Hi Ed...I think your idea about getting a color doppler ultrasound is a
good one because that can "see" areas that can't be sampled by the
trans-rectal biopsy.  But before I did anything else, I'd have the
current biopsy slides reread by one of the known PCa expert
pathologists.  Then, assuming the PSA doesn't come down, my first steps
would be to get some cheap blood tests, such as a free PSA and PAP
(prostatic acid phosphatase), maybe you've already done this?  I'd
follow those with the cdus by Dr. Lee or Dr. Bahn, or the endorectal
MRI at UCSF with Dr. Shinohara, depending where you live...Best wishes
and good health, ron

Duke K. Bahn MD
Medical Director, Department of Radiology
Prostate Institute of America
Community Memorial Hospital of San Buenaventura
168 N. Brent Street, Suite 402
Ventura, CA 93003
888-234-0004
805-585-3082
Fax: 805-641-3965
dkbahn@cmhhospital.org

Fred Lee, MD
Crittenton Hospital
1135 W University Dr, #420
Rochester, MI 48307
(248)650-4699

Katsuto Shinohara MD
1600 Divisadero Street, 3rd floor
UCSF
San Francisco, CA 94115
Tel:415-476-1611
Fax:415-476-8849
kshinohara@urol.ucsf.edu
Assistant, Mary, at 415 353 9877

 I would get a doc that you have trust in, and then follow his advice for
future testing and possible treatment.  Sometimes finding a tumor is
literally like finding a needle in a haystack.  I have a friend that had a
family history and elevated PSA for years, before they finally got a
positive.

The first thing that comes to my mind here is that you
have a diagnosis.  The pathologist actually saw the
inflammation that is "consistent" with prostatitis.

As I understand it, that means that a likely explanation
for your high PSA has been found and the alternative
explanation, prostate cancer, has been shown to be
unlikely.

Again, as I understand it, the majority of cases of prostatitis
are NOT caused by bacterial infections.  Many are.  But
still more are not.  Personally, if it were me, I would much
prefer a urine culture to find out whether I had a bacterial
infection than a course of antibiotics to treat an infection that
is likely not present.  Doctors don't know what causes the
majority of cases of prostatitis and don't know how to
treat it.  They prescribe antibiotics because 1) it sometimes
works and 2) it makes them and the patient feel like they
are doing something when, in fact, there is nothing they
can do.

In this case it seems particularly unwarranted.  You would
be getting antibiotics not to treat prostatitis (because it isn't
bothering you at all) but simply to treat a lab score.  Why?
Does that make sense?

If the PSA comes down after your antibiotics, then you know
the cause.  If it does not, you do not know the cause, but
you still have evidence that it is prostatitis and not cancer.
So I wouldn't rush to get another biopsy unless, over some
period of time, the PSA goes up again.

There is a chance that the doctor who did the biopsy missed
the cancer, and a chance that he hit the cancer but the lab
couldn't find it.  For that matter, there's even a chance that
the blood test was wrong and your real PSA was higher
or lower.  But I think the odds of those things happening are
not high.  It often happens that two pathologists grade the
same cancer differently as regards Gleason scores, but
in this case the pathologist didn't find any cancer at all.

I think you're likely in pretty good shape.  If you have no
pain in the prostate, then your prostatitis is not serious (I
can testify that the pain can be very noticeable in bad
cases).  You might try anti-inflammatories like ibuprofen
as another way to bring down the prostatic inflammation,
but again, if it isn't bothering you and isn't cancerous, it's
hard to see why you need any treatment at all.

Best of luck.

   Alan