Does a normal cystoscopy effectively rule out bladder cancer?

Question

Hi doctor,

I am a 36-year-old male who has been experiencing the following symptoms for the past two months:

Frequent urination.
Burning sensation before and after urination.
A constant urge to urinate after drinking fluids.
Pain in the testicles, penis, and groin area.
Blood in the urine on seven to eight occasions (not clear blood, but urine appeared slightly red).

Test conducted:

Ultrasound was conducted 1.5 months ago to examine the prostate gland. The doctor observed white spots on the screen and diagnosed a prostate gland infection. Doxycycline was prescribed, but it did not alleviate my symptoms. I am uncertain if this diagnosis was accurate.
The computed tomography scan for the kidneys was expected, but the radiologist mentioned a suspicion of a thickened bladder wall. My urologist explained that a thickened bladder wall might be due to an empty bladder (as I had emptied my bladder before the CT scan) or a more serious condition. A cystoscopy was performed subsequently, which revealed a normal bladder appearance.
Blood test PSA (prostate-specific antigen) levels were slightly elevated at 1.87.
The urine culture test showed the presence of red blood cells, crystallization, and Staphylococcus.

Following are my questions:

What could be the cause of my symptoms?
If it were bladder cancer, would a routine cystoscopy and a slightly elevated PSA level rule it out?
PSA elevation is generally associated with prostate issues, correct?
Could the presence of Staphylococcus in the urine be the underlying cause of my symptoms? Unlike the crystallization and blood, it was indicated as positive but not marked with an asterisk.
Based on this information, what is your diagnosis, and what would you suggest for further evaluation or treatment?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have read your query and understand your health issues.

I can confirm that this is a case of chronic urinary tract infection caused by the pathogen Staphylococcus. Your symptoms, including urinary frequency, urgency, burning sensation during urination, and pain, are consistent with this diagnosis.

The previous diagnosis did not yield positive results. Based on your history, that diagnosis seems somewhat atypical.

The thickened bladder wall observed on the computed tomography scan is not due to an empty bladder but is more likely caused by the ongoing infection. Your prostate-specific antigen (PSA) level is not elevated to a degree that would raise significant concern. PSA levels are typically much higher in cases of prostate cancer. At this point, there is no reason to worry. However, I recommend repeating the PSA test after two weeks and following up with the report. Serial PSA measurements are crucial to monitor any progression and to detect potential prostate cancer at an early stage.

The condition is a chronic urinary tract infection.
Cystoscopy would have detected bladder cancer. Based on your results, you do not have it. The slightly elevated PSA is explained above.
Yes, Staphylococcus is the causative pathogen, and it must be treated effectively.

Suggestions:

I would prescribe a 28-day course of Ciprofloxacin, provided you are not allergic to it. This broad-spectrum antibiotic is effective against Staphylococcus and other pathogens. Please consult your physician to obtain a prescription.
Additionally, I recommend taking Phenazopyridine for two days to alleviate the pain associated with the infection. Your physician can also prescribe this medication.
Incorporate cranberry juice into your daily routine and consume it frequently. It has been shown to relieve many symptoms associated with urinary tract infections.

This approach should help resolve your condition effectively.

If you have any further questions or doubts, feel free to consult.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

The increase in PSA (prostate-specific antigen) levels from the previous value is very minor and insignificant in the context of your overall condition. This slight elevation is most likely due to the prostate stimulation you underwent. Only a significant increase, such as a 10- to 20-fold rise, would be a cause for concern.

The symbol given in the findings has no clinical significance. It is not an abbreviation for any medical condition or concern. In most cases, some symbol is used to indicate that additional details about a particular item or point are provided elsewhere in the document or discussion. Its purpose here seems to be purely stylistic and does not denote anything medically important.

As for your concern regarding my expertise in urology, allow me to clarify: internal medicine encompasses a broad field of medical knowledge, including exposure to specialties such as urology and nephrology during training. Internal medicine specialists are trained to address a wide range of medical issues, which is why it is such a demanding and highly respected field. You can trust the guidance I have provided.

I hope this explanation has been helpful.

If you have any further doubts or queries, please feel free to consult.

Thank you.