSA of 23 and bacteria (few). My regular Dr. then put me on Cefpodoxime 200 mg (2/day) and I finished it on 12/13/15. It was really hard on my stomach. He told me to come back on 12/21/15 and he would give me another PSA test and urine test.
In the meantime, per some pressure from friends I went ahead and made an appointment with a well regarded Urologist/Oncologist . I saw him on 12/17/15. His nurse practitioner took my initial information at the appointment and sent me to the lab to get another urine test. She was really having a hard time understanding my history but eventually figured it out. The Dr. came in the room later and she told him the story. He performed another DRE and said I had an enlarged prostate. The urine test came back negative. He told me that they would do another PSA test and if the results were not good then they would probably do an Ultrasound. If they were alright he would like to see me in 6 months. They also did something that measured how much urine I was retaining and it came out that I was retaining more than average.
That leaves me where I am now on 12/20/15. I received a note from the Dr with the blood test results and it stated that my PSA is still high (11) and that I needed to get and ultrasound and biopsy. This seems strange to me because the PSA is going down and I had an infection. My PSA was 2.4 in August of 2015.
Brief Answer:
Need to repeat PSA test every month .
Detailed Answer:
Hello
Thanks for your query ,based on the facts and entire episode of sequence of events I can summarize that you probably have enlarged prostate with secondary infection causing rise in PSA level .
I shall be happy if you can post me few more details to help me in making comments on your problem.
1) Do you have urinary symptoms like frequency,urgency,nocturia etc suggesting enlarge prostate ?
2) What is the size of prostate reported on ultrasound Scanning ?
3) What is the volume of post void residual urine ?.
Raised PSA levels in the blood is always suspected to be due to Cancer of the prostate unless proved otherwise by a prostate biopsy .However it can rise with Benign Enlargement of prostate or with infection of prostate <
Normally when ever I get a patient with raised PSA I evaluate the patient with digital rectal examination for presence of any hard palpable nodule in prostate and do following basic test
1) Urine routine and Culture
2) Ultrasound Scanning of Abdomen and Pelvis
3) Trans Rectal Ultrasound Scanning (TRUS).
Once the diagnosis of enlarged prostate is confirmed I start him appropriate antibiotics as per culture report and Tomsuloin once daily .Repeat Serum PSA after 3 weeks to confirm whether it has lowered down or not .
If it shows downward trend I continue with medicine and repeat it after one month
Normally if PSA levels is raised due to enlarged Prostate or infection it comes down to normal levels within 4 -5 months .
I never jump to conclusion of raised PSA levels to be due to cancer of the prostate nor advice Prostate Biopsy I decide to go for prostate biopsy when three or four PSA tests done over a period of 4-6 months show raising trend or above normal level of 4.
Do not worry .Continue taking antibiotics and Tomsulosin and repeat PSA test after 4 months to take decision regarding doing prostate biopsy .
Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil
Need to repeat PSA test every month .
Detailed Answer:
Hello
Thanks for your query ,based on the facts and entire episode of sequence of events I can summarize that you probably have enlarged prostate with secondary infection causing rise in PSA level .
I shall be happy if you can post me few more details to help me in making comments on your problem.
1) Do you have urinary symptoms like frequency,urgency,nocturia etc suggesting enlarge prostate ?
2) What is the size of prostate reported on ultrasound Scanning ?
3) What is the volume of post void residual urine ?.
Raised PSA levels in the blood is always suspected to be due to Cancer of the prostate unless proved otherwise by a prostate biopsy .However it can rise with Benign Enlargement of prostate or with infection of prostate <
Normally when ever I get a patient with raised PSA I evaluate the patient with digital rectal examination for presence of any hard palpable nodule in prostate and do following basic test
1) Urine routine and Culture
2) Ultrasound Scanning of Abdomen and Pelvis
3) Trans Rectal Ultrasound Scanning (TRUS).
Once the diagnosis of enlarged prostate is confirmed I start him appropriate antibiotics as per culture report and Tomsuloin once daily .Repeat Serum PSA after 3 weeks to confirm whether it has lowered down or not .
If it shows downward trend I continue with medicine and repeat it after one month
Normally if PSA levels is raised due to enlarged Prostate or infection it comes down to normal levels within 4 -5 months .
I never jump to conclusion of raised PSA levels to be due to cancer of the prostate nor advice Prostate Biopsy I decide to go for prostate biopsy when three or four PSA tests done over a period of 4-6 months show raising trend or above normal level of 4.
Do not worry .Continue taking antibiotics and Tomsulosin and repeat PSA test after 4 months to take decision regarding doing prostate biopsy .
Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I would say before I had the infection my urination was fairly normal during the day. I am saying this because I did not think of it as a problem. In the night I usually wake up once at about 4 in the morning. This is when I have trouble starting to urinate. I have to stand for awhile and when I go back to bed I
sometimes feel like I have to go again. One thing I found interesting is that I started taking Vyvanse for depression/ADHD and I could swear it was making me urinate more.
They never measured the size of the prostate but the Dr guessed it was 3 times the normal size.
The did do a PVR test after I took my urine test. I did not know they were going to do this so I did not really empty. They measured 170ml but I am not sure about that.
I am glad I contacted you because I think the Dr is to aggressive on wanting to do a biopsy. It is strange though because he is well known. I don't know but I think his Nurse Practitioner is maybe making decisions like this for him.
I do have a dull ache and my right groin area and my right testicle is slightly sensitive. That being said I have always had a little trouble with it retracting.
I am going to go for another PSA test next since it is has been about a month.
Any further comments are appreciated.
Thank you
sometimes feel like I have to go again. One thing I found interesting is that I started taking Vyvanse for depression/ADHD and I could swear it was making me urinate more.
They never measured the size of the prostate but the Dr guessed it was 3 times the normal size.
The did do a PVR test after I took my urine test. I did not know they were going to do this so I did not really empty. They measured 170ml but I am not sure about that.
I am glad I contacted you because I think the Dr is to aggressive on wanting to do a biopsy. It is strange though because he is well known. I don't know but I think his Nurse Practitioner is maybe making decisions like this for him.
I do have a dull ache and my right groin area and my right testicle is slightly sensitive. That being said I have always had a little trouble with it retracting.
I am going to go for another PSA test next since it is has been about a month.
Any further comments are appreciated.
Thank you
Brief Answer:
Repeat Ultrasound Scanning with Post void urine ressidue .
Detailed Answer:
Hello
Thanks for follow up .
The size of the prostate and post void residual urine volume is always reported by Sonologist who performs the scanning and is mentioned in scanning report .
The cancer of the prostate is very slow growing cancer hence I always prefer not to be aggressive in going for biopsy unless three consecutive report show raised PSA .
Repeat Scanning and PSA again before taking decision for biopsy .
Thanks and Regards.
Dr.Patil..
Repeat Ultrasound Scanning with Post void urine ressidue .
Detailed Answer:
Hello
Thanks for follow up .
The size of the prostate and post void residual urine volume is always reported by Sonologist who performs the scanning and is mentioned in scanning report .
The cancer of the prostate is very slow growing cancer hence I always prefer not to be aggressive in going for biopsy unless three consecutive report show raised PSA .
Repeat Scanning and PSA again before taking decision for biopsy .
Thanks and Regards.
Dr.Patil..
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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