New Problem

Tommy, I too had an elevated PSA. It was at the beginning of my second round of BCG treatments, and my Uro also wanted to undertake an immediate prostrate biopsy. I refused, suggesting the test be delayed for several mos., while continuing a regime of PSA testing and monitoring. My decision is based on the articles I've found. However, I'm no expert in this field, and the Uro nurse was quite smug about it being my decision not to undergo this (pAiNfUlL)procedure right away. I gotta ask myself if there's something the Uro wasn't telling me based on the TURBT I had Sept '07. Who knows?

However, I appear to have similar symptoms/issues that you have described Tommy. I think my problem is related to granulomatous prostatitis from the BCG treatments. I had no prostrate symptoms before my TURBT. Anyway, it was my choice to postpone based on what "LITTLE" I know, and given that the Uro does not want to do any other tests (even though I've only had 3 PSA tests in the last 8 mos., 7+, 2+, and the last was 6+. I've also not been offered a DRE, which I suspect would yield hardened, or enlarged prostrate due to granulomatous prostatitis. But I'm only 53, so several more mos. wait for the prostrate biopsy is good enough for me.

Check out the following couple of websites on this issue:

1) "Prostate Cancer / What's New"
www.cornellurology.com/prostate/new/
(2nd paragraph under the heading "Evaluation/detection")"Treatment with intravesical BCG for transitional cell carcinoma will typically result in a 2-fold increase in PSA, as seen in a recent study for 75% of patients. The effect on PSA is self-limited and will resolve within 3 months."

2)"Granulomatous prostatitis on needle biopsy"
findarticles.com/p/articles/mi_qa3725/is_199707/ai_n8772067/pg_5

3)"Transrectal Ultrasound Appearance of Prostatic Granulomas Secondary to Bacillus Calmette-Guerin Instillation" www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7XMT-4HMG7RP-1B&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=92386251531c32f2ef3c1194f5883a25

I hope these articles help, in addition to the one mentioned in the earlier post.

Good luck...

Gordo

PS To Moderator...Just an idea. This might be a good thread to copy under Men's Issues.

Tommy,

I also had a spike in psa after bcg (lots of acronyms) along with a questionable nodule in prostate that I did not have prior to bcg. I went ahead with the biopsies (I also had a positive FISH) and everything was normal. My psa has since decreased, but not at an alarming rate. I also developed flank pain after all the biopsies and bcg. Apparently bcg can cause positive FISH, elevated psa and flank pain (cystitis in the kidneys?). I had heard about the elevated psa, but did not realize the others. We all respond differently I guess. I have since had a negative FISH, 2 negative cystos, and get to postpone my next bcg until June.

Good luck with any decision you have to make. Just to let you know, the prostate biopsy was not any worse than a TURB for me - at least you know what to expect. I hope everything turns out all right.

Ross

I'm not sure if it's a case of which takes priority, bladder or prostate. When I started this BC road, a main reason I saw my URO was urgency and the feeling of not voiding completely. He checked my prostate but also did a cysto to be save, thus the bladder cancer. The URO felt since the prostate was slow to develop, we should attack the bladder first. ( I'm sorry, I wrote my d/x was 07, it was 06). After 15 BCG and untold cystos, I was due this week for another. As he was scoping and viewing through my prostate, he became concerned and said we need to talk now about the prostate. I'm sure the urthea was closed a bit(always uncomfortable while passing through with BCG catheter) and that was his concern. I feel priority has to be the the most aggresive problem, then on to the next. Thanks

Tommy...i think this is an issue with a lot of men with BCG and an elevated PSA so entirely appropriate to be discussed here. Your uro is doing things right with the DRE also. I found this link from the NCI...might be helpful...might not..??
www.nci.nih.gov/cancertopics/factsheet/Detection/PSA
Pat

Tommy....glad you brought it up. I'm in a similar situation - after second BCG maintenance round my PSA tripled from my baseline of 4 to 13 and has been riding there for about 4 mos. There's a study out by some Tel Aviv uros that shows a 3X increase is common but I'm at the point where it should be returning to the base line and it's not. I'm scheduled soon for my next round of BCG to be followed by prostate biopsy, but I'm trying to see if my uro can reverse that order as I am a lot more worried about the prostate - having recently had a biopsy of red areas in the bladder come back negative. Does anyone have any input on this? Which should get priority? Heard of cases where PSA stay elevated for longer than 3 mos and then returns to normal? Have bladder in remission and then lose to the beast in the prostate? If it's not one thing it's another. brewster

Thanks Pat for the link. My PSA was realtively high before BC. I have not had any furhter BCG treatments since Jan. We just want to rule out prostate before further BCG continue. I'm sorry to be discussing prostate on this bladder sight, but I thought others might be experiencing same deliema. Thanks again