PSA at 5.3

[OMI100]

I have some post on my PSA story.
You might want to search and read my journey.
Inspire is a good place to go and learn about procedures.
My URO said BIOPSY and I said:
1. 4K Blood test. (good results)
2. 3T-MP-MRI. (no issues found)
Attached is something I copied from a long thread at Inspire that has a LOT of good information on biopsy procedures..
As noted above the standard biopsy is a crap shoot.
If you need one, a MRI guided one that will target areas of concern would be what I would do if I ever needed one (After the 3T-MP-MRI to identify areas of concern)
Everyone is different and no history of PCa in my family so not worried and have to calm down my primary care Doc every time he sees a new PSA test ran
BTW a LOT of things can give a high PSA besides PCa.
Hope my attachment helps..

 

[Neil]

I changed my TRT protocol, after 3 months my PSA has come back down to 3,4. then 3.2.

If I may ask, what did you change it from, and to what? Thanks!

 

[Nelson Vergel]

I started TRT (200mg/week) on 8-1-2016 and PSA was 1.2.

On 8-10-18 PSA was 3.6
On 4-8-19 PSA was 5.3

My doctor gave me a urine test for protein and sent me to a Urologist. Urologist did a DRE and found no lesions, masses, cysts etc. of course prostate was enlarged. Urologist prescribed Uroxatral 10mg (which I didn't take) and requested a prostate biopsy and was scheduled for June 3.

I came to this site and started reading and learned about the selectMDX test and called the Urologist and they don't do that test, so I got referred to another Urologist that does do the selectMDX test and scheduled to see him tomorrow.

I did a few 12 week cycles of 500mg of test in the last 3 years with 300/mg of trenbolone for 6 of those weeks.

Any thoughts?

Thanks!

Most PSA increases are due to prostatitis. Get tested for prostate infection.

What Every Man Should Know About Prostatitis

Seven causes of a high PSA that are not cancer

Read this one about factors that can affect PSA

Factors that Can Affect the Accuracy of Your Blood Test Results

 

[DragonBits]

If I may ask, what did you change it from, and to what? Thanks!

I was taking Nebido (testosterone undecanoate) along with HCG, I believe eliminating the HCG was key.

My reasons for thinking that:

I was on Nebido solo therapy for 5 years, my PSA stayed stable all those years. I quit TRT entirely for 24 months, used Clomid for a few months to speed thing up to increase my sperm counts. It worked. My sperm count recovered.

Early last year, I started again with Nebido but added HCG. After 5 months my PSA went up from 2.4 > 3.9. This was the first time ever in my life PSA went up.

I am currently age 66. Age is likely also a factor. It’s possible but not likely there are other factors outside of HCG in my case, dhea, pregnenolone, testosterone cream.

I researched HCG/LH, and there are research articles indicating the presence of LH and HCG receptors are found in prostate BHP tissues.

“Expression of Luteinizing Hormone/Human Chorionic Gonadotropin Receptor Gene

in Benign Prostatic Hyperplasia and in Prostate Carcinoma in Humans “

Also:

“Among men however, the side effects of the HCG diet generally affect the prostate area and causes them to become enlarged over time.”

Side Effects of HCG Diet in Men - HCG Diet Success Program - Lose 30-40 Lbs in Next 40 Days


It’s certainly not conclusive that HCG was the cause, I have also seen research that HCG might help BPH, and men take HCG with no negative effect on PSA. How many men take HCG with TRT, no way of knowing, how many develop BPH or an increased PSA score, no way of knowing. Is HCG blamed for the increased PSA score, I doubt it, but there isn’t any data available to analyze. I don’t think a lot of the male population are on TRT and even fewer are also taking HCG, so it’s a fairly small data set to deal with. Age is likely also a factor.


Seems clear, but then again, consider this. Confusing to say the least.

CONCLUSIONS:

These findings suggest that HCG may provide a well tolerated and beneficial therapy for BPH that will be investigated in subsequent studies.

