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Elevated PSA count. Looking for advice

maldorf

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Has anyone on here dealt with this? Mine has been elevated off and on for years now. I do have an enlarged prostate and its been that way for about 10 years now too. I figure its probably just from that. I had my GP stick his finger up you know where and feel it and he just said it was enlarged. No shit! Im taking Flomax med for it now and it increased my flow to an acceptable rate. Ive been just fine really.

My endocrinologist is freaking out now and says he wont treat me anymore unless I got to an urologist. So tomorrow im going to have to call his office and have him refer me to someone. I really cant stand my endo, but dont want to mess with changing to another and risk getting another one that is a pain in my ass. I think this doctor is worried I have freaking prostate cancer.

I didnt think it was a big deal if the count is just slightly elevated and is that way for a long time. It hasnt increased over the years at all. Im not sure why he is just now all worried about it. He must have had another patient or read about a case where someone had cancer. The level last week was 4.16 and then in March it was higher at 4.63. It has been down in the mid 3s. It seems to vary quite a bit. Ive read that having sex/or masturbating and exercise before the test can elevated it. I had just done legs the day prior to this last test.

Has anyone else on here had a similar experience where your level is just slightly above the normal of 4.0? Did you make a trip to the urologist? Wondering how your case turned out. Im sure he will do a rectal exam and then im thinking he will probably want to do a biopsy. Id like to avoid the biopsy if I can, im worried about problems that could come about because of that. Has anyone here had the biopsy? Any issues there?

If it aint enough that Im in full heart failure, now I have to deal with this bullshit.
 

maldorf

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I think just recently someone on here had sepsis caused by doing a biopsy.
 

NEMSZ

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I think just recently someone on here had sepsis caused by doing a biopsy.
That would be my dad lol

Yea sepsis is a possibility after a biopsy but the first place he got it at was a mess.. My dad’s PSA was around 6.0 when they did it the first time and then the Urologist that saved his life has been in charge ever since, my dad’s PSA has gone as high as 12 and the Urologist recommended getting another biopsy, my dad was terrified but these guys did way more precautionary measures with antibiotics before, the day of (putting a liquid antibiotic in his anus through an enema to hold for 30 minutes then flush out) and after the biopsy, my dad was like nothing ever happened after that biopsy and thankfully everything came back negative... His PSA for the past year or so has hovered around/between 7-9 which is high, the Urologist determined TRT isn’t the cause because on and off it was still the same, he said that some people just have high PSA as they get older and suffer from enlarged prostate with no other consequences..

My dad sometimes has trouble urinating and his flow isn’t the best at times, he does take LE Green Tea Extract, Swanson Pygeum, Pumpkin Sees Oil and Pycnogenol 2 pills each morning and night. It didn’t help by a whole lot, but his PSA lowered about .5 and has stayed stable and he says he pees better..
 

maldorf

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That would be my dad lol

Yea sepsis is a possibility after a biopsy but the first place he got it at was a mess.. My dad’s PSA was around 6.0 when they did it the first time and then the Urologist that saved his life has been in charge ever since, my dad’s PSA has gone as high as 12 and the Urologist recommended getting another biopsy, my dad was terrified but these guys did way more precautionary measures with antibiotics before, the day of (putting a liquid antibiotic in his anus through an enema to hold for 30 minutes then flush out) and after the biopsy, my dad was like nothing ever happened after that biopsy and thankfully everything came back negative... His PSA for the past year or so has hovered around/between 7-9 which is high, the Urologist determined TRT isn’t the cause because on and off it was still the same, he said that some people just have high PSA as they get older and suffer from enlarged prostate with no other consequences..

My dad sometimes has trouble urinating and his flow isn’t the best at times, he does take LE Green Tea Extract, Swanson Pygeum, Pumpkin Sees Oil and Pycnogenol 2 pills each morning and night. It didn’t help by a whole lot, but his PSA lowered about .5 and has stayed stable and he says he pees better..
Ok, thanks. Good to know his 2nd biopsy went well. If the doctor makes me get one I will keep in mind the antibiotics etc. The thing that sucks for me, whenever I go on antibiotics it cranks up my INR really high and then I risk having a bleed. I will also have to go off my coumadin for the surgery I would think, and the days leading up to the surgery I have to inject my stomach 2x a day with an anticoagulant. It sucks big time. Then for the next 2 weeks or more i have to get my INR checked to make sure im in theraputic range. It is just a big mess. All of this is going to require lots of trips to the doctor and each time I risk exposure to covid-19. Im still staying out of public as much as I can. Hopefully the urologist wont be an alarmist like my endo and let me go without a biopsy. At this point I am being forced to see an urologist, otherwise my endo wont prescribe the testosterone anylonger.

