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Should Niftas and Urimax be continued to bring down PSA level when diagnosed with a nodular prostate?

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Posted on Wed, 3 Jun 2020
Question: On 14/2/18 I had master health chek up one of the serum result showed PSA 19.79, As advised consulted urologist who did DRE and prescribed Urimax D one in the night and zanocin 200 mg 101 and did plan for biopsy. I took second opinion and the Urologist did DRE and found Nodular prosate L bon firm PR Gr.I and prescribed urimax 0.04 for one month and niftas 100 mg for 15 days and advised to come with PSA Urine routine and culture test which showed PSA 20.10 urine P vulgaris and prescribed Ceftum 500 mg twice for 20 days and 250 mg twice for 10 days and urimax for 6 months. Now PSA level shows 13.48. When I was taking nifas 200 mg for 15 days and urimax for one month the psa came down to 12.1 and now after taking ceftum the psa level slightly increased. Shoud I to presume that should again take niftas 100 mg and urimax 0,4 daily as this medicines had worked to bring down my PSA level Sir. Kindly advice and help me. My prostate volume 31 cc . Please help me sir
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Answered by Dr. Remy Koshy (2 hours later)
Brief Answer:
Explained below,

Detailed Answer:
Hello,

I have gone through your details, but before I can comment more, I would request you to upload the test reports so that I can go through them for more clarity.

Also when was the last urine culture done? If you haven't repeated an urine culture after your course with T. Niftas, it would be best for you to get one done, so as to look for any persisting resistant urinary infection. Sometimes, there can be instances where a multi-drug regimen has to be Implemented for the complete cure of urinary infection.

Also as your doctor has found a nodular prostate on DRE, it would be worthwhile to undergo a biopsy to allay any unwanted doubts.

I hope this helps,

Regards
Above answer was peer-reviewed by : Dr. Remy Koshy
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Follow up: Dr. Remy Koshy (1 hour later)
Actually the purpose of my seeking advice is that I do not want to undergo invasive biopsy at this age of 74 as I am alone with no other help s my wife is also sickly and nobody to help us. Therefore I thought that if I now continue the earlier antibiotics Niftas 100 mg 101 which was prescribed and which I took for 15 days and the psa level came down to 12.10 from 19.79 it will perhaps help in reducing the psa level from 13.48 to considerable level making it postponing the biopsy and continue to watch psa level every month or twise a month sir. Kindly advice me
doctor
Answered by Dr. Remy Koshy (19 hours later)
Brief Answer:
Follow up,

Detailed Answer:
Hi Sir,
Thanks for writing back,
Sorry for the delay in replying,

I can certainly understand your present situation and after going through all the details again, I presume that the symptoms you are experiencing can to be due to calcification in the prostate caused by chronic prostatitis. Your PSA seems to be increasing due to the persistent bacterial infection causing more calcification.

This is why you were requested to do a biopsy to confirm the cause and also the causative organism. Your PSA should return to its normal levels once the calcification is removed completely.

Its management involves:
- Injection of antibiotics directly to the calcified area
- Surgery and removal

For now, I can only advise on further continual of antibiotics if you can upload your previous urine culture report and also a recent one which is to be done after taking T. CEFTUM. I need to go through both the reports in order to advise about that.

I hope this helps,
Please upload your reports soon so that I can suggest accordingly,

Kind regards


Above answer was peer-reviewed by : Dr. Remy Koshy
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Follow up: Dr. Remy Koshy (2 hours later)
I have already given the ist urine culture report datd 20/2/18 that no growth and even then the urologist prescribed T zanocin 200 mg 101 for 5 days and urimax D for 5 days. then again the uralogist had on 24/2/18 prescribed urimax 0.04 for one month and niftas 100 mg 101 for 15 days and advised sr. psa and urine routine and urine culture on 21/03/18 i consulted urologist with psa 12.10 and routine urine analysis normal report and urine culture showed proteus vulgaris on that basis the urologist has prescribed ceftum 500 mg 101 for 20 days and ceftum 250 mg 101 for 10 days urimax 0.4 for 6 months called for review after one month with psa. Now the latest psa dated 2104/18 showed 13.48 and urine cultue report showed no growth after 24 hours. since previous report of psa 12.10 was obtained with the urimax 0.4 and neftas 100 mg with no growth urine culture test I saught advice whther the same regiment could be used now by taking urmax 0,4 and neftas for 15 days or one month to see whether psa value could be brought down sir.
doctor
Answered by Dr. Remy Koshy (2 hours later)
Brief Answer:
Follow up,

Detailed Answer:
Hello again,
Thanks for the detailed follow up,

As your present urine culture does not show any growth, I would not recommend taking T. NIFTAS, as prolonged usage can cause bacterial tolerance and resistance to the medicine. You can discuss the option for alternative antibiotics like Ciprofloxacin or Cefuroxime for another 2 weeks or so. But the better option would be to inject the antibiotic directly into the nodule if possible by DRE.

You can continue on Urimax as it helps you with your symptoms

I hope this helps,

Regards
Above answer was peer-reviewed by : Dr. Remy Koshy
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Dr. Remy Koshy

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Should Niftas and Urimax be continued to bring down PSA level when diagnosed with a nodular prostate?

Brief Answer: Explained below, Detailed Answer: Hello, I have gone through your details, but before I can comment more, I would request you to upload the test reports so that I can go through them for more clarity. Also when was the last urine culture done? If you haven't repeated an urine culture after your course with T. Niftas, it would be best for you to get one done, so as to look for any persisting resistant urinary infection. Sometimes, there can be instances where a multi-drug regimen has to be Implemented for the complete cure of urinary infection. Also as your doctor has found a nodular prostate on DRE, it would be worthwhile to undergo a biopsy to allay any unwanted doubts. I hope this helps, Regards