A trial study: the effect of low dose human chorionic gonadotropin on the symptoms of benign prostatic hyperplasia. - PubMed - NCBI


You could also google “Receptors for Luteinizing hormone-releasing hormone (LHRH) in benign prostatic hyperplasia (BPH) as potential molecular targets for therapy with LHRH antagonist cetrorelix”

Receptors for Luteinizing hormone-releasing hormone (LHRH) in benign prostatic hyperplasia (BPH) as potential molecular targets for therapy with LHRH antagonist cetrorelix | Request PDF


As men age, it’s natural for testosterone to decline while LH often increases, and as men age they often get BPH. Are those two hormone changes related to BPH, not known.


IMO it’s not natural to have both a high LH level and a high testosterone level. High testosterone causes a reduction in LH which is used to moderate testosterone production. Does this unnatural situation cause any problems, my guess is usually it doesn’t, but sometimes it does cause problems.


I do believe HCG preserves testicular size, though I don’t think the atrophy is not all that great and is usually reversible, it does happen. I believe HCG with TRT is likely to preserve fertility. Upstream downstream hormones, don't know, but HCG didn’t’ seem to do anything positive for me.

It would be interesting to resume using HCG and retest PSA to see if it causes a rise again. It would be interesting to do that, but I haven’t used HCG since my PSA went up and I will never use it again. It also could be that having very low levels of LH is actually a benefit in connection with BPH/PSA.


I am going to retest PSA today. It will be nice if PSA goes down more, but I was hoping for stable.

So IMO, each person needs to make their own decisions about this subject as it isn't at all clear.

 

[Nelson Vergel]

I was taking Nebido (testosterone undecanoate) along with HCG, I believe eliminating the HCG was key.

My reasons for thinking that:

I was on Nebido solo therapy for 5 years, my PSA stayed stable all those years. I quit TRT entirely for 24 months, used Clomid for a few months to speed thing up to increase my sperm counts. It worked. My sperm count recovered.

Early last year, I started again with Nebido but added HCG. After 5 months my PSA went up from 2.4 > 3.9. This was the first time ever in my life PSA went up.

I am currently age 66. Age is likely also a factor. It’s possible but not likely there are other factors outside of HCG in my case, dhea, pregnenolone, testosterone cream.

I researched HCG/LH, and there are research articles indicating the presence of LH and HCG receptors are found in prostate BHP tissues.

“Expression of Luteinizing Hormone/Human Chorionic Gonadotropin Receptor Gene

in Benign Prostatic Hyperplasia and in Prostate Carcinoma in Humans “

Also:

“Among men however, the side effects of the HCG diet generally affect the prostate area and causes them to become enlarged over time.”

Side Effects of HCG Diet in Men - HCG Diet Success Program - Lose 30-40 Lbs in Next 40 Days


It’s certainly not conclusive that HCG was the cause, I have also seen research that HCG might help BPH, and men take HCG with no negative effect on PSA. How many men take HCG with TRT, no way of knowing, how many develop BPH or an increased PSA score, no way of knowing. Is HCG blamed for the increased PSA score, I doubt it, but there isn’t any data available to analyze. I don’t think a lot of the male population are on TRT and even fewer are also taking HCG, so it’s a fairly small data set to deal with. Age is likely also a factor.


Seems clear, but then again, consider this. Confusing to say the least.

CONCLUSIONS:

These findings suggest that HCG may provide a well tolerated and beneficial therapy for BPH that will be investigated in subsequent studies.

A trial study: the effect of low dose human chorionic gonadotropin on the symptoms of benign prostatic hyperplasia. - PubMed - NCBI


You could also google “Receptors for Luteinizing hormone-releasing hormone (LHRH) in benign prostatic hyperplasia (BPH) as potential molecular targets for therapy with LHRH antagonist cetrorelix”

Receptors for Luteinizing hormone-releasing hormone (LHRH) in benign prostatic hyperplasia (BPH) as potential molecular targets for therapy with LHRH antagonist cetrorelix | Request PDF


As men age, it’s natural for testosterone to decline while LH often increases, and as men age they often get BPH. Are those two hormone changes related to BPH, not known.


IMO it’s not natural to have both a high LH level and a high testosterone level. High testosterone causes a reduction in LH which is used to moderate testosterone production. Does this unnatural situation cause any problems, my guess is usually it doesn’t, but sometimes it does cause problems.


