TRT and PSA Worry

[caston41]

Hello, I posted this on FB, Nelson asked me to post here, so here's what I posted:

Hey guys! I a little paranoid about my PSA. They check it almost every time they check my T levels. It's been rising each time since '11. Started out at 1.6, then 1.9, the about three months ago, 2.1. Is that unusual? I just had another blood draw again, I'm hoping it has leveled off. I'm 57, I take inject T every 10 days, used to be 14. This is the first draw I've had since increasing the frequency 90 days ago. My dose are the small vials. 200mg or ml? Can't remember. I got a new endo 90 days ago, she's the one who finally was ok with the increase. She's gone now, so all bets are off. I appreciate any thoughts or encouragement!

My newest reading was 2.7, and Nelson suggested I look at the part on velocity. Patient's Guide to Prostate Cancer: How is Prostate Cancer Detected? Ok, this worried me. I'm going to follow up with my primary. Someone told me to make sure I had no sexual activity before 48 hours of the test. No jostling activities of the prostate either. Since seeing that, I read numerous accounts of test scores dropping after a re-test. I'm pretty sure I had activity.

So I made an appointment with my PC doc this week to discuss that and a couple of other items. I'm going to ask him what he thinks about a re-test.

Any thoughts would be great, kind of nervous here.

 

[Excel Male]

Unless your next PSA is higher than the last one, I would not worry. TRT can increase PSA.

"Averaging several investigations of the effect of TRT on PSA, men receiving testosterone will have an associated increase of 0.30 ng/mL/y in serum PSA, with older men experiencing a greater increase of 0.43 ng/mL/y.5"

From: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472885/

Do you pee frequently or cannot void completely when you pee? Do you get up to pee at night? Has your doctor done a digital rectal exam on you? These questions will help address if you have a prostatic inflammation issue.

You can calculate your risks here: http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp

Please read : Does testosterone cause prostate cancer?

Also, keep in mind that certain things can increase PSA, so avoid these before a PSA test:

Participate in vigorous exercise and activities that stimulate or “jostle” the prostate, such as bike riding, motorcycling, and riding a horse, ATV, or tractor, or getting a prostatic massage for 48 hours before your test.

Participate in sexual activity that involves ejaculation for 48 hours before your test. Ejaculation within this time frame may affect PSA results, especially in younger men.

Schedule a PSA test if you have a urinary tract infection. A bacterial infection in the urinary tract can cause PSA levels to rise temporarily. If you are not sure if you have a urinary tract infection, have a urine test before your PSA test to make sure. If you do have a urinary tract infection, you should wait at least six weeks after you have completed your antibiotic treatment before you have your PSA test.

Schedule a digital rectal examination (DRE) before your PSA test. Although a DRE should not have an impact on PSA levels, having the PSA test first is a precaution.

 

[caston41]

Thanks for the detailed answer! Besides age, I have one risk factor. My dad had prostate cancer, although I can't remember how old he was when he got it. Probably in his 60's. They caught it early, I believe as a result of PSA testing. Due to previous non related surgeries, his only treatment option was seed implantation. It was successful, and he never had a re-occurrance, he's active and turns 84 in a few weeks.

I'll be curious if my PC ok with re-testing due to my sexual activity before my last test. Maybe he'll think I'm fine being under 4.0 and not want to take any action? Especially if a re-test improves. Seems that docs don't agree at all on when to do a biopsy anyway.

I do not have any problems urinating, and to my knowledge I have no infections. I will be undergoing an IV infusion for a unrelated condition in the near future that will wipe out all of my B cells for up to a year. This is a good reminder to check with my doc. Is it possible to have an prostatic infection and not know it? It could get out of hand after this treatment if not caught before hand. Can you have a prostate infection or UI w/o any symptoms?

Last thing I neglected to mention, that back in Sept. I had a clean DRE by a urologist.

 

[Gene Devine]

Admin is dead on accurate with his post; love it!

If you are really worried, ask your Doc for a Prostate biopsy and be done with it...worth the peace of mind IMO.

