High PSA & Prostatitis | Ask a Prostate Expert, Mark Scholz, MD

Mark Scholz, MD, explains how prostatitis can complicate a prostate cancer diagnosis and how new PSMA-PET scans may help clarify these situations (pending FDA approval).

0:05 Do you have any stories from your practice of prostate cancer patients who experienced prostatitis?

3:37 What is Proscar used for? How can it complicate a diagnosis?

4:54 How effective is the PSMA-PET scan at diagnosing prostate cancer?

6:28 Is 3T MRI as effective as PSMA-PET scans for detecting abnormal lymph nodes?

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[billhopen]

I'm 70, my high PSA bounced from 5's to 8's to 5's to 8's....then suddenly to a PSA of 25 ! not only that, scan measured my prostate at 250cc..a huge one, and DRE showed it was lumpy, MRI scan revealed suspicious #4 and #5 hard lumps. I have a strong family history of prostate cancer 3 uncles dying of it. I was convinced as were all my 3 docs, cancer was present....but...a targeted MRI/ultra sound fusion biopsy proved the lumps, as well as all 12 needle cores...totally non-malignant...no cancer present.

[RaysDad]

When my PSA rose to over 9 I was referred to a urologist for a biopsy. The samples were sent to a lab that said it couldn't make a determination, but a second lab diagnosed 3 3 prostate cancer. My GP then referred me to a surgeon who recommended a radical prostatectomy. My PSA rose to over 14. For a second opinion I went to the best doctor I know, a radiologist, for an MRI. The MRI showed no cancer but my prostate volume was 3X normal. So the radiologist recommended regular PSA monitoring and a yearly MRI. My GP prescribed Finasteride. That was 6 years ago. My PSA is now regularly between 2 and 3. This is the first year since my diagnosis that I'm going to skip the MRI. My GP and I agree that my cancer diagnosis was probably a false positive.

[barrydee]

Tomorrow is my initial visit to the Urologist. I am suffering from what I believe to be BPH. I also have a PSA reading of 10.1 currently. so this video has given me some reassurance it is not always cancer with a high PSA.

[quintonstone]

I had a PSA test with a result of 10.45. The year before it was 1.85 I had to wait four weeks to see a urologist who did a digital exam and felt what he called a "small bump" He wanted a 12 core biopsy performed and I had to wait four more weeks. Just had my biopsy and it came back benign . He now wants to wait three months and do another PSA test. I spent two months totally scared to death waiting to get a biopsy just to find out all cores had no cancer. No to figure out next step.

[rafaelchavez]

Thank you for explaining the pet scan test.

[jkim]

I'm 39, Dr thank you for sharing this information. My psa level was a 11.5 back in September, my primary had me take Dutasteride for 1 week and then I saw an urologist that told me to get off the Dutasteride right away. Weeks later I couldn't take it no more cause my anxiety and I went to the er and they did a ct scan and another psa and came back 5.4 and another few weeks or so my primary did another psa test and it was 6.9. My current urologist checked over my CT scan and did Dre and has ruled out that I have inflammation. This interview made me feel so much more assuring thank you for sharing again.

[swarfmaster]

I had 5 uti’s over a 6-7 week period. My urologist wanted to cut but to me it felt like it really was my prostate giving harborage for the bug. I made an appointment with an infectious disease specialist. I explained to her what I thought and we picked an antibiotic I knew would partition fairly equally between water and oil. I did a 3 week treatment with phosphomycin 8 months ago and I am still free of uti’s. I no longer feel like I have a walnut in my crotch.

[marianobrothersmototv]

Sir, My age is 48
My psa before is 12.1
then i take medicine
After 2 weeks my psa is 6.21
Any advice..thanks

[richardclarke]

I'm only 37 and suffering from all the symptoms except no blood. Been going on for 2years getting to the point I can't take it no more especially at night. Finally made the phone call to doc's this morning, hopefully nothing to serious 🤞

[byronbailey]

At 73 I suddenly had a jump from PSA 1.0 to 28.0. DRE and biopsies showed normal prostate. Was a spike due prostatitis. Antibiotics brought it down to 2.0.

[theadvocate]

55 and diagnoses with BPH in 2013. Now 55, my PSA is at 3.85 and GP says I need to see a urologist.

[steinshaw]

Hmm, thanks for another great video. My PSA has started to rise a few months after stopping ADT. Now back on ADT and added Zytiga. Scans didn't show anything. I keep wondering if there is something else that could be causing the PSA to go high. PSA is responding to ADT so grateful for that. Wanted a PSMA scan but it was not approved by insurance. Maybe next time.

[byron]

Don't know if my PSA was a mistake or my prostate symptoms are from something else, like a weak pelvic floor? But i have had symptoms such as urgency to urinate, frequent urination, growing pain, and even difficulty starting stream and emptying my bladder. But, my last PSA was only 0.2 (wonder if this is a mistake? that seems unusually low even for a healthy prostate.) When I had my first prostate exam when these symptoms started (age 45), I was told my prostate was slightly enlarged but normal for my age. But I sometimes have extreme symptoms.

[hordboy]

Seems to me that a PSMA PET scan ought to be done before a biopsy? Or am I missing something? That would save a lot of needless biopsies along with the associated anxiety and discomfort.

[bencamicia]

I believe my symptoms fall into the chronic prostatitis category . Since 2020, my PSA has gone up & down from 3 to 6, with the feeling that a Ballon was in the rectom.

[anthonyfreund]

My PSA came in at 96.5 recently. There are many factors that have to be considered before you make out your will and assume it's prostate cancer (or even worse metastasized prostate cancer). If you've had BPH or an infection those numbers can be significantly inflated. Stay on top of this number and trust your doctors. Push them for a biopsy if you aren't feeling 'right' down below. That's your best course of action.

[virgiliovidal]

Hi. I just had a prostate multiparametric MRI due to PSA of 4.7 ug/L, i am still waiting for the result of the MP MRI. I just want to ask, what if on the MP MRI result no cancer or malignancy is seen on my prostate, do i still need to have a PSME PET scan? Is PSME PET SCAN only needs to be done if there is a cancer seen on prostate? Thank you very much.

[shamrock]

Is it suggested to take medicine to bring down your PSA ? I believe I would rather get an MRI to rule out cancer first. I’m 58 and my PSI has slowly risen over the years. The past 3 years it went from 4.1 to 4.0 and this year 6.0 but then I took another PSA test a few weeks later and it was back down to 4.8. My rectal exam went well but he still wants me to get a 3T MRI just to be safe. I will be scheduling that in the next few weeks. I have no family history but after doing research I found it doesn’t matter if you have a family history or not, you can still get prostate cancer. I want to play it safe

[CharlesHarkerSanJose]

Where is a reliable center to get a PSMA-PET in AZ/SoCal?

[dennishayes]

will taking B 17 cause the psa to go higher?