PSA numbers increasing on testosterone- Should I stop TRT?

[Nelson Vergel]

I am not sure if I had sex before it. I think I did. Do people usually have an increase in psa value as they use trt or psa stabilize after some time ?

Everyone with baseline low T has a slight increase in PSA when starting TRT. It's part of the saturation point.

Time-course of effects on the prostate​

In hypogonadal men treated with testosterone, levels of PSA rise usually up to levels of eugonadal men (84). Upon judging the time-course of effects of testosterone on the prostate, it is of note that aging itself is a factor in the rise of both prostate volume and PSA (84), and there is no endpoint in the effects of testosterone on the prostate. A rise in PSA levels was noticed after 6 months, whereafter over the following 24 months there was no significant further increase (85). Other studies have found a rise of PSA levels after 3 months (40), some only after 12 months (43). An increase in prostate volume was noted after 3 months (86) and after 12 months (44). One study over 24 months found no significant increase in both PSA and prostate volume. In a study of 123 subjects over 42 months of testosterone gel application, there was significant increase in serum PSA over the first 6 months and then no further significant increases with continued testosterone treatment was found (87). In a study of 81 hypogonadal men (mean age 56.8 years) followed for a mean (range) of 33.8 (6–144) months PSA levels did not increase significantly at 1-year intervals for 5 years (88). The data are summarized in Fig. 5.

Reference: Onset of effects of testosterone treatment and time span until maximum effects are achieved

 

[M.J]

Take-home point

*The increase in PSA will be greatest in men with marked TD and least (or absent) in men with milder degrees of TD




post #12

Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring

ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

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*An initial increase of prostate-specific antigen (PSA) and prostate volume with TTh is frequently seen over the first 2–6 months because the prostate is an androgen-dependent organ. The increase in PSA will be greatest in men with marked TD and least (or absent) in men with milder degrees of TD. The PSA level at 6 months after initiation of TTh should be used as the new baseline

Testosterone and Prostate Effects

7.1 Introduction Historically, testosterone (T) was thought to be involved in negative prostate events such as the growth of benign or malignant prostate tissue. This notion stems from the seminal 1941 article by Huggins and Hodges, which demonstrated that in men with metastatic prostate cancer...

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7.2 Prostate-Specific Antigen (PSA) Changes

In summary, the above data are inconclusive and somewhat contradictory. Results seem to suggest a possible effect of TTH on increasing PSA, although the overall effect is likely minor and appears to be more prominent among men with lower baseline TT levels. Larger, adequately powered series dedicated to specifically evaluating changes in PSA is required to definitively address whether TTH truly increases PSA, particularly in men with normal baseline TT levels.


7.3 Prostate Volume Changes

These findings are consistent with the previously described saturation model, in that, at lower baseline TT levels (i.e., below the saturation point), increases in TT result in concomitant increases in prostate volume.

I assumed I would stay around 1.4 as I have seen myself going down to 1.4 after saturation as Nelson mentioned, though I have changed protocols few times until reaching the current one, but now I am 1.94 I will check that level later again in case sex has something to do with it.

What do you mean by “”TD””

 

[M.J]

Everyone with baseline low T has a slight increase in PSA when starting TRT. It's part of the saturation point.

Time-course of effects on the prostate​

In hypogonadal men treated with testosterone, levels of PSA rise usually up to levels of eugonadal men (84). Upon judging the time-course of effects of testosterone on the prostate, it is of note that aging itself is a factor in the rise of both prostate volume and PSA (84), and there is no endpoint in the effects of testosterone on the prostate. A rise in PSA levels was noticed after 6 months, whereafter over the following 24 months there was no significant further increase (85). Other studies have found a rise of PSA levels after 3 months (40), some only after 12 months (43). An increase in prostate volume was noted after 3 months (86) and after 12 months (44). One study over 24 months found no significant increase in both PSA and prostate volume. In a study of 123 subjects over 42 months of testosterone gel application, there was significant increase in serum PSA over the first 6 months and then no further significant increases with continued testosterone treatment was found (87). In a study of 81 hypogonadal men (mean age 56.8 years) followed for a mean (range) of 33.8 (6–144) months PSA levels did not increase significantly at 1-year intervals for 5 years (88). The data are summarized in Fig. 5.

View attachment 19611

Reference: Onset of effects of testosterone treatment and time span until maximum effects are achieved

I understood the saturation thing. however I should have been close to 1.4 “original reading” as after reaching saturation it went down close to it, yet now it’s 1.94, although I don’t think sex had to do anything but just in case I will redo the test later and see…thanks.