 

[BigJohn]

My last PSA was 7. The Urologist wanted to do a biopsy but I was adamantly against it. I have a very close friend in another state, who BTW is a very well know Uro tell me regular biopsies are going away to be replaced by MRI (3.0 Tesla) to the pelvic area. I had hat done and NO Cancer! Before I would let them do a regular biopsy on my prostate I would check this out, you insurance shouls cover it. If you want to PM me I will give you more info on the friend who is a Uro. He's in Florida.

 

[Nelson Vergel]

Thanks BigJohn. More information here:

Using MRI To Diagnose And Treat Prostate Cancers

 

[Bass]

mine kept creeping up then leveled and became stable. prior to TRT my PSA was 0.5, then kept going up slowly to 1.2, then lowered my dose and now its back to 0.8 without abstaining! I agree TRT can cause PSA levels to rise, some of it probably due to increased sexual activates! another thing I want to mention, I noticed PSA levels go up when my E2 goes up.

 

[Nelson Vergel]

T

I do not have any problems urinating, and to my knowledge I have no infections. I will be undergoing an IV infusion for a unrelated condition in the near future that will wipe out all of my B cells for up to a year. This is a good reminder to check with my doc. Is it possible to have an prostatic infection and not know it? It could get out of hand after this treatment if not caught before hand. Can you have a prostate infection or UI w/o any symptoms?

Last thing I neglected to mention, that back in Sept. I had a clean DRE by a urologist.

Yes, you can have a prostate infection without symptoms. It happened to me and after months I had accumulated calcium in my urethra due to a long infection. My urine flow eventually was almost blocked. I got it fixed with laser therapy.

 

[Bass]

Yes, you can have a prostate infection without symptoms. It happened to me and after months I had accumulated calcium in my urethra due to a long infection. My urine flow eventually was almost blocked. I got it fixed with laser therapy.

Nelson, how effective was the laser, and what were the side effects and recovery protocol?

 

[Nelson Vergel]

Super effective to restore pee flow. But I would not recommend the green laser to anyone. The main side effect that is not explained to patients is retrograde ejaculation (you shoot to your bladder instead of normally through your gland). Not fun to cum dry.


http://www.miamiurologyconsultants....-bph-urological-consultants-florida-miami.php

 

[HarryCat]

If you are really worried, ask your Doc for a Prostate biopsy and be done with it...worth the peace of mind IMO.

I'll spare you my prostate biopsy horror story but needless to say having one is a decision that should not be made without serious consideration of the pros and cons.

 

[Tom Larabee]

Super effective to restore pee flow. But I would not recommend the green laser to anyone. The main side effect that is not explained to patients is retrograde ejaculation (you shoot to your bladder instead of normally through your gland). Not fun to cum dry.


http://www.miamiurologyconsultants....-bph-urological-consultants-florida-miami.php

Nelson, are there any other alternatives that are as effective as the laser if someone found themselves in a similar situation?

 

[Nelson Vergel]

Nelson, are there any other alternatives that are as effective as the laser if someone found themselves in a similar situation?

That link I showed also described this technique:


Miami urologists Dr. David Robbins and Dr. Amery Wirtshafter are proud to offer their patients a minimally invasive office-based option for the treatment of BPH.

TherMatrx® Office Thermo Therapy™ is a safe, effective, non-surgical treatment for relief of enlarged prostate, also known as benign prostatic hyperplasia (BPH). It will help relieve enlarged prostate symptoms and restore your quality of life. Best of all, a single treatment administered in your urologist's office can provide long-lasting symptom relief.

No cutting or incision is needed. Instead, the urologist temporarily inserts a small, flexible catheter into the urethra; the system begins to work by slowly raising the temperature in a very specific area of the prostate. This causes changes in the prostate tissue that results in increased urine flow.

The symptoms associated with your enlarged prostate begin to improve within six weeks as you begin to improve your overall quality of life. For most men, a single treatment is effective for long-term relief.


The Procedure
A small, flexible catheter is inserted into the urethra, the canal that carries urine from the bladder. After it is placed, the system will begin to work by slowly raising the temperature in a very specific area of the prostate.

