Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.
I am 66 yrs old with prostate cancer and prostatitis. Regarding the cancer, I have come to terms with it and comfortable with my plan:
My Gleason is 3+3=6. After getting the "news", talking to others, researching alternative options, my plan is to have Davinci robotic surgery performed by Dr. Menon at the Vattikuti Institute of Henry Ford Hospital in Detroit. Before the operation I need need to be completely free of the infection and to lose more weight. I lost 65# since January but a little more will reduce risks/breathing, etc. Since killing the infection and losing weight can't happen overnight, and my Gleason score did not call for urgency, Dr. felt waiting till March/April would not be a problem. (but I shouldn't do a long term "watchful waiting")
Following years of PSA in 2.5 to 3 range, it rose to 6.0 last year. Digital exams by family doc over the past 10 yrs yielded a gradually but normally enlarged (age related) prostate but I had minimal BPH symptoms. I can't write my name in the snow or hold it all day like when I was 18 but no getting up at night or other problems. I was sent to a urologist who did a more thorough digital exam (an more uncomfortable) yielding a greater enlargement on one side and recommendation of a biopsy.
I chose a different urologist not because I was unhappy with the first, but wanted a provider with color doppler ultrasound equipment. This was advised by a friend because the color better identifies areas for biopsy over a "shotgun" method using black and white. This urologist wanted me to repeat the PSA test again after taking Cipro for 2 weeks, to rule out any infection causing high PSA#. The number was in the same range and a biopsy was scheduled. I refilled the Cipro to take through the biopsy along with another antibiotic, (can't remember name) Both meds were continued for 5 days after the biopsy.
I used a fleet enema prior to the biopsy. I was apprehensive and uncomfortable, I survived. Before leaving his office, I was able to urinate. Blood in urine and feces were evident for several weeks. I didn't discover blood in ejaculate for several more weeks as I wasn't in the mood or curious. This eventually did happen and yes, it was bloody but eventually disappeared.
Post-biopsy fever and symptoms
After blood in urine subsided I began to notice an increase in frequently and urgently with discomfort (burning). I developed a fever (101.5) and felt lousy (headache overall achy). I was put on the Cipro again. Symptoms (fever, etc) decreased in a couple days and I continued the RX for 15 days. A week after stopping Cipro, symptoms returned. (temp, etc). Septra was prescribed to be taken over 3 months ending Nov 20th.
Frequency and some burning began to increase about Dec 1. I called the urologist who called in an RX and told me to go back on Septra until the operation. (This was all related via his office people) During my consultation with Dr. Menon's assistant, he asked if there were any urine tests prior to starting antibiotics. This wasn't done. Because of this, I did not start the Septra immediately. I felt uncomfortable calling and "second guessing" the doctor and instead called Vattikuti where I spoke with Folushio (one of Menon's team). He faxed an order to a lab local to me. Once i gave a sample, I was to start the Septra which even if it isn't the right one for the infection, has proven to reduce symptoms which by then had increased. I'm still awaiting the results of the urine test and whether I need to be on a different antibiotic.
Taking the Septra has reduced my fever, aches, etc to normal and the frequency of urination somewhat. However, I do have an urge to move bowels more frequently. I "feel" as if there is something up my rectum. I am drinking lots of water with the idea of trying to flush the infection out. Water, of course does not flush our the seminal fluid in the prostate and "flushing" is a different process.
After my temperature came down, I did attempt that process to flush my prostate. Since there is some discomfort in my pelvic area, my partner offered to satisfy me orally. This proved easier because I could also not achieve full erection. I have always been able to achieve an erection in the past, except for occasions where we tried for a second (or third) attempt at intercourse without enough time for me to revive. In these situations, although unable to become completely firm, oral stimulation always brought me to climax, even where there was next to no ejaculate yet resulting in the same pleasurable sensation.
As I began to build towards an orgasm, there was pain in my prostate; so much so that I asked her to stop. I also lost my less than firm erection and discomfort continued for several hours. That was a couple days ago and I'm not sure when there will be another opportunity. (It's complicated).
I have read an article about "why doctors don't want to treat prostatitis" and wondering. Other than normal slowing down, loss of fire hydrant like pressure and increased frequency, I never had these symptoms before the biopsy. I'm almost wishing it never happened. As is evident by the detail I included, I hope for many more years of active sex. I have accepted the cancer and have chosen the best alternative that I think will let me continue an active sex life. This does not preclude that regaining capability after the surgery will take effort. My partner is considerably younger and willing to help me with this effort even though our situations preclude daily or even regular contact. (as mentioned, it's complicated)
Suggestions / Advice?