 

[madman]

I assumed I would stay around 1.4 as I have seen myself going down to 1.4 after saturation as Nelson mentioned, though I have changed protocols few times until reaching the current one, but now I am 1.94 I will check that level later again in case sex has something to do with it.

What do you mean by “”TD””

testosterone deficiency

 

[MIP1950]

I am on Trt for almost two years now.
Originally my psa was 1.4
After starting it went to 1.72 or something close to this.

After stabilizing I went down close to 1.4.

Just now I tested and got 1.94.

I am not sure if I had sex before it. I think I did. Do people usually have an increase in psa value as they use trt or psa stabilize after some time ?

IMO, those aren't increases to be concerned about. They're just small fluctuations. Mine keeps gradually increasing in increments of .5 to 1 point. Now at 4.98. I also have an elevated hs-CRP. My urologist and I think the PSA increases are due to inflammation. Had all of my teeth extracted this past week due to long term untreatable dental problems. Had low grade infections, too. Once my gums are healed and finished with the antibiotic and other drugs, I'll recheck the PSA and see my urologist.

 

[NC58]

New Member so please excuse me if I am not following protocol by posting this here. I am 64 and have been on TRT for 20 years gradually decreasing the dose over time as I am keep responding to a lower dose. I regularly check my PSA and it fluctuates with a high of 6 (came down with Cipro) to a low of 2. It stays mainly in the mid 3s with TRT but whenever it exceeds 4 I go off TRT for 30 days and retest my PSA. The PSA comes down to the mid 2s. DREs over the years have always been fine. Recent PSA was 2.7 with 15% free which came down from 5.7 after stopping TRT for 25 days. Are these types of fluctuations concerning? Thanks

 

[Nelson Vergel]

Are these types of fluctuations concerning? Thanks

I would not worry too much. But I will ask Dr Khera what he thinks and get back to you. TRT always "saturates" the prostate to a certain point. That point varies in men.

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[Nelson Vergel]

But I will ask Dr Khera what he thinks and get back to you. TRT always "saturates" the prostate to a certain point.

This is what he said:

"Absolutely we offer telemedicine consults for new and established patients. The fluctuating PSA scores do not sound concerning and usually requires no further work up if most recent PSA is two after antibiotics. Sounds like patient has chronic prostatitis. Depending on family history and risk factors we could always consider a prostate MRI and a PHI panel to further assess his risk."

 

[DragonBits]

New Member so please excuse me if I am not following protocol by posting this here. I am 64 and have been on TRT for 20 years gradually decreasing the dose over time as I am keep responding to a lower dose. I regularly check my PSA and it fluctuates with a high of 6 (came down with Cipro) to a low of 2. It stays mainly in the mid 3s with TRT but whenever it exceeds 4 I go off TRT for 30 days and retest my PSA. The PSA comes down to the mid 2s. DREs over the years have always been fine. Recent PSA was 2.7 with 15% free which came down from 5.7 after stopping TRT for 25 days. Are these types of fluctuations concerning? Thanks

My PSA has also been jumping around. A high of 5.7, Fb 2022 4.2, march 2022 4.7, , though percent free was 27.6 in Feb.

My age is 69. My urologist got me a prostate MRI, there was low signs of cancer, a PI-RADS#2. Prostate size was 62 cc DREs were normal.

I am glad I got the MRI, I wanted to know the more exact size, though the Uro estimated 60cc The larger your prostate, the more PSA it will produce. So size matters a lot. So for that size, a PSA of 4-5 is normal.

I didn't see your age, and did your doc estimate prostate size?

 

[NC58]

This is what he said:

"Absolutely we offer telemedicine consults for new and established patients. The fluctuating PSA scores do not sound concerning and usually requires no further work up if most recent PSA is two after antibiotics. Sounds like patient has chronic prostatitis. Depending on family history and risk factors we could always consider a prostate MRI and a PHI panel to further assess his risk."

Thank you Nelson. Father had Prostate cancer who had radioactive seeds and is still going strong at 96. One Uncle had prostate cancer. Both were smokers and did not watch their diet. I have a pretty good diet being a former competitive athlete. My bodyweight dropped 25lbs over the past several years due to a severe bout of Lyme and Anaplasmosis and I decided to keep it off. Most of the time when PSA goes over 4 it will come down with antibiotics or stopping HRT for 30 days. I will check my PSA again in 3 weeks and it elevated I would consider a consult with Dr. Kehra.