The TherMatrx® system continuously measures the prostate temperature and ensures you are given the optimal “dose” of heat.

When the treatment is complete, the doctor will remove the treatment catheter. A urine drainage catheter may be required for two to five days after treatment. This catheter will ensure that urine can pass during the immediate post-treatment healing period.
The entire procedure takes approximately 40-60 minutes.

Typically, patients will see improvement in their enlarged prostate symptoms between six weeks and twelve weeks after their treatment with TherMatrx.

Clinical Results

TherMatrx offers a number of benefits:

Proven safety—TherMatrx received Federal Drug Administration (FDA) approval in 2001. Since that time, more than 75,000 men have safely benefited from the therapy. In a clinical trial, no long-term side effects were observed, and all treatment side effects were minor and quickly went away on their own.

Significant Improvement in Symptoms—The American Urological Association (AUA) BPH Symptom Score questionnaire helps determine the severity of a patient's enlarged prostate symptoms by assigning them a number. The AUA Symptom Score was used in the clinical study to measure how much symptoms were improved after treatment with TherMatrx.

The Results: AUA Symptom Scores improved by 47% after treatment with TherMatrx after 12 months.

Improved Quality of Life—Perhaps the most important measurement of how well a treatment works is its effect on quality of life. When an enlarged prostate starts to affect your quality of life, you should talk to a doctor about your treatment options.

The Results: After treatment with TherMatrx, patients in a clinical study reported a 49% increase in their quality of life 12 months after treatment.

Minimal sexual side effects reported in clinical studies

The Results: In the clinical study, less than 1% of men treated with TherMatrx had a decrease in sexual function as a result of treatment."

 

[Tom Larabee]

Good to know there are other options without the retrograde ejaculation issue.

 

[Bass]

Super effective to restore pee flow. But I would not recommend the green laser to anyone. The main side effect that is not explained to patients is retrograde ejaculation (you shoot to your bladder instead of normally through your gland). Not fun to cum dry.


http://www.miamiurologyconsultants....-bph-urological-consultants-florida-miami.php

thanks Nelson!

 

[Gene Devine]

Many men do well on a simple Alpha Blocker to increase urine flow...helps with erections as well!

 

[caston41]

I missed all these great responses, and I never followed up with what my PC said. He was ok with leaving my dose where it's at, and re-check my PSA in Sept. He didn't ask, and I didn't mention, that my dad had p. cancer. He did fine with seeds. Not sure that would change his mind. I told him about refraining from sex before a test, and he didn't think that made much difference. I told him that if he was recommending a biopsy to me, I would first want to re-test, but since he wasn't, I was ok to leave it be.

I recently listened to a uro on XM Doctor Radio mention that MRI is getting very good. I can't remember the specifics, but I think there is some type of MRI, or some specific skill the doc has to have to get the benefit. But when that's all in place, the only draw back is price. My insurance, probably a no go. I am curious, that if they take 12 samples, then do you get charged for 12 separate times for lab work?? I think I know the answer to that too! :-(

Thanks again for all the great feed back.
Jack

 

[OMI100]

Hmmmmm Interesting thread.
Not wanting to "hijack it".
I am interested in the TURP / TUMT / latest and greatest. Was looking here for just such info a day or so ago. Would like to suggest a new folder / tab for just discussion of this topic alone.
Looks like there might be more folks than me interested in the latest procedures out there with positives and negatives identified. Getting tired of getting up all night to pee

 

[raygo]

Nelson, do you recall having an increased PSA during this time? I've been tracking my PSA ... 2.9, 1.7, 4.1 over a year. I'm pretty sure I have BPH symptoms. Flow is definitely weaker, and I cannot control my velocity at all. I don't have to get up at night, but I also tend not to drink at night either. I have a Uro appointment in May. There will be no T for me until my doc is sure my prostate is ok. Also, does testosterone have any negative impact on BPH? Thanks.

 

[Nelson Vergel]

Seven causes of a high PSA that are not cancer