YOU STOPPED AT: Post-RARP Consideration: • You may have some

COMPLETING: POST-RARP URINARY TRACT INFECTION CONSIDERATIONS

Let me finish this important section about UTIs and PSA testing after your robotic-assisted radical prostatectomy (RARP).

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POST-RARP CONSIDERATION: URINARY TRACT INFECTIONS

Post-RARP Consideration:
• You may have some urinary symptoms after RARP (common)
• Urinary incontinence or urgency doesn't cause PSA elevation
• BUT actual UTI (bacterial infection) DOES cause elevation

Urinary Symptoms That DON'T Affect PSA:
✓ Stress incontinence (leaking with cough/sneeze)
✓ Urge incontinence (sudden urge to urinate)
✓ Nocturia (frequent nighttime urination)
✓ Weak urinary stream
✓ Hesitancy (difficulty starting urination)

These are common post-RARP and don't raise PSA.

Urinary Symptoms That DO Indicate Possible UTI:
⚠️ Dysuria (burning with urination)
⚠️ Frequency (urinating >8 times daily)
⚠️ Urgency (sudden, strong urge)
⚠️ Cloudy or bloody urine
⚠️ Pelvic pain or pressure
⚠️ Fever or chills

If You Have These Symptoms:
✓ Contact your doctor BEFORE PSA test
✓ Get urinalysis to check for infection
✓ If UTI confirmed: Treat with antibiotics
✓ Delay PSA test 48 hours after starting antibiotics
✓ Retest PSA once infection is cleared

Why This Matters for Your [date removed] Test:
✓ If you develop UTI symptoms before May 25, contact your doctor
✓ Don't proceed with PSA if you have active UTI
✓ Reschedule PSA for 48 hours after starting antibiotics
✓ This ensures accurate results

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8. DO CONTINUE NORMAL MEDICATIONS
   ✓ APPLIES TO YOU: YES
   
   Why:
   • Most medications don't affect PSA
   • Stopping medications could harm your health
   • Continue exactly as prescribed
   
   Medications That DON'T Affect PSA:
   ✓ Blood pressure medications
   ✓ Diabetes medications
   ✓ Heart medications
   ✓ Cholesterol medications
   ✓ Pain medications
   ✓ Anxiety/depression medications
   
   Medications That MIGHT Affect PSA:
   ⚠️ 5-alpha reductase inhibitors (finasteride, dutasteride)
      • These LOWER PSA by 25-50%
      • If you take these, your PSA baseline is already adjusted
      • Continue taking them (don't stop before test)
      • Your oncologist knows about this effect
   
   Recommendation:
   ✓ Continue ALL medications as prescribed
   ✓ Tell your oncologist about any new medications
   ✓ Don't stop or change medications without asking

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9. DO STAY HYDRATED
   ✓ APPLIES TO YOU: YES
   
   Why:
   • Normal hydration doesn't affect PSA
   • Dehydration can concentrate PSA (falsely elevate it)
   • Proper hydration ensures accurate results
   
   Recommendation:
   ✓ Drink normal amount of water (8-10 glasses daily)
   ✓ Don't over-hydrate (trying to "flush" system)
   ✓ Don't under-hydrate (trying to concentrate urine)
   ✓ Just drink normally

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10. DO EAT NORMALLY
    ✓ APPLIES TO YOU: YES
    
    Why:
    • Fasting is NOT required for PSA test
    • PSA is measured in blood, not affected by food
    • Normal eating ensures you feel well for appointment
    
    Recommendation:
    ✓ Eat normal breakfast morning of test
    ✓ Light meal is fine (toast, eggs, fruit)
    ✓ Avoid heavy meal right before (causes discomfort)
    ✓ Avoid caffeine if it makes you jittery

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11. DO GET NORMAL SLEEP
    ✓ APPLIES TO YOU: YES
    
    Why:
    • Sleep doesn't directly affect PSA
    • Good sleep improves your overall health
    • Helps you feel calm for appointment
    
    Recommendation:
    ✓ Aim for 7-9 hours night before test
    ✓ Maintain normal sleep schedule
    ✓ Avoid sleeping pills unless you normally take them

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12. DO LIGHT ACTIVITY
    ✓ APPLIES TO YOU: YES
    
    Why:
    • Light activity is fine and healthy
    • Doesn't affect PSA results
    • Helps manage stress
    
    What's OK:
    ✓ Walking (even brisk walking)
    ✓ Light stretching
    ✓ Gentle yoga
    ✓ Light swimming
    ✓ Normal daily activities
    ✓ Work activities
    
    Recommendation:
    ✓ Continue light activity 48 hours before test
    ✓ Just avoid vigorous exercise
    ✓ Resume normal exercise after test

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SPECIAL POST-RARP CONSIDERATIONS FOR YOUR [date removed] TEST

TIMELINE SINCE YOUR RARP:
• Your RARP was performed: [Based on your PSA nadir of 0.004-0.012 ng/mL,
  likely 2-5 years ago]
• You're now in long-term surveillance phase
• Your PSA is stable at ultrasensitive levels
• Pre-test precautions are STANDARD for you

POST-RARP SPECIFIC FACTORS:

1. SURGICAL SITE HEALING
   ✓ By now (2-5 years post-RARP), surgical site is fully healed
   ✓ Precautions are about preventing temporary inflammation
   ✓ Not about protecting healing tissue
   ✓ Still important for accurate PSA measurement

2. URINARY CONTINENCE STATUS
   ✓ If you have stress incontinence: This is normal, doesn't affect PSA
   ✓ If you have urge incontinence: This is normal, doesn't affect PSA
   ✓ If you have dysuria (burning): This might indicate UTI
   ✓ If you have hematuria (blood in urine): Tell your oncologist

3. SEXUAL FUNCTION
   ✓ If you're sexually active: Follow 48-hour abstinence precaution
   ✓ If you're not sexually active: No concern
   ✓ Erectile dysfunction is common post-RARP, doesn't affect PSA
   ✓ Penile rehabilitation doesn't affect PSA

4. RECTAL SYMPTOMS
   ✓ Some post-RARP patients have mild rectal symptoms
   ✓ Rectal bleeding or pain: Tell your oncologist
   ✓ These don't affect PSA but should be evaluated
   ✓ Schedule evaluation AFTER PSA test if possible

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YOUR SPECIFIC PRE-TEST CHECKLIST (May 23-25, 2026):

48 HOURS BEFORE TEST ([date removed]):

□ Avoid ejaculation (if sexually active)
□ Avoid vigorous exercise (light activity only)
□ Avoid bicycle riding (use other cardio if needed)
□ Avoid any urologic procedures
□ Check for UTI symptoms (dysuria, frequency, urgency)
  → If present, contact doctor before proceeding
□ Continue all medications as prescribed
□ Drink normal amount of water
□ Get