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Thread: Elevated PSA

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    Rwy's Avatar
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    Elevated PSA

    Hi everyone- Not sure if any of the old members are around its been awhile since I last posted. Hope everyone is doing well-

    I have been on TRT for about seven years now. I am 40 years old. I am currently taking 100 mg once a week, and I am at a test level between 500-600, and I am okay with that. All my blood work is excellent except over the past 12 months my PSA has been jumping between 2 to 2.76. My current TRT Dr wanted to rush me to biopsy. I got a second opinion and that DR was not well versed in TRT, so we abruptly ended the appointment. My 3rd opinion today told me its time to start taking a more in-depth look.

    Today my PSA came in a 2.25 which is down .25 from three months ago. However, my rectual exam revealed my prostate is def enlarged but smooth. The 3rd opinion stated today he wants me off everything. I am currently taking HCG on my own because my wife and I are going to start trying for our second child soon. I am okay with pausing the Test but not the HCG. If I do have prostate cancer and need to have my prostate removed, I will not be able to have another child.

    I am curious to hear others suggestions or thoughts.

    I am really hoping the test is causing my prostate to grow which reflect a higher PSA and I do not have prostate cancer. However, if it is cancer I do not want to be infertile. I want to try and get my wife pregnant before having my prostate removed.

  2. #2
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    kelkel is offline HRT Specialist ~ AR-Platinum Elite-Hall of Famer ~ No Source Checks
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    Odds are it's simpy age causing your prostate to grow. It happens to the best of us. Doesn't mean you should not look into it but I definitly would not push the panic button or hop off your TRT. Consider the psa range is normally 0.0 to 4.0. Many things can cause psa spikes such as infections, bacteria, ejaculation to close to blood work and the list goes on. TRT though is only known to initially elevate psa, it then returns to its baseline.

    It's also not really testosterone directly but DHT that can cause the issues over time. The prostate saturates with testosterone at around 240 ng/dl from memory. This was proven by Dr. Morgantaler who is arguably the most knowledgeable doc in the world when it comes to testosterone. He's studied it for decades. In particular it's called the "Saturation Model."

    New Concepts Regarding Testosterone and Prostate Cancer: A Breath of Fresh Air | Cancer Network | The Oncology Journal

    https://www.ncbi.nlm.nih.gov/pubmed/18838208

    If you want an in depth look into it then I'd opt for a T3-MRI. It's non invasive (meaning nothing shoved up your arse) and is like a typical MRI. I had it done when my prostate started having a mind of it's own and bouncing all over the place. It would normally run at .08 or so. It came back at 1.2 which like you, alarmed me. I re-tested in about two weeks and it was a 2.0. At this point I scheduled the T3 which came back clear. I'm now on Finasteride at 5 mgs p/d and do just fine. My new norm is probably around a 1.6 or so. That's life. I've had no issues with Fina which is a type 2 - 5 Alpha Reductase blocker. Basically it blocks the conversion of T to DHT. It's effective at about a 70% rate.

    Not that your asking but in my opinion I'd continue on your test and hcg until further testing is done. Try to get the T3 asap. Anything less will probably be invasive. Take a minute and read this on Maintaining Fertility while on TRT with HCG. If you don't read the whole article at least drop down to the HCG section. Show it to your doc.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378070/

    Hope it helps!

    kel
    Last edited by kelkel; 12-13-2017 at 02:54 PM.
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    Thanks for this information Kel. I was full on panic mode earlier and neglected to mention he only wanted me to come off TRT for 6 weeks so he could do blood work and then measure my PSA. If my PSA was still high after 6 weeks of no Test or HCG he would want to do a biopsy. I think coming off Test for 6 weeks is not ideal but doable.

    I just googled T3 Mri for prostate and that sounds more reasonable than coming off trt. I am going to speak with him about it. As for adding something to help with the enlarged PS this Dr is def not the right fit. He was perplexed on why my old fertility Dr put me on HCG with TRT. He thought I should have been taken off trt and HCG should have bumped my levels enough to give me desire to have sex.