I think my 10+ years of steroid usage greatly sped up the growth of my prostate. My guess is that I just have BPH and thats causing the 4.2 PSA level.

It sounds like with your dad, the main thing they watch for is big jumps in the PSA level. Mine has never been over 4.7 or so and always ranges between 3.5 and that. Im just going to have to deal with this now, otherwise im stuck getting a new doctor for TRT or buying stuff on the black market like in the old days. With my heart failure I do not want to take anything now that isnt from a true US pharm.
 

lm89

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2 guys I work with in their mid 50’s both tested high PSA, doctors freaked them out without asking any questions as to why it could be high. Turns out, things as simple as eating bbq or in one coworkers case, riding a bike can elevate your number. I guess it’s best to treat this test as we would a number of other tests we do. Limit the amount heavy exercise in the days leading up to the test. None of my coworkers have touched gear in their lifetime. Just your regular type of men. They both were retested within a few weeks after following a few restrictions and both came back well within range. If I recall correctly, 1 of them tested @ 9. Anyways, hoping this is the same situation you find yourself in and don’t have a hassle with the TRT
 

danieltx

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As the last poster stated, PSA can get elevated from many things.

Last year, my dad had his usual physical and his PSA was off the charts - it had always been normal before. He had shingles at the time and believed that was the cause. His doctor didn't believe that and said if it was he'd put him in a medical journal as he'd never heard of that occurring.

He had a scan and the doctor found nothing suspicious - he said he looked as normal as anyone he'd ever seen. The doctor told him to come back when his shingles cleared up and they'd test again.

His shingles cleared up a few months later, he was retested, and everything was normal. He hasn't had issues with it since.

Do you know your free PSA? That can be a better indicator of issues than PSA alone.
 

maldorf

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No free level on test. This doc isn't the best, that's for sure. He's forcing me now to see an urologist. Maybe he will test me for that.

My prostate is enlarged and my psa has been up above 4 for years, off and on so its nothing new. I don't know why my endo is freaking out on me all of the sudden.
 

chemical engineer

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The literature I have read is that the best course of action is to watch and wait. More times than not aggressive action causes more harm than good. 90 percent of people diagnosed with prostate cancer die of something else. Sounds like the endo is trying to cover his ass! No pun intended.
I’m not a doctor, but I did stay at a holiday inn express last night.
 

maldorf

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The literature I have read is that the best course of action is to watch and wait. More times than not aggressive action causes more harm than good. 90 percent of people diagnosed with prostate cancer die of something else. Sounds like the endo is trying to cover his ass! No pun intended.
I’m not a doctor, but I did stay at a holiday inn express last night.
I agree, I think he is afraid of malpractice. Something must have scared him with another patient maybe, or a colleague had something happen. Nothing has really changed for me in the past 10 years or so. I really dont want to go but im going to have to.
 

gotgame

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Prostate MRI on 3T no endorectal coil. NO biopsy blindly EVER. No DRE.

If comes back as just BPH hit it with a good dose of 5AR inhib which is also protective
 

maldorf

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Prostate MRI on 3T no endorectal coil. NO biopsy blindly EVER. No DRE.

If comes back as just BPH hit it with a good dose of 5AR inhib which is also protective
Id like to do a MRI, but I have a defibrillator and not sure if one can be done on me. I think it can be turned off though while the MRI is done? Is that right? I guess then they can just turn it on after the test is complete? That would require probably the Boston Scientific rep to be in the room with me to do that, or another tech familiar with the device? Not sure how involved that is, and if there is any serious risk to me doing the MRI. Gotgame, do you know about this?

Ive got so much shit wrong with me that doing most tests becomes a bitch.

Why do you say no DRE? You think its a waste of time? I can see that.

By no blind biopsies, do you mean that there should be a good reason to do one. More of a reason that just having a PSA level of 4.6?
 

NEMSZ

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Prostate MRI on 3T no endorectal coil. NO biopsy blindly EVER. No DRE.

If comes back as just BPH hit it with a good dose of 5AR inhib which is also protective
Id like to do a MRI, but I have a defibrillator and not sure if one can be done on me. I think it can be turned off though while the MRI is done? Is that right? I guess then they can just turn it on after the test is complete? That would require probably the Boston Scientific rep to be in the room with me to do that, or another tech familiar with the device? Not sure how involved that is, and if there is any serious risk to me doing the MRI. Gotgame, do you know about this?

Ive got so much shit wrong with me that doing most tests becomes a bitch.

Why do you say no DRE? You think its a waste of time? I can see that.

