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Have been dealing with prostatitus. Noticed blood in urine. Is surgery essential? Why is there back pain?

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I have been dealing with prostatitus over the years. My PSA has gone 2010 - 2.9, 2011 -3.1 , 2012 - 3.3.

My doctor last week noticed blood in the urine under microscope. He wants to do a biospy and check the urinary canal. I am 57 years old. I have pain in the back but have not taken any antibotics.
My question-- my gut is why not give me anibodies and recheck me, rather than jump to surgery?? Isn't there also a "real" PSA test?
I also experience a sharp pain in my lower back two weeks ago. Could barely walk. I am thinking about getting a second opinion first. He did not ask me how I felt that day. He was busy getting to a surgery.
Posted Tue, 22 May 2012 in Men's Health
Answered by Dr. V. Sasanka 3 hours later

Thanks for the query.

I understand your concerns. Let me give you some information that will help in making your decision.

If urine analysis has shown blood in the deposit, even an asymptomatic patient is usually advised cystoscopic examination of the lower urinary tract, so that a sinister lesion like a malignancy may not be missed. The procedure is not a cumbersome one, and if a urologist can combine it with a prostate biopsy, the patient is spared another visit.

There is more than a theoretical risk of malignancy, especially considering that you are male over the age of 50 years and Prostate Specific Antigen (PSA) is gradually on the rise, the risk of prostate cancer is bit higher. The procedure is not entirely without side-effects, however you should discuss with your urologist regarding the appropriate antibiotics you will need to take before and after the procedure. Also, not all malignancies are picked up on biopsy, and re-biopsies are also advised in certain circumstances.

A couple of issues which you have brought up, and I can address them right now -

a) Yes, sometimes you can be prescribed antibiotics for infections of prostate and your PSA could come down. But the rate of PSA increase over the past 2 years does not suggest an infectious etiology. You can consider consult a second urologist if you’re unhappy with the current one.

b) We do ask for serum estimation of Free PSA in cases where we are reluctant to do biopsy, hoping that as Free PSA levels are higher in benign conditions.
A ratio of Free to Total PSA of over 25% indicates a relatively more benign cause, and if less than 10% more suggestive of malignancy. And anywhere in between lands you back in square one!

Hope I have been able to help you, Let me know what is happening, and is there any way I can help you.

Good luck.
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