 

[NC58]

My PSA has also been jumping around. A high of 5.7, Fb 2022 4.2, march 2022 4.7, , though percent free was 27.6 in Feb.

My age is 69. My urologist got me a prostate MRI, there was low signs of cancer, a PI-RADS#2. Prostate size was 62 cc DREs were normal.

I am glad I got the MRI, I wanted to know the more exact size, though the Uro estimated 60cc The larger your prostate, the more PSA it will produce. So size matters a lot. So for that size, a PSA of 4-5 is normal.

I didn't see your age, and did your doc estimate prostate size?

Thank you very much for your input. The urologist has never mentioned the size other than saying everything feels fine. I will certainly ask the size question next visit in October. I am 64 years old. I had a biopsy done in 2002 after with a PSA of 2.2 as urologist said it had gone up .4 in 6 months. 6 spots analyzed no cancer. I was not very well versed in what to do with a rising PSA so I went along with it. After that episode he has prescribed antibiotics when PSA is elevated and it has come down each time either with the antibiotics or stopping HRT. Urologist wanted to do another biopsy in 2020 when PSA was 5.4. I stopped HRT for 30 days and PSA came down to 3.7 so I cancelled the biopsy as I did not want to go through that again. I mentioned MRI and he said insurance wouldn't pay for it which is hard to believe as I have very good insurance. I have changed testosterone esters the past several years from cypionate to small does of propionate to better control testosterone, estrogen and I am wondering if the ester effects the PSA differently?

 

[NC58]

I would not worry too much. But I will ask Dr Khera what he thinks and get back to you. TRT always "saturates" the prostate to a certain point. That point varies in men.

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Thank you for the video Nelson, very informative!

 

[DragonBits]

Thank you very much for your input. The urologist has never mentioned the size other than saying everything feels fine. I will certainly ask the size question next visit in October. I am 64 years old. I had a biopsy done in 2002 after with a PSA of 2.2 as urologist said it had gone up .4 in 6 months. 6 spots analyzed no cancer. I was not very well versed in what to do with a rising PSA so I went along with it. After that episode he has prescribed antibiotics when PSA is elevated and it has come down each time either with the antibiotics or stopping HRT. Urologist wanted to do another biopsy in 2020 when PSA was 5.4. I stopped HRT for 30 days and PSA came down to 3.7 so I cancelled the biopsy as I did not want to go through that again. I mentioned MRI and he said insurance wouldn't pay for it which is hard to believe as I have very good insurance. I have changed testosterone esters the past several years from cypionate to small does of propionate to better control testosterone, estrogen and I am wondering if the ester effects the PSA differently?

My PSA was 2.1 when I was 43 back in 1996. I started TRT in late 2009 at 57, my PSA was 2.2, and stayed in a range for 2.2-2.8 for five years on TRT, Then I stopped TRT for ~1.5 years, started back up in 2018 at 65 with a PSA of 2.4, but added in HCG this time. In 5 months, my PSA shot up to 3.9. I was concerned, though since it was a test I bought myself, no doctor was involved.

I thought perhaps the HCG had something to do with it, but hard to tell.

Since then it has gone up and down, not sure of the reasons. I tried Life Extension Ultra Prostate, stopped HCG, never stopped TRT. The lowest it went since that time was 3.2.

I first went in 2018 to an urologist to see if he would prescribe TRT, but no luck there.

He was useful for the DRE, selectMDX test and MRI. He wanted to do a biopsy, I refused as IMO there was not any evidence to suggest cancer. And most important, a negative biopsy isn't definitive, you can still have cancer, they can easily miss the cancer. Often they will want to do multiple biopsies. No on in my family has ever had any kind of cancer (one uncle had leukemia). Every blood urine test came back as unlikely to be cancer.

I would ask your doctor about the selectMDX test, it's ~$500 but in my case insurance covered it. You can google it, it's an excellent test. And if you do another biopsy, get a MRI first to see where if it indicates any cancer, and I would only get an ultrasound or MRI-guided biopsy as a guide to tell the doctor where to do the biopsy.

 

[NC58]

My PSA was 2.1 when I was 43 back in 1996. I started TRT in late 2009 at 57, my PSA was 2.2, and stayed in a range for 2.2-2.8 for five years on TRT, Then I stopped TRT for ~1.5 years, started back up in 2018 at 65 with a PSA of 2.4, but added in HCG this time. In 5 months, my PSA shot up to 3.9. I was concerned, though since it was a test I bought myself, no doctor was involved.

