We started by going over all past history, tests and symptoms. He explained the process and began with a Digital Rectal Exam. You think I would get use to this by now, but no such luck. His DRE was more aggressive and painful on my Prostate than the previous exams, he found a small lump at the base of my Prostate very near the midline, and said it could have been easily missed by others. He ordered a urine test for infection and took a sample for another PSA-3 test. He explained different labs might vary in how they evaluate the PSA-3. He preferred to use Bostwick Laboratories for the PSA-3 and felt their evaluations more accurate than most. The PSA-3 test result came back in a few days at 49.4, higher than previously tested. Not good, though Dr. Tamburri explained the score rise could be from different procedures in different labs.
Dr. Tamburri also ordered a PSA Total and Free test that is additionally called a Free/total Ratio PSA or a Percent-Free PSA test. Upon release into the blood, PSA is enzymatically active, but protease inhibitors rapidly inactivate it. Most PSA is bound to various serum proteins. The bound PSA is called “Complexed” PSA. The unbound PSA is called “Free” PSA. The standard PSA test measures both components of PSA: free and protein bound. The PSA Total and Free blood test measures only the unbound (or damaged) type of PSA, called the Free PSA. In patients with Prostate Cancer, a higher proportion of PSA is bound. A low percentage of free PSA may warrant a Biopsy, while a higher percentage of free PSA would tend to be better for the patient. This test greatly helps to refine the standard PSA test results and provide for a clearer picture when it comes to deciding on a Prostate Biopsy. My score for the PSA Total and Free Test later came back at 31%, better and higher than the Cancer cutoff limit of 25% suggesting a lower possibility of Prostate Cancer.
At this point we proceeded with the Power Color DopplerUltrasound. It was done in his exam room and after applying sufficient amounts of lubricant to my anus a rather large probe was inserted up my rectum and focused on my Prostate. I had thought the DRE’s uncomfortable, but they paled to this procedure. During the Ultrasound I was able to view with Dr. Tamburri most all areas of my Prostate. He pointed out several small spots that looked like calcium deposits or cysts. Based on the Color Doppler Ultrasound, they had no significant blood flow to them, which was contraindicated of Prostate Cancer. Cancer tumors often grow rapidly, he said, and will show extensive blood flow near their sites on the Ultrasound. He also pointed out the small lump he felt during the DRE at the base of my Prostate near the midline. This as well did not have the localized blood flow to indicate Cancer, though he didn’t know for sure what was causing the spot. Overall my Prostate exhibited, as Dr. Tamburri pointed out to me, a greater blood flow than normal. This suggested to him that there could be an underlying infection throughout the Prostate. As Dr. Tamburri explained sometimes with Prostatitis, a swelling and inflammation of the prostate gland, there may be physical symptoms without the infection showing in the urine. Symptoms of Prostatitis can include painful urination, pain in the groin, pelvic area or genitals, and sometimes, flu-like symptoms. This certainly matched for several of my past symptoms.
After the exam we chatted about the results and options. Based on Prostate blood flow patterns, my Prostate over sensitivity, symptoms, and test history, Dr. Tamburri prescribed a treatment for Prostatitis that included taking Cipro for 30 days. He also said with the PSA and PSA-3 test results, and the spot on my Prostate, there was an indication that I may have a non-aggressive Prostate Cancer that should be closely monitored over the next year. He felt that metastic disease was not a high risk at this time. In addition to the Cipro he suggested I begin taking 4g to 5g per day of Ascorbate Vitamin C; 4 Caps per day of Metagenics EPA-DHA 720 essential fatty acids from cold-water fish, and 8 Caps every other day of Thorne Meriva-SR Curcumin Phytosome. (More on this to follow)
I stopped at a pharmacy on my way to the Phoenix airport and began taking the Cipro. Within a few days I was taking the other supplements. Taking this much Cipro over a month can be problematic. It has a risk of tendonitis and tendon rupture in all ages and the risk is further increased in patients over 60 years of age; in other words me. The first 3 weeks were without problem. Into the fourth week I began to experience pain near my joints in several places including arm and leg. As I continued to take the Cipro the pain began to increase so I did stop the Cipro slightly before the full course, and over time the pain subsided and went away. Later I found out that there are other medications that could have been supplemented for the Cipro.
The good news is that after the course of the Cipro, I went in to Group Health for a PSA test and the result came back with a score of 3.5. This was a significant change. I felt much relieved though cautiously concerned for what the future may hold.
Next installment: Decision for the Prostate Biopsy