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What Can Cause General Inflammation In Prostate Area And Can Sudden Rise In PSA Levels Cause Asymptomatic Prostatitis Or BHP?

Posted on Fri, 17 Jan 2014

Question: What can be attributed to a 74 year old man, who always had a normal psa level, over a four month period have a spike in Total PSA now at a 26, but free psa % at 54.8? Is this a possible cancer, infection, or BHP? There are no symptoms of BHP nor infection. Can inflammation from a rubber band ligation from August be attributed? Can bloodwork sometimes not pick up on occult infections? What can cause a general inflammation in this prostate area? Can this spiking be asymptomatic prosititis or BHP? Thanks!!!!!

Answered by Dr. Dr. P. T. Patil (6 hours later)

Brief Answer: Raise in PSA levels could be due to Prostatitis Detailed Answer: Hello Thanks for your query,based on the facts that you have posted it appears that you have noticed sudden rise in serum PSA levels (26ng/ml.) . I shall be happy if you can post me few more details to help me in making comments on your problem. 1) Have you consulted qualified Urologist and got your clinical and digital rectal examination done to rule out enlarged prostate or presence of any hard nodule in prostate?. 2)Have you done ultrasound scanning or Trans rectal ultrasound scanning (TRUS)? Raised PSA is suggestive of either BEP.,Cancer of the prostate or Prostatitis.In absence of any urinary symptom a single reading of high value of PSA can not be a tool to judge the nature of pathology.Final diagnosis can be confirmed only by doing multi core ultrasound guided prostate biopsy. Please repeat your PSA and consult qualified Urologist for proper clinical assessment. to come to conclusion and final diagnosis. As regards your other queries I would state that It is unlikely to be due to ligation of rubber band . Blood examination is not related to presence or absence of infection .It will reveal the level of PSA in blood at that particular point of time and does not suggest nature of pathology. 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

Follow up: Dr. Dr. P. T. Patil (1 hour later)

Dr. XXXXXXX Good morning! Thanks for your responses to my questions. A digital rectal was done twice, with no lumps felt. A sonogram biopsy has been scheduled. Dad is under the care of an excellent Urologist. A urine analysis was done, and it does not show any sign of infection. My dad also does not have any symptoms of BEP nor any type of infection. The Psa is normally below a 3. This past October it went to an 8, six weeks later a 16, three weeks later 22, and another two weeks later a 26. His free psa % continues to remain at around 55%. I am not sure if prostate cancer has or may show such a pattern? Is it still possible to have an infection of the prostate without symptoms of an infection? I am worried that this may be an aggressive tumor. If so, how rare is it to have these symptoms out of the blue? When you say blood examination is not related to the presence or absence of an infection, what does that mean? If there was an infection, wouldn't one's white blood cell count be raised? Thanks again!!!!

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer: Prostate Biopsy will confirm Cancer of Prostate Detailed Answer: hello Thanks for follow up. Raising trend of Serum PSA is highly suspicious of Cancer of prostate.If turned out tobe positive further treatment will depend upon the extent of tumour (Whether the tumour is organ confined or infiltrated in surrounding structures) Please go ahead and get his biopsy done to confirm the diagnosis. By blood examination which I have mentioned in my reply earlier I meant serum PSA and not WBC count which gets raised in presence of infection.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (13 hours later)

Dr. XXXXXXX Good evening! Thanks for your responses! Although the total psa is rising, does the total free psa; which is greater than 25%, no longer play a role in thinking that this can still be a benign condition? Can an occult infection of the prostate (prostatis) also create a jump in psa readings? Can this also perhaps be a benign prostatic hyperplasia; or does BPH not usually jump like this? Also, upon digital rectal exam, wouldn't the prostate feel enlarged if there was BPH? Is it unusual to have an aggressive prostate cancer at age 74? Thank you!

Answered by Dr. Dr. P. T. Patil (9 hours later)

Brief Answer: Only Biopsy will reveal the true pathology. Detailed Answer: Hello Thanks for follow up. Infection of the prostate will not raise PSA to such a extent. Free PSA more than 25% can be considered absence of Cancer of Prostate. Yes it cab be BHP. Digital rectal exam may or may not be confirmative about BHP. Age is not criteria for aggressiveness of cancer . Thanks and regards. Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (28 minutes later)

Dr. XXXXXXX Good morning! Thanks for ALL of your ADVICE! My dad is going for this biopsy, and we will soon find out! 1.)Would you know if inflammation, in general, could, out of the blue, raise PSA levels so high? 2.)Can you have BHP develop, out of the blue, within such a short time frame, without any symptoms? 3.)Are most prostate cancers treatable, or have you seen aggressive cases? 4.)The Urologist did not feel any tumor, upon Digital Rectal, isn't this a good sign that it is more likely BHP, or can small tumors not be felt? 5.)Does Free PSA total scores become irrelevant, and not so promising, when total psa's jump so quickly? 6.)Can there be occult infections hidden, and discovered upon biopsy? 7.) If caught early, can prostate cancer treatment be successful? Happy almosy New Year!!

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer: In early stages.Prostate cancer is 100% curable Detailed Answer: Hello Thanks for writing again. I can understand your anxiety and concern for your father. 1) Infection of the prostate Prostatitis can raise PSA to such a level. 2) It is unlikely to have BPH without any symptoms. 3)Most of the cancer prostate confined to only prostate can be cured by Radical Prostatectomy. 4) Digital rectal findings have its own limitations and one can have cancer detected on biopsy without any palpable nodule. 5)Value of free PAS less than 10% is supposed to be landmark for Cancer of prostate. 6)Yes it can be confirmed on biopsy. 7) Yes cancer of the prostate is 100% curable if detected in early stage . Thanks and Regards. Dr.Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar