Ask The Urologist Anything (Dr Michael Rotman)

[CoastWatcher]

Dr. Rotman,

Thank you so much for your advice.

If you have any recommendations for a center in the Raleigh/Durham area of NC please let me know. Actually, in order to receive proper treatment, I would travel to a center anywhere if you have any recommendations. I have been dealing with these issues for 5 years, and I will do what it takes to get this behind me.

As a moderator here, I'll be reposting your question as a new thread.

 

[jsr0367]

Dr. Rotman

Dr. Rotman,

It is with great appreciation that you are on this online community. It is challenging to get answers to my questions when I see my Uro. Your presence is of great benefit to us!

I have been on TRT for 2 years and my dose has been increased because of fatigue. He bumped me from 150mg (.75mls) to 180mg (.9mls). All are injected with a 22ga needle in the quad muscle.

My PSA has always been in the 3 range for years even before TRT. Since being on TRT it visits 4 and goes back down.

A week ago my PSA jumped to 5.83 from 3.60. My Estradiol (not sensitive) went from 16 to 29 in the same time frame.

My uro stopped TRT and prescribed Bactrim DS (generic version) twice a day.

I had the test on Saturday and wife and I had no kids Thur and Friday and had fun twice each day. Plus I am a cyclist and ride 20 miles a day. I normally abstain from both before a test. Couple questions if you could be so kind:

• Do you think my two days of fun messed up my test?
• And, I am a bodybuilding and use preworkout supplements that have caffeine. How critical is caffeine to PSA. I usually take 300-400 mg a day between PWO and tea.

My uro is planning on visiting biopsy after the antibiotic. BTW - I am 50, eat very clean and lean. No processed junk. No added sugars.

Thank you again!!

 

[DrRotman]

Thank you for the kind words!

Many issues here so I will take them 1 at a time .

1. Sexual activity 24-48 hours before a PSA test is generally discouraged as there is some that believe it can effect the results negatively.

2. Caffeine is not known to effect PSA results unless it triggered a prostatitis like syndrome resulting in inflammation in the prostate.

3. PSA test results can sometimes vary depending on the assay a particular laboratory uses. Make sure the lab used for analysis , uses the same assay or make sure the same lab is used for comparative purposes.

4. Testosterone does cause 0.3-0.4 elevation in PSA among your average patient so that has to be taken into account.

5. A level of 3 below the age of 60 is abnormally high but other factors including family history are important as well.

6. If PSA remains elevated inquire about a 4K test from your urologist.

 

[jsr0367]

Doctor,

Thank you so very much for your reply.

Warmest,

John Romero
Rochester, NY

 

[OMI100]

Dr. Rotman,
What are your views on TRT treatment when someone also has / is being treated for prostate cancer.
I have read where one approach is to stop TRT as it is felt that TRT may aggravate and or spread the cancer, yet current research does not support that position.
I have read where others use high levels of T (1800 to 3000) to treat some forms of prostate caner with great success.

Thanks,
omi

 

[Inject]

Years ago i remember reading about clomid and night blindness or something along those lines. Is it risky to be on clomid long term?

 

[DrRotman]

Dr. Rotman,
What are your views on TRT treatment when someone also has / is being treated for prostate cancer.
I have read where one approach is to stop TRT as it is felt that TRT may aggravate and or spread the cancer, yet current research does not support that position.
I have read where others use high levels of T (1800 to 3000) to treat some forms of prostate caner with great success.

For the appropriate candidate, one can treat hypogonadism in a patient cured of prostate cancer. There are multiple studies being performed to better determine safety in patient selection. One still has to be vigilant.

Dr. Rotman

 

[DrRotman]

Clomid has been associated with some vision issues in a small percentage of patients but I don't think any long term harm has ever been proven. I generally discontinue the medication on a patient that experiences this side effect.

Dr. Rotman

Years ago i remember reading about clomid and night blindness or something along those lines. Is it risky to be on clomid long term?