By no blind biopsies, do you mean that there should be a good reason to do one. More of a reason that just having a PSA level of 4.6?
Gotgame is definitely the guy to talk to in this department and it reminded to me add in some things about my dad’s situation;

His first one was just a straight “get a biopsy” and obviously we know how that turned out and the doctor was a piece of shit, I remember he and his office basically blamed my dad for getting sepsis...

And as others said, anything can alter a PSA reading, ejaculation within 2 days or so of a test, exercise, riding a bike etc.. My dad checked all the boxes before to make sure he could get as accurate a test as possible..

The new urologist, the one who saved him, monitored him and when his PSA raised again he did get my dad an MRI first, the results apparently aren’t always crystal clear and it came back inconclusive, which in his words meant it may or may not be something serious. He gave my dad the option for the 2nd biopsy but also said it would make 100% sure what’s going on and better to be safe than sorry, of course we as a family said the same thing.

So maybe your doc can do an MRI and get enough not to need a biopsy..
 

Kaladryn

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Well your PSA numbers are pretty high, but what is concerning to doctors is generally rapid changes in PSA. The problem is that 4 is the threshold for further testing, after the first 4 reading, he probably was able to wait and retest, but after two readings over 4, he is probably obligated to refer you for further testing. I'd consider doing so. I'm assuming you are on 5mg/day finasteride already with those numbers?

Also, because 4 is the 'official' threshold for further testing, you may get the same advice from other doctors also, definitely see a urologist imo.
 

maldorf

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Well your PSA numbers are pretty high, but what is concerning to doctors is generally rapid changes in PSA. The problem is that 4 is the threshold for further testing, after the first 4 reading, he probably was able to wait and retest, but after two readings over 4, he is probably obligated to refer you for further testing. I'd consider doing so. I'm assuming you are on 5mg/day finasteride already with those numbers?

Also, because 4 is the 'official' threshold for further testing, you may get the same advice from other doctors also, definitely see a urologist imo.
Not on any finasteride. Just taking Flomax, an alpha blocker.

Its just frustrating to me because my level has been up around 4 for years now and my prostate has been growing now for the past 15 years. The men in my family have BPH so I'm not surprised, and I was on bodybuilding doses for over 10 years.

I'm going to go in and see a urologist to get my doc off my back. If he wants to do a biopsy I might say no.
 

gotgame

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Id like to do a MRI, but I have a defibrillator and not sure if one can be done on me. I think it can be turned off though while the MRI is done? Is that right? I guess then they can just turn it on after the test is complete? That would require probably the Boston Scientific rep to be in the room with me to do that, or another tech familiar with the device? Not sure how involved that is, and if there is any serious risk to me doing the MRI. Gotgame, do you know about this?

Ive got so much shit wrong with me that doing most tests becomes a bitch.

Why do you say no DRE? You think its a waste of time? I can see that.

By no blind biopsies, do you mean that there should be a good reason to do one. More of a reason that just having a PSA level of 4.6?
Perfectly safe. Radiology office will contact rep. Rep will put in MRI safe mode. No problem. will need device card which specifies which device so the MRI parameters specific to that can be used. I scan patients like that every weeek.

By no blind biopsies i mean it used to be standard of care to just go and jab a needle around the prostate if PSA is high to check for cancer.. Really not a good accurate way of doing things. If someone is biopsing anything on me i want them to be targeting something specific. So the best approach, in my opinion, is to have a prostate MRI first.

So lets take this situation.

PSA is 4. Then goes to 6. Dont just assume its BPH and take a 5AR inhib... gonna wanna watch it. Then it goes to 6.5.. Ok so some urologists are gonna wanna jab a needle in your prostate. The problem with that is that if there is cancer there then its super easy to miss it. The other issue is complications...from prostate infection, inflammation and then you can get scarring and other stuff which could potentional make a MRI later on more challenging to interpret.

The better option ( and the one i did with my own father) is get a prostate MRI on a 3T with contrast. It is a great screening tool. its really quite sensitive. Meaning if its negative it does a good job on ruling cancer out. So if it comes back negative and its just BPH you then hit it with some 5AR inhib and shrink it down and trend the PSA. 5 AR inhib are also protective to a degree against prostate cancer.

If something is seen as abnormal on the prostate MRI then that area can get targeted on the biopsy either via MRI guided biopsy or ultrasound guided. But not blindly jabbing a needle in there.

I dont like DRE as most cancer is gonna be missed, its super subjective and quite frankly i dont want some guys finger in my ass when i could have just gotten an MRI...


completely unrelated but cute story that made my day...

I was seeing a patient today and she brought in her 6 year old daughter. her daughter looks at my arms and is like " why are all your veins on the outside???" im like ohh i like to go to the gym.. shes like " its dangerous to have veins on the outside, if you cut yourself you could die. you should know that because your a doctor" lmao..thank you lol
 

maldorf

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Perfectly safe. Radiology office will contact rep. Rep will put in MRI safe mode. No problem. will need device card which specifies which device so the MRI parameters specific to that can be used. I scan patients like that every weeek.