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    I forgot to mention step one medication wise for you imho should be low dose daily Cialis. It's approved by the FDA for BPH and is simply a healthy item for any man to take. Only reason not to implement it would be if you suffer from abnormally low BP. I do 10 mgs per day (5 x 2) and have for years. I couple it with Doxazosin at 1mg x 2 per day. Doxy is an alpha blocker / smooth muscle relaxer so it will benefit you in two ways as both the prostate and penis are smooth muscle. Win-win.

    Request it from your doc but be prepared to educate him on it. It's possibly out of his league as is TRT with far to many docs.

    Be well Rwy. Hope it helps.
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    bullshark99 is offline Member
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    RWY,

    Panic mode, been there.......My baseline 7 yrs ago was 1.7. Six months into TRT I jumped to 2.5, this absolutely freaked me out. Short version here, turned out to be nothing. Over the last 7 years I have gradually gone from as low as 2.0 all the way up to 3.05 last year. A month ago I was 2.95, I retested 5 days later with a different lab and was 2.65. OK, think you can see where I am going....... the number is gonna bounce around natarually and also depending on the lab so don't "split hairs" and get too dialed in on a specific number.
    I have seen multiple Drs and have had multiple DRE's and all said you have nothing to worry about. If the number Double's PAY ATTENTION, this is not good, btw its called "velocity".
    One of the urologists acted as I needed to get a Biopsy IMMEDIATELY or I was gonna die.....(he probably just wanted to get paid). My PSA was only 2.5 when I saw him. People with cancer many times have PSA in the 20's and 30's and even higher so don't freak out if you increase 20 or 30 basis points, a million things can cause that, all benign.
    I completely agree with Kel, if you need to do something or "feel" you need to then go with the MRI. Keep everyone posted here, this is obviously a subject matter that is very important to most of us.

    Best

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    Youthful55guy is online now Knowledgeable Member
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    Good advice all around. Not much more to add except to reiterate some points.

    1) PSA values can vary from lab to lab, so don't compare results from different labs.

    2) Keep in mind too that there are two types of PSA tests, screening and sensitive. Make sure you are not comparing the results of one type of test to another, even if it's from the same lab.

    3) There is debate in the medical community as to whether even DHT plays a primary role in prostate cancer. The old "truths" are being questioned. Current thought is that it may be related more to the T:E ratio, but that's still open to debate. One thing is for sure, exogenous T (or DHT) does not "cause" cancer. It may (or may not) exasperate it when it is present. The latter is what is being intensely debated.

    4) I want to reiterate Kel's advice on the MRI. I've read posts where guys claim that the biopsy itself can elevate PSA because you are causing trauma to the prostate, so repeated biopsies can make the situation look even worse.

    5) If you didn't know this already, it's good to point out that recent or frequent ejaculation can elevate PSA levels. The act of ejaculation can cause minor trauma to the prostate and temporarily raise PSA. You should abstain from all sex (with a partner or solo) for a minimum of 72 hours prior to the blood draw.

    6) I also support kel's advice on Cialis. I take 2.5 to 5 mg daily for health reasons. I could get by sexually without it, but it certainly gives the erection a boost too. I have no experience with Doxazosin. One more thing to add to my research list.

    Best of luck! Keep us informed.

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    Rwy's Avatar
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    Thanks everyone for the information and support. During my panic, I forget that my best friends brother is a top trauma surgeon in Manhattan who took my call yesterday.

    He said-Smooth Surface during the exam, PSA is currently 2.25, not direct relatives with Prostate cancer tell them to piss off with their biopsy and see more patients.

    Its intrusive and comes with its own inherent risk. Tell them to get one if its a walk in the park.....He did think it would not be a terrible idea to come off for six weeks and have PSA tested again just for shits and giggles. But he agrees with you guys that its BPH.

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    David LoPan's Avatar
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    The PSA test is not a good indicator IMO and a lot of doctors as well. Nothing like a good finger up the ass to check and see first. Glad I have a doctor that is a woman. Also, at age 40 it is time to get your colonostomy done. Are you having any stream issues?

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    Quote Originally Posted by Rwy View Post
    Thanks everyone for the information and support. During my panic, I forget that my best friends brother is a top trauma surgeon in Manhattan who took my call yesterday.