 

[jsr0367]

Just had a recent blood draw for PSA Complex performed by my GP. My uro did not run this test and never does a complex. My PSA is now down to 4.41 from 5.83 in 7 days of Bactrim. The GP labs came with:

PSA, Total: 4.41
Percent Free PSA: 15
PSA, Complex: 3.75
FREE PSA: .66

The lab put in the narratives for these results and were scary to me. Terms like "% risk of positive prostate biopsy result with negative DRE" and "In patients with Total PSA of 4-10 ng/ml, the probability of finding prostate cancer on needle biopsy is: 10 to 15 - 28%, 15 to 20 - 20%, 20 to 25% - 16%, >25% 8%

Should I lose any sleep over this result?

 

[DrRotman]

Hi, can you let me know your age and if you have any family history of prostate cancer.

 

[jsr0367]

Hi, can you let me know your age and if you have any family history of prostate cancer.

No Hx of Prostate CA. My aunt had BRCA in 1977. I had Thyroid CA in 2001 with I131 and Thyroidectony. Been clear every since.

My dad always had recurring prostate infections and had biopsy 6 mos ago. No cancer.

 

[DrRotman]

Thank you for the information. I will assume you are probably around 50-60 years old. The recommendation today would be that you should have a prostate biopsy. With a PSA above 4 you still have a significant chance of finding prostate cancer. You can request a 4K PSA from your urologist which may stratify your risk better if you are hesitant to undergo a prostate biopsy. Good luck with your decision making process.

 

[jsr0367]

Just turned 50 in March.

So, it is apparent that life is going to change for me and my family from this point forward?

Thank you for the information. I will assume you are probably around 50-60 years old. The recommendation today would be that you should have a prostate biopsy. With a PSA above 4 you still have a significant chance of finding prostate cancer. You can request a 4K PSA from your urologist which may stratify your risk better if you are hesitant to undergo a prostate biopsy. Good luck with your decision making process.

 

[DrRotman]

There is a 75-80 percent chance the biopsy is benign. The prostate biopsy procedure can be performed with light sedation as I do in my office so it is painless and the infection rate is 1percent or less in good hands. In addition prostate cancer does not always have to be treated so I would be calm at this time and just move through the process in a timely fashion. No life altering events at this time.

 

[jsr0367]

How can Caffeine use impact PSA. I use a preworkout supplement with caffeine in it.

Thank you for the information. I will assume you are probably around 50-60 years old. The recommendation today would be that you should have a prostate biopsy. With a PSA above 4 you still have a significant chance of finding prostate cancer. You can request a 4K PSA from your urologist which may stratify your risk better if you are hesitant to undergo a prostate biopsy. Good luck with your decision making process.

 

[DrRotman]

It is unlikely but you can stop caffeine for 48-72 hours along with no ejaculation or pelvic exercises , and repeat the PSA and ask for the 4K PSA .

 

[jsr0367]

I will ask but doc may not allow it. Worse case, I see my GP who will do it. He listens to me.

Thank you for the information. I will assume you are probably around 50-60 years old. The recommendation today would be that you should have a prostate biopsy. With a PSA above 4 you still have a significant chance of finding prostate cancer. You can request a 4K PSA from your urologist which may stratify your risk better if you are hesitant to undergo a prostate biopsy. Good luck with your decision making process.

It is unlikely but you can stop caffeine for 48-72 hours along with no ejaculation or pelvic exercises , and repeat the PSA and ask for the 4K PSA .

 

[OMI100]

TY Dr. Rotman

 

[goga]

DrRotman, please comment on the following results:
Doppler Ultrasound:
PSV: 34.5
EDV: 4.5
IR: 0.9

Do you think TRT may improve EDV (with or without PDE5s)? What dose of PDE5 would you start with?
I'm in my 40's. Have low Free T and low "normal" (for my age) total T.

 

[DrRotman]

No TRT alone won’t increase flow and i can’t analyze those numbers without knowing what they injected you with as a test dose, what the waveform looked like, and where they took the measurements from on the penis. Can’t recommend a treatment with just numbers and no clinical picture.