Biopsy or not?

My situation is extremely frustrating. It’s happened four times over 10 years. My urologist several years ago did an advanced test on me for “Genx” testing (can’t remember name). They found bacteria in the Prostate and some weird infection germ. They put me on a novel antibiotic for 2 months to kill it. Two years later I got a severe prostate, and UT infection. Damn near got sepsis before I could get to a doctor. I finally got phone service to medical and had to move pretty fast before going down. Blood, severe pain, unable to walk fast and my body was a wreck. I was close to having to be hospitalized or medavaced out. I was in a very remote region of the world. I had to do a 2 month cycle of cipro 1000mg a day. I was in the military for 34 years. I have to carry cipro with me any time I travel. When the symptoms hit I have to start antibiotics immediately. I can’t leave home without my antibiotics…I truly hate my prostate. It’s like walking around with a grenade in my guts waiting for it to go off. I don’t smoke or drink, and avoid all beef and pork. All my labs are good and take no meds. This thing is my Achilles heel.

I’ve had four different urologists over 12 years, I went through them fast. I’m now with a large group of urologists and professionals. Urology is strange. You gotta work hard to find good ones. I’m thrilled with the folks I work with now and they’re on top of my case, they have all the resources in their HQ to conduct my testing and most treatments. I have a VA primary care physician and my private insurance doctor. I get opinions from them all and get checked regularly. I’ve worked with a nutritionist as well to modify my lifestyle according to my body chemistry.

Best of luck brother and praying it’s nothing .

Did you have robotic removal?

I’m not using VA for follow up, I have both private insurance and VA. VA also now allows us to use outside medical groups.

yes.

How are the side effects?

Three other friends have had robotic removals and they had really good results. Both my brother in laws had partial removal. One of them had a it come back and go really aggressive on him. His last hope is some new specialized treatment therapy with drugs. It is literally his last hope; this nudges me toward full removal and just sucking it up if I have to go down this path. One friend lost his Dad and brother to it and they opted for radiation therapy. It mutated and came back hard. They both passed away with it. He opted for full removal and has been cancer free for 8 years. My fear is half stepping compromise while it's controllable with some new method and it coming back stronger. Obviously there's a lot of missing information and probably poor knee jerk opinion. At 64 sex is not my first priority...but I don't want to be incontinent either. My uncle had full removal in his 60s and was butchered in the 1970s, he lived until 80 but was incontinent the rest of his life. My great uncle died of it in his early 40s.

Off topic from cancer for a moment but regarding your bacterial issues: I knew a man who got a mild case of food poisoning from a good restaurant; typical vomiting, diarrhea, etc. until it ran its course. A few months later he developed severe gastric pain. Battery of tests revealed a stomach ulcer caused by H. Pylori bacteria; this is THE most common reason for ulcers - not stress, spicy foods, etc.
Anyway he did the antibiotic protocol and in one month he was fine. Fast forward 6 months, he’s got terrible groin and testicle pain. They aspirated some fluid and it turns out the H. Pylori had migrated to hid scrotum. They blasted him with some drug combo and he recovered completely. I assume he’s fine (lost contact with him) now, I hope!
My point is that some bacterial infections (Lyme Disease, etc) are extremely difficult to eradicate; they can stay latent for years or crop up regularly like clockwork. Unfortunately they can also become antibiotic resistant.
If you had 34 yrs in the military, God only knows what you might have been exposed to; attempting to culture this infectious agent would be better than throwing antibiotics at it willy nilly. Cipro is powerful, but it too can be useless if resistance has occurred.
Right now your main concern is cancer but perhaps a consult with an infectious disease specialist might be better than anything a urologist can do for you. Best
Phil

Interesting, during this mess my primary care Doctor has put me on a 2 week course of cipro now before I PSA test again for her. The VA tested my PSA again last week. After 4 days of the antibiotics my minor symptoms have been relieved…strange! And she’s taken some other samples. My primary private Doctor is not convinced at all this is anything. My VA doctor wants to monitor regularly. My urology team wants an immediate biopsy.

I cannot give you medical advice but since your MRI only hinted at one PiRad4 - which could be cancerous and treated focally - might it not be better to pursue whatever is causing this repeated infection?
The recent Cipro dose may have blunted the attack, but you’ve been down this road before.
Cipro is a broad spectrum antibiotic so they like to use it when they don’t know the exact cause of the infection; this way they can kill everything….hopefully! Carpet bombing doesn’t guarantee you’ll kill everything, right? In fact, some broad spectrum antibiotics are much less effective than those targeting a SPECIFIC bacterium. Until they find out what that is, they’re shooting blind.
Here’s an idea and I would run it by your urologist AND infectious disease specialist. If you do a biopsy some of that tissue - or perhaps an extra core so as not to confuse things - could be cultured.
It’s a simple matter of putting some of your infected prostate tissue in a culture dish with growth medium to see what grows out.
Also, the pathologist examining your biopsy slides would need a heads up that he might be seeing bacteria, mold or yeast in your specimen; or at least to be on the lookout for it.
Yes, it will take coordination on your part and cooperation on theirs but it’s certainly worth a try
Phil