    He said-Smooth Surface during the exam, PSA is currently 2.25, not direct relatives with Prostate cancer tell them to piss off with their biopsy and see more patients.

    Its intrusive and comes with its own inherent risk. Tell them to get one if its a walk in the park.....He did think it would not be a terrible idea to come off for six weeks and have PSA tested again just for shits and giggles. But he agrees with you guys that its BPH.

    Good to hear. In future rounds of BW start monitoring your dht levels as well. It doesn't always take a lot of testosterone for dht to be above range.
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    Youthful55guy is online now Knowledgeable Member
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    Quote Originally Posted by kelkel View Post
    Good to hear. In future rounds of BW start monitoring your dht levels as well. It doesn't always take a lot of testosterone for dht to be above range.
    I can testify to that! I'm convinced that even if I ate the whole $^%# saw palmetto plant, it wouldn't bring my DHT levels down. I've recently adjusted my T dose down after dropping my Armour Thyroid dose and seeing a drop in SHBG with concomitant rise in Free T. I'm hoping that finally brings DHT into range. BPH has not been a major issue, but I have been told by two docs that I have a big prostate (but with a smooth surface and very low PSA).

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    Rwy's Avatar
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    Quote Originally Posted by David LoPan View Post
    The PSA test is not a good indicator IMO and a lot of doctors as well. Nothing like a good finger up the ass to check and see first. Glad I have a doctor that is a woman. Also, at age 40 it is time to get your colonostomy done. Are you having any stream issues?
    I have a pretty powerful stream still. Maybe once in awhile at night I have to get her going

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    So I came off TRT for two months, and of course, my PSA test post test was the highest its been at a 3.25. I switched Dr's, and he specializes Urology and in TRT. He even said this is why this test can be so frustrating. We both were expecting the number to be down now that my body had more than enough time to clear the test. He gave me an exam and said everything felt fine. He ordered a 4k blood test and another PSA.

    My PSA came down to a 2.67, and because of that number, my 4k test was rejected by the company that does it. They said I am in range for my age. Talk about frustrating! This Dr is not pushing biopsy but does not think its wise to be on TRT until we get this figured out.

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    Quote Originally Posted by Rwy View Post
    So I came off TRT for two months, and of course, my PSA test post test was the highest its been at a 3.25. I switched Dr's, and he specializes Urology and in TRT. He even said this is why this test can be so frustrating. We both were expecting the number to be down now that my body had more than enough time to clear the test. He gave me an exam and said everything felt fine. He ordered a 4k blood test and another PSA.

    My PSA came down to a 2.67, and because of that number, my 4k test was rejected by the company that does it. They said I am in range for my age. Talk about frustrating! This Dr is not pushing biopsy but does not think its wise to be on TRT until we get this figured out.
    A properly run TRT protocol will not hurt you one bit. What about asking for the T-3 MRI?
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    Quote Originally Posted by kelkel View Post
    A properly run TRT protocol will not hurt you one bit. What about asking for the T-3 MRI?
    I agree with you. I think its obvious now that TRT played no role in my PSA bouncing all over the place. The problem I am now running into is no one wants to give me a script for TRT with a PSA thats considered high for my age.

    As for the MRI. I was told the 4k test was more accurate. I have no idea if that is true or not.

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    Very confusing if this Dr specializes in TRT??? Little off topic but curious how you have been 'feeling' over the past 60 days being off TRT??

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    Quote Originally Posted by bullshark99 View Post
    Very confusing if this Dr specializes in TRT??? Little off topic but curious how you have been 'feeling' over the past 60 days being off TRT??
    I do not feel great but do not feel like the world is ending either. I thought I was doing a good job keeping my dose down and not bloating but once off I def shed some water weight. This TRT Dr has been added to the list of not seeing again. I called the company who does the 4k test, and told me I was denied only for my age. Not that I was in range. Why he would make up such a thing. I have no idea.

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    Quote Originally Posted by Rwy View Post
    I called the company who does the 4k test, and told me I was denied only for my age. Not that I was in range. Why he would make up such a thing. I have no idea.
    Maybe having a doctor write a letter of medical necessity to your insurance provider would help?
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