By no blind biopsies i mean it used to be standard of care to just go and jab a needle around the prostate if PSA is high to check for cancer.. Really not a good accurate way of doing things. If someone is biopsing anything on me i want them to be targeting something specific. So the best approach, in my opinion, is to have a prostate MRI first.

So lets take this situation.

PSA is 4. Then goes to 6. Dont just assume its BPH and take a 5AR inhib... gonna wanna watch it. Then it goes to 6.5.. Ok so some urologists are gonna wanna jab a needle in your prostate. The problem with that is that if there is cancer there then its super easy to miss it. The other issue is complications...from prostate infection, inflammation and then you can get scarring and other stuff which could potentional make a MRI later on more challenging to interpret.

The better option ( and the one i did with my own father) is get a prostate MRI on a 3T with contrast. It is a great screening tool. its really quite sensitive. Meaning if its negative it does a good job on ruling cancer out. So if it comes back negative and its just BPH you then hit it with some 5AR inhib and shrink it down and trend the PSA. 5 AR inhib are also protective to a degree against prostate cancer.

If something is seen as abnormal on the prostate MRI then that area can get targeted on the biopsy either via MRI guided biopsy or ultrasound guided. But not blindly jabbing a needle in there.

I dont like DRE as most cancer is gonna be missed, its super subjective and quite frankly i dont want some guys finger in my ass when i could have just gotten an MRI...


completely unrelated but cute story that made my day...

I was seeing a patient today and she brought in her 6 year old daughter. her daughter looks at my arms and is like " why are all your veins on the outside???" im like ohh i like to go to the gym.. shes like " its dangerous to have veins on the outside, if you cut yourself you could die. you should know that because your a doctor" lmao..thank you lol
Great info, thanks so much!

Whats your opinion on 5 AR inhibitors? Wondering if there can be some bad side effects from that. Guys on here might like to know. I'm unsure. It seemed like my GP prescribed the alpha blocker because its more mild and has fewer sides. He didn't tell me that specifically, but its the feeling I got.

I'm worried about symptoms from having low DHT. Only time mine was low was when my total test was really low and I felt like death. Wondering how low DHT feels if the 5 AR inhibitor kicks it down low but my total/free test is normal.
 

gotgame

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5AR inhib are a useful tool and the majority of guys will not experience any side effects whatsoever. I personally have taken finasteride and dutasteride. I had my DHT levels checked and they were at some points pretty low and othertimes bottom of normal range and i felt fine both times.

the alpha blockers work on the symptoms and not the underlying issues. while they can be useful for guys who cant shrink down there prostate they arent helping decrease the prostate size. Prolonged BPH can be difficult to treat hence why some guys will need a TURP or take meds like flomax or cialis and chronic urinary retention can cause renal issues.

with that said some guys do have issues from 5AR's and there are cases of post finasteride syndrome which while very rare i do think is real... in fact my own father had severe issues from finasteride...i mean bad depression and mood changes but that is quite rare.

Prolonged stimulation of the prostate gland from DHT levels from cycle or high dosed TRT can cause many issues that guys on this board just bury there head in the sand about. I do think that prolonged high DHT levels can increase ones risk for prostate cancer. So all those guys taking high doses for long peroids of time or taking high dose " TRT" i do think your risk of prostate cancer is going up...

You are gonna get some super smart guy saying ohhh but gotgame...it doesnt CAUSE cancer.. blah blah... ok but its prolonged stimuation increases ones risk...its not too hard to go from hyperplasia to dysplasia. its true for almost all other hormonally sensitive cancers.. lets say breast cancer... we KNOW that conditions that cause elevated estrogen levels increase a womans risk for breast cancer ( and mens)... its not something most would argue .... but guys on here will get upset if you claim DHT levels from AAS increases your prostate cancer risk... just silly...

We have had quite a few guys in this community have prostate cancer some of it was advanced. Ive seen it in bodybuilders in there 40's. Can i prooove that AAS caused it. ofcourse not..and its not CAUSING it..but its a hormonally responsive type cancer so once you get some cancer cells that may otherwise lay dormant for the rest of your life its now be stimulated but super high DHT levels and bam... its growing.

Upon autopsy most men if they live long enough will have prostate cancer its just never detected. But lets say now your 60 yr old... doing "TRT" at 200mg... the occasional cycle...some tren...lil dbol mixed in.. just a bit... you think those cancer cells which may be present are just gonna lay dormant.. or do you think they are gonna be loving that DHT rich environment.
 

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