UTI and enlarged prostate

Anna2022 · August 8

DH is early stage 6 and is currently being treated for a UTI, today will be day 4 of antibiotics after doc visit, a fall at midnight, EMS and later a trip to the ER to rule out injury and determine if any blockage in urinary tract. He was not admitted to hospital. It's a long story with more details that I wont share here but as you all probably already know, it has been an exhausting episode for both of us.

The trip to the doc and ER also revealed an enlarged prostate (with super high PSA of 52, which may be elevated by infection and/or indicate cancer- I will need to explore this complication and retest after infection clears) and possible prostate infection (prostatitus?).

We don't have the final results of the urine culture (which apparently takes about 3 days, plus its the weekend!) but he was put on Bactrim antibiotic to start some healing until they determine if a more targeted antibiotic is necessary. There is some relief from the antibiotic, I think. His back pain has cleared to normal levels, he is less agitated and confused and his urine looks more normal.

However, the combination of UTI, meds, and enlarged prostate is hard to manage. He has urgency to pee every 1/2 hour or so if agitated, and maybe every 45 minutes if he is calmer. I believe he is responding to the UTI urge and prostate pressure, not the true need to pee. He does not report pain but he is an unreliable reporter! He is getting little rest because of the trips to bathroom. He is already on Tamsulosin to help with the urge so an increase there to ease the urge probably isn't indicated because increasing the dose elevates his fall risk.

Looking to contact doc on after hours line for help with a bladder relaxer and see if the culture came back after hours or whatever might be needed but in the meantime, I thought I'd check here to see if any of you have any experience with a similar scenario or suggestions on how to manage this? He's exhausted and he is a fall risk.

Many thanks!

Maru · August 8

Nightmare scenario. So sorry that all this is happening. My DH is 91 with enlarged prostate. It seems to be a problem with no solution. I feel for both you and your LO.

Anna2022 · August 8

https://alzconnected.org/discussion/comment/279399#Comment_279399

Thank you! I learned today that being the squeaky wheel gets some response - I used the Doc's portal at 2am to explain the situation and got a response for additional meds and OTC to start this weekend. ON A SATURDAY! It doesn't solve everything - DH is still confused and agitated and has lots of repeat questions about everything related to this episode but at least it may be the normal confusion?? Redirection and donuts also seem to help.

persevere · August 9

I would recommend you seriously look into hospice. They are there for you 24/7 with meds immediately available.

jgreen · August 9

I agree with @persevere - look into hospice. And if DH does not qualify, then perhaps palliative care?

Sending hugs 💝 💝

harshedbuzz · August 9

@Anna2022

I am so sorry you and your DH are dealing with all of this. I appreciate that your DH needs so relief from his symptoms, but do be careful with bladder medications (oxybutynin, tolterodine, solifenacin, fesoterodine, and trospium)— some meds are anticholinergic which are associated with worsening confusion in older adults even without dementia. Beta-3 like mirabegron and vibegron medications are safer choices.

You might want to consider how far you want to go with testing vis a vis prostate cancer. As with any screening or test, ask yourself "what are we going to do with this information?"

The biopsy itself is unpleasant, and the treatments could be very hard on him. Dad had radiation which took a couple months of daily hospital visits and laying very still for the treatment. It caused burns and scarring. Surgery would involve anesthesia which typically causes some progression in the dementia— sometimes temporary sometimes not. My dad had a recurrence of prostate cancer just before he was diagnosed in the middle stages. He and mom elected to treat which meant a hormone injection every 6 months. This was doable and we continued in an attempt to keep it out of his bones.

Thinking of you as you deal with all of this.
HB

Anna2022 · August 10

https://alzconnected.org/discussion/comment/279481#Comment_279481

@harshedbuzz. Thank you! What you say makes sense. I did not know this but its lucky that the doc suggested mirabegron and the prescription was filled. DH symptoms have abated, thanks mostly to the antibiotic, so not sure whether it is needed at this time. Its been a slow improvement but steady. We have a appointment tomorrow for check-in and next steps.

I totally get the question, what are we going to do with this information, regarding testing. I remember @M1 talking about this very same thing and it has stuck with me. The urology group that is suggested for us has a specialized unit for patients dealing with complex cases and dual diagnosis situations, including dementia. I am hoping to find a doctor within that unit who understands the nuances of dementia and the concept of "just because we can do it, is it really the best thing under the circumstances."

Anna2022 · August 10

I appreciate the comments about checking out hospice. I did a little research - I don't think DH would qualify yet for hospice just solely on his dementia diagnosis - he's in early stage 6 (DBAT). But if advanced or aggressive prostate cancer is diagnosed, he would likely qualify. Primary Doc wants to retest PSA to see if the high PSA level lowers at all with UIT treatment and I'm told that the urologist will probably wait awhile after the UTI clears to test the PSA again as well - that will give a more accurate reading that wont be affected by any infection.

UTI and enlarged prostate

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