I do believe HCG preserves testicular size, though I don’t think the atrophy is not all that great and is usually reversible, it does happen. I believe HCG with TRT is likely to preserve fertility. Upstream downstream hormones, don't know, but HCG didn’t’ seem to do anything positive for me.

It would be interesting to resume using HCG and retest PSA to see if it causes a rise again. It would be interesting to do that, but I haven’t used HCG since my PSA went up and I will never use it again. It also could be that having very low levels of LH is actually a benefit in connection with BPH/PSA.


I am going to retest PSA today. It will be nice if PSA goes down more, but I was hoping for stable.

So IMO, each person needs to make their own decisions about this subject as it isn't at all clear.

Did you ever get checked for a prostate infection??

Prostatitis question

 

[Neil]

Dragon, thank you so much, your response is very complete! I certainly will not be trying HCG!! And if you could update this thread with your new PSA test I would be in your debt. Us 60's guys are all in this. I do take some DHEA, like 12.5mg micronized, I see you had it down on your list.

 

[Nelson Vergel]

You guys are complicating matters by not following urology procedures for increased PSA. Get a urinalysis and a sperm bacterial growth test. In rare cases, your doctor might massage your prostate and test the secretions.

Treatment of Prostatitis

 

[Dr Justin Saya MD]

Blind and TRUS biopsy misses over 90% of the prostate but level of error is generally considered to be around 25% inaccurate in terms of false negative. Also, there is still controversy over what stage of cell change/mutation qualifies as cancer, maybe cancer or maybe kinda sorta cancer, but classified as abnormal but not cancerous cells.

SelectMDX claims 98% negative predictability accuracy. With positive results it gives some differentiation of indolent vs aggressive.

I am a member of the high PSA club as well. I chose SelectMDX with PSA 9.3, and it came back negative, so still watching... If I am pushed to a next step, my choice would be 3T MP MRI and if subsequent biopsy The MRI imaging provides an overlay for fusion biopsy which is much better targeted than a 12 needle TRUS. The next better level would biopsy under active MRI monitoring. It depends on what the initial MRI would find.

You should have become a urologist, Blackhawk.

 

[Deleted member 16042]

You should have become a urologist, Blackhawk.

LOL! Just seek to educate myself when faced with such things.

Talk with you Tuesday.

 

[OMI100]

What Nelson said !!!!

 

[DragonBits]

Did you ever get checked for a prostate infection??

Prostatitis question

No, I didn’t request nor did the urologist suggest those tests, I didn't have any symptoms associated with prostatitis so that makes it less likely (but not impossible) I would have had prostatitis

I got a DRE from a urologist and asked him to estimate my prostate size. He said 50 cc. It would have been more accurate to have done an ultrasound, but it’s not like I was conducting research so I didn’t request that to be done. It could be the urologist was biased by his knowledge of the PSA level, and I wonder if your PSA level goes down does that mean your prostate shrank?

I believe there are drugs / supplements that decrease your PSA without affecting prostate size. Such as NSAIDs and statins. It’s uncertain whether these drugs mask PSA levels or actually affect cancer/ BPH.

The estimated PSA associated with prostate size is divided by 10, meaning 50 CC prostate size is likely to produce a PSA level of 5.0. My PSA level at the time was 4.2, so that is consistent with an enlarged prostate.

I believe having a 50 CC prostate and prostatitis would likely produce a much higher PSA level.

 

[DragonBits]

Dragon, thank you so much, your response is very complete! I certainly will not be trying HCG!! And if you could update this thread with your new PSA test I would be in your debt. Us 60's guys are all in this. I do take some DHEA, like 12.5mg micronized, I see you had it down on your list.

I pretty much quit everything that could have any sort of hormonal effect (outside of the big guy, testosterone, which I never stopped) and added anything that is reputed to lower PSA or help with BPH. Not that I had any symptoms of BPH, or if I did it was so mild that I can't be sure, only that I had elevated PSA.