Right now the prostatitis is my primary concern but that doesn't reduce the number of worms in this can.
Have Chronic Prostatitis and Prostate cancer and I've been told that the only form of treatment I should consider is Surgery. Any form of Radiation including Proton Therapy may cure the cancer but make the Prostatitis worse. Your discomfort from the Prostatitis can't be that bad if you can even think of sex. Did your doctor tell you that he thinks the surgery will et rid of the tumor and cure the other problems? Sex after surgery may take a while.
How are you doing now? Still fevers? I've re-read your story and want to be sure I understand something. Did you ever have prostatitis before the biopsy? Or are you only describing fever and symptoms that started after the biopsy that established the prostate cancer diagnosis?
I never had any symptoms of fever, burning, stop/start peeing, or pain ejaculating before the biopsy. My stream wasn't able to power wash the bowl, but then I'm not 18 yrs old either. Following the biopsy in August, 2011, I have been on and off three different antiobiotics. (Cipro, Ceftin, Septra). Each time I stop taking antibiots, the symptoms return within a week or less.
The results of the urine test indicate that my infection was not reactive to Cipro but it was reactive to Septra. (In other words the Cipro I initially was taking didn't work but the Septra did) . Perhaps this is how the infection was able to take hold. I was also taking Ceftin together with Cipro a few days before and after the biopsy.
Given my local urologist didn't order a urine test, there was a delay in communicating with Dr. Menon's assistant who did order a urine test. It was during this time that I waited to restart the Septra when I felt the most discomfort in my prostate. Following my giving a sample to the lab, I started Septra and fever, burning symptoms ceased. However, I did have a dull ache.
While I wasn't "thinking of sex", I did think it might "flush" the seminal fluid and reduce the infection. As i said, the pain was too much. Following that incident and continued Septra, the pain ceased and I am able to "flush" seminal fluid without pain.
I am still taking Septra and am pain free and mostly symptom free except peeing more frequently than before the biopsy. I did have a discussion with Dr. Menon's assistant (doctor) in the last couple days. These are his advice / conclusions
* It is likely I had some form of infection and it was never symptomatic
* The biopsy likely cause soreness, etc and other symptoms
* Although I had been on Septra for 45 days, the infection is stubborn
* Removing the prostate will indeed remove the infection (This will happen in late March/April). Per the biopsy and color doplar ultrasound, there is no cancer outside the prostate. It is not growing fast. Removing it will remove the cancer.
* His concern is I may develop resistance to the antibiotics
* I am to continue taking Septra through the end of January and see if the symptoms return when I stop
* If they return, I will consult with him again and perhaps another antibiotic is the answer.
I am aware return of sexual activity will take a while following surgery. I am curious as to how long it will take without "therapy" options including injections or pump. I was told when ability returns, there would be no ejaculate but the "feeling' of orgasm would still be there. Can someone explain this? Does it take longer to reach an orgasm? Will the intensity be lessened?
In regards to using injections and pump or even presence of a device at home is a problem. My situation is complicated and I probably should be looking for suggestions for this issue on a site that deals with extramarital affairs.
It sounds like you had some mild BPH (benign prostate hyperplasia) and prostate cancer. And that you did not have a spontaenous, primary prostatitis, which is the case for most of our members, but rather a biopsy related, secondary fever and symptoms. I'd like to change the header in your intro from "prostatitis" to "post-biopsy fever and symptoms," to help new readers get a more operational and true sense of what you are describing.
If it's of any interest, you may want to join our prostate cancer forum, which deals extensively with prostate cancer surgery, erectile dysfunction, and other facets. You may find specific interest in the discussion about babies after prostatectomy, which touches on the issue of extra-marital affairs.
Remember that this web site is public and searchable.
Yes I did have some BHP but it was not significant. Do you mean you'd change the title or is it something I would do? I can't find a way to edit it but if you can do it, sure. I think I will join the other forum you mentioned.
Hi, Dr Krongrad. I´d like to make you a question. I believe that more of the prostates you removed by LRP goes through biopsies after the surgery. I want to know in a proportionally way, how many of them shows bacterials prescence on it. I´m a patient with not knowledge to understand the illness, i´m sorry if my question is a little silly, but i ask myself if the patients that go through antibiotics are able to erradicate the infectious agents or the prostate can´t be penetrate by antibiotics because or their structure, or if the bacterias are able to resist the antibiotic treatments, because they are out of the spectrum of usual abx. Thanks in advance and sorry for my awful english.
All the prostates go to the pathologist, who fixes them in formaldehyde before staining and reading. This processing does not allow for bacterial culture, because bacteria would all be killed by the formaldehyde. And because bacteria cannot be seen by the H&E stained slices.