I thought perhaps the HCG had something to do with it, but hard to tell.

Since then it has gone up and down, not sure of the reasons. I tried Life Extension Ultra Prostate, stopped HCG, never stopped TRT. The lowest it went since that time was 3.2.

I first went in 2018 to an urologist to see if he would prescribe TRT, but no luck there.

He was useful for the DRE, selectMDX test and MRI. He wanted to do a biopsy, I refused as IMO there was not any evidence to suggest cancer. And most important, a negative biopsy isn't definitive, you can still have cancer, they can easily miss the cancer. Often they will want to do multiple biopsies. No on in my family has ever had any kind of cancer (one uncle had leukemia). Every blood urine test came back as unlikely to be cancer.

I would ask your doctor about the selectMDX test, it's ~$500 but in my case insurance covered it. You can google it, it's an excellent test. And if you do another biopsy, get a MRI first to see where if it indicates any cancer, and I would only get an ultrasound or MRI-guided biopsy as a guide to tell the doctor where to do the biopsy.

I am quite fortunate to find such a great website and forums in which people share and help others. I am very grateful. I have tried a number of supplements over the years but have not had much luck with their ability to effect PSA. I have read some studies on the use of Metformin and Quercitin and their beneficial affects on the prostate. Will be trying that as well. Thank you for the suggestion on the selectMDX test. I just pulled up some information on it. Depending on the next test results I will push for the selectMDX test and if need be an MRI. If the urologist balks I will look for another one who is more receptive.

 

[NC58]

This is what he said:

"Absolutely we offer telemedicine consults for new and established patients. The fluctuating PSA scores do not sound concerning and usually requires no further work up if most recent PSA is two after antibiotics. Sounds like patient has chronic prostatitis. Depending on family history and risk factors we could always consider a prostate MRI and a PHI panel to further assess his risk."

Hi Nelson,
I just received my recent PSA test which came back at 3.0 but the Free PSA was 10% which does cause some concern. With my father and uncle both having prostate cancer and successfully treated for it I am going to contact Dr. Khera for a telemed consult. My urologist has not seen the latest test as my primary doctor had given me a test as part of my physical but the only things my urologist has shown concern with the PSA velocity and PSA over 4.0. Based on Dr. Khera's response to the question you posed to him he seems like he is more receptive to other testing. Again thank yoy

 

[Match]

Seven causes of a high PSA that are not cancer

www.excelmale.com

 

[MIP1950]

After 6 months, and several PSA tests, my number, which had been slowly going down, is now 3.75, from its high of 4.95. Didn't add anything to the few supplements I take,nor change my diet all that much. Regardless, glad to see it declining.

 

[M.J]

Since I started TRT
My PSA is moving between 1.28 up to 1.93

I have changed protocols stopped HCG frequently due to traveling during all those time, I guess it’s normal to have such fluctuations with me changing protocols.
Now I only do 20mg EOD but I stop HCG from time to time due to traveling which I guess affect my testosterone level which also plays a rule with psa movement.

 

[rugbyhit]

New Member so please excuse me if I am not following protocol by posting this here. I am 64 and have been on TRT for 20 years gradually decreasing the dose over time as I am keep responding to a lower dose. I regularly check my PSA and it fluctuates with a high of 6 (came down with Cipro) to a low of 2. It stays mainly in the mid 3s with TRT but whenever it exceeds 4 I go off TRT for 30 days and retest my PSA. The PSA comes down to the mid 2s. DREs over the years have always been fine. Recent PSA was 2.7 with 15% free which came down from 5.7 after stopping TRT for 25 days. Are these types of fluctuations concerning? Thanks

Just stumbled in your post. I'm in the same boat...PSA has been over the place, based on how my dosing. I just got my labs back and I'm at 4.33, after being in the mid 3. But have been as high as 6. I'm stopping my TRT for 30 days, see where I'm at. This has been going on for the last 6 years.

 

[Smokin Joe]

My psa has recently risen to 4.5 and my Uro ordered a TRUSS biopsy.
I chose not to have the biopsy right now and stopped trt about 60 to 80 days ago I believe.
Retested psa a month ago and it was back to 3.7.
Will recheck soon to see if there's changes.
I will have a biopsy regardless but I'm trying to go Transperenial instead of rectal.