BCG and PSA?

Hi Alex. No knowledge of PSA/prostate cancer, I just wouldn't take any chances in your situation, I'd get onto Urology and ask, ask, ask. That's just my reaction simply to what you have stated.

Why not try the prostate cancer forum too?

best and keep us posted, 

Denby

Thanks Denby. You’re quite right and I have an appointment for Friday so not too long to wait. 

I thought about trying the prostate cancer forum but thought it might be a bit soon. But they probably won’t mind! I’ll have a go. 

Thanks again. 

Hi AlexMP. I've not had the pleasure of BCG so not the best to reply, but being on here for a fairly long time, I can not recall anyone talking about a connection between BCG treatment and PSA. As Denby says, your medics may have an answer. Good to know you have an upcoming appointment. Let us know. I hope all goes well. Best wishes.

Hi Alex, Apparently up to 40% of male BCG patients experience a marked rise in their PSA results and these readings don’t return to normal until about 3 months after the treatments are done. Just to make you feel a bit less anxious . ...... however that still leaves 60% so don’t let it slide  Orillia.

Thanks Rily. Much appreciated. I’ll let you know what they say. 

Hi Orillia, That’s reassuring and I’m only a month out since my last BCG. I’ll see what the urologist says tomorrow. Oddly my kidney function has gone crazy too with a very low eGFR and high creatinine. All very strange results but hopefully all will become clear. 

Hi,

My partner is 56 and had a routine CT scan to follow up his bladder cancer a few weeks ago. This showed an area of concern in the prostate which was treated as infection but an MRI scan was also booked and he has now been told he needs a prostate biopsy as they suspect it is prostate cancer but not linked to the bladder. I know he had a PSA test a year ago but we don't know the result. He was sent for another last week and I do know that BCG treatment can cause a rise so this may well be the case for you. I have also read that BCG can cause changes that mimic prostate cancer on MRI scan and am just holding out a bit of hope that this is the case with my partner. I haven't dared look into what it might mean if he has prostate cancer as well as bladder cancer. Very difficult not knowing and unfortunately his consultant is not someone who communicates with any encouragement. 

Wishing you well. 

Hi Catfan,

Sorry to hear about your partner’s possible prostate cancer. It must be a real worry. I hope that it turns out to be BCG damage or prostatitis. I hadn’t heard that BCG can mimic prostate cancer on MRI. That makes sense in my case with two positive prostate MRIs.

Lack of communication from a consultant sounds all too familiar! Mine has said that at least prostate cancer is nowhere near as aggressive as bladder cancer so that’s some consolation. I’ll have an MRI if my PSA remains raised in a few weeks. 

I haven’t had a CT for a few years. I seem to remember we are supposed to have them every two years. I’m not sure I want to know but I should probably remind the hospital.

The biopsies (if he has a positive MRI) are ok so tell your partner not to worry too much. It’s just the waiting for results as we all know…

As you say, the real quandary is what happens if it turns out to be prostate cancer. I don’t know what grade or stage your partner’s BC was but I’ve been told that the bladder has to go if I have a recurrence. Not sure if they can remove the bladder later if the prostate has to go now. Hopefully, neither of us will have to face that decision.

Please let us know how things go. Best of luck and wishing you both well!

Alex

Hi Alex,

Thanks for your reply and the reassurance about the prostate biopsy not being too bad.

My partner has Ta, grade 3 which was diagnosed around November last year. He has had 12 BCG treatments and a recent normal flexi cystoscopy.

The prostate issue first came up when he had a CT scan a year ago and consultant said he wasn't sure about an area of shadow around the prostate. A PSA was done (no mention of result) and the surgeon said he would take a biopsy when he was doing the TURBT. The only mention I can find of this is that a letter says prostatic urethral biopsy was normal. I think this is not a standard prostate biopsy but is done if cystectomy might be needed. Anyway fast forward a year and he was called for a routine CT scan and the consultant asked him to take antibiotics for 3 weeks and booked an MRI scan. At the time he said it was not of immediate concern and possibly infection, abscess or cyst.

The MRI scan shows an area of abnormality which the consultant has told him verbally is likely to be prostate cancer but unrelated to the bladder cancer.

I have found by googling that a small percentage of men have abnormal MRI which looks like cancer but is caused by BCG treatment. I guess I am just hoping this might be the case as he is only 56 and it seems a bit coincidental that this has happened too. 

Do you have experience of an abnormal MRI not proving to be prostate cancer?

Sorry for the long post! 

It sounds like your partner’s urologist is on the ball but could be better at passing on information! Presumably they must have identified a suspicious area on MRI. These areas are normally measured on the PIRADs scale (https://prostatecanceruk.org/prostate-information/prostate-tests/mri-scan), which grades lesions by risk of likelihood to be “clinically significant cancer”. They normally biopsy everything which is PIRADs 4 and 5 but sometimes also 3 if there are other risk factors.

Yes, I’ve had two suspicious areas (both PIRADS 4/5), so high/ very high likelihood to be cancer but which turned out to be benign (inflammation and atrophy). No mention that it was caused by BCG. Only a biopsy can confirm the diagnosis. 

Like your partner I also had biopsies from the prostatic urethra but mine were taken in a separate TURP operation. There was CIS there initially but luckily no infiltrative cancer. BCG looks like it has done the job so far. Bladder cancer in the prostate has a poor outlook so it’s good that he’s had that checked out. 

I think it’s pretty common that many of us over the age of 50 have areas of prostate cancer, often the type that will never progress. But to make sure there isn’t the more the aggressive type (which I have been told by my urologist is still much less aggressive than high grade BC) they often find the low risk type leading to worry that a man might otherwise not have had. 

It's a worry isn’t it. Since my PSA is rising again I’ll probably have to have a new MRI but maybe it will go back down. I hope your partner turns out not to have prostate cancer. It’s enough with a high grade BC diagnosis! Has he finished with BCG then? I ended up having 27 treatments over 3 years which has left me with chronic pain and a bladder with the capacity of a gnat!

All the best,

Alex