I started back taking 12.5 mg DHEA and 12.5 mg pregnologne, my serum level of DHEA was 234 after ~ a month taking the 12.5, I can't say it helps with anything, but it doesn't seem to hurt anything either. I stopped taking the LEF prostate formula back in March but still take lycopene and a baby aspirin, just on the general idea it's likely good and I still have a supply of those things.

I stopped the LEF prostate formula because my shbg zoomed up from 41 >66 then 73 even a month after stopping the LEF formula. Naturally, a high SHBG drops FT, E2 and DHT. IE: DHT had dropped from 77 >43. It wasn't clear that I suffered any ill effects from that, but it's not what I want long term. I have yet to retest any of those things. I am only assuming that the increased SHBG was caused by something in LEF prostate formula, they have a lot of ingredients. My SHBG is normally 35-41.

There are other blood tests not related to this subject I took and never posted about, such as an omega-3 index report. I did a lot of blood tests, like another one was Glucose Tolerance Test (4 specimens), I got needled 4 times in 3 hours.

Overall I feel good, and honestly I am losing interest in doing so many blood tests.

 

[OMI100]

FWIW
From Nelsons link (a GREAT link with a lot of good info) above:
"Diagnosis
Prostatitis is not easily diagnosed or classified. Patients with prostatitis often present with varied, nonspecific symptoms, and the physical examination is frequently not helpful."
You CAN have prostatitis and not even know it, as some of the symptoms can be so MINOR that you pass them off to other causes. I know, as I speak from experience of have prostatitis and not knowing it.
I have covered my HIGH PSA journey in a number of prior post
If the simple test were not ran, and only a DRE was done, it could have been missed.
My 2 cents

 

[hotdog]

Here is another FWIW.
In 2016 I had a surprise test result... PSA 5.6
No symptoms.
Off I went to a urologist.
DRE normal. Urinalysis said no infection.
I got the statutory course of antibiotics from the urologist and... PSA went down over next three months 2.2, 2.1 and finally 1.3.
I think symptomless prostatitis was a likely culprit.

 

[ocman]

My urologist recommended this course of diagnosis:

1-get Select MDX
2- if positive, get MRI and if positive, do fusion biopsy
3- If negative continue to monitor PSA and consider future MRI as next step.[/QUOTE]
I have a question, #2 says get MRI.
What exactly can they tell from the MRI other than lesions?

 

[Deleted member 16042]

UCLA based talk about MRI, MRI guided biopsy and Guided TULSA PRO

Another view: Probably more than you want to know about Prostate biopsy


MRI provides imaging for targeted fusion biopsy instead of random TRUS. In some rarer cases live MRI guided biopsy can be available.

 

[ocman]

Thanks, I will watch those videos!

I had the SelectMDX test today and the Urologist (results in 2 weeks) said he thinks I should still do the biopsy, they only offer the TRUS biopsy.

He said he could send me to UCI for the MRI. He said they do an MRI and if they find anything questionable they will do the MRI biopsy otherwise they will do the TRUS biopsy. That way you save money.

He said normally the insurance companies do the TRUS first then the MRI biopsy. They put in for the MRI biopsy to see if it will get approved. If I need the MRI biopsy and it's approved I will call that doctor with questions.

 

[OMI100]

"He said he could send me to UCI for the MRI. He said they do an MRI and if they find anything questionable they will do the MRI biopsy otherwise they will do the TRUS biopsy. That way you save money."
If your MRI comes back negative why would anyone want to do a blind biopsy?
How is that saving you $$$?
Also if one goes the MRI route you need to research how many the hospital does and how may the DRs have read. It is a skill to be able to adequately read the MRI and get a good diagnosis.

 

[ocman]

"He said he could send me to UCI for the MRI. He said they do an MRI and if they find anything questionable they will do the MRI biopsy otherwise they will do the TRUS biopsy. That way you save money."
If your MRI comes back negative why would anyone want to do a blind biopsy?
How is that saving you $$$?

He said the MRI can't tell you 100% if it's cancer.

 

[Deleted member 16042]

He said the MRI can't tell you 100% if it's cancer.

Neither does TRUS biopsy, there is about 25% false negative error.

Watch the videos.