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Urology/PSA prostatitis

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Question
Dear Dr.

 I have experienced numerous episodes of nonacterial prostatitis since I was 37. I am now 67. I am very familiar with the symptoms and my bouts usually run their course in a few weeks to a few months. Sometimes I go several years between episodes. MY PSA always rises during an episode.

 For the last three years I ave been taking Prozac (PTSD) and Flomax (BPH), although the BPH has been around about 12-15 years.

 For the last 7 years or so my PSA has been in the 2.4-2.6 range.

 The combination of the two drugs have caused several episodes of delayed ejaculation or inability to ejaculate which resolve if I skip the Flomax for a week or two.

 Two weeks prior to my annual checkup I had a bad experience with inability to ejaculate and foolishy tried to finish with masturbation for an extended time. The next day I felt "sore".

 My annual blood test showed a jump of PSA to 3.2 MY FP didn't think much of it given the history I just presented. A week later I came down with the all too familiar symptoms of prostatitis which have now ebbed and waned for almost 4 weeks.

 Is it likely that the rise in PSA preceeded the symptoms ?

sorry for the long question
thanks in advance
Tom

Answer
Tom:

First, you are overthinking this issue.  Your physician indicated he wasn't concerned and neither am I about the miniscule rise.

Since you are having ejaculatory problems with the flomax (tamsulosin), which is a commonly known side effect, why not ask your physician to substitute alfuzosin?  It works just as well and has almost no effect on ejaculation.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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