Urology Consult Needed?

In June of 2012 I started TRT. My T level, prior to TRT was in the 125ng/DL-250ng/DL range. Prior to TRT I suffered from ED, low libido, loss of pubic hair, low energy, and had trouble focusing at work. All of these symptoms disappeared after starting TRT. After several months of yo-yo T levels, we got the dosage and injection interval correct. At one time my T level was so high (>1500ng/DL) they could not measure it. I was having spontaneous erections (at age 56), and thought of sex constantly. That got corrected. I now inject every ten days, 0.8 ml. My last measured T level, at mid cycle, was 648ng/DL. Last year it was 540ng/DL.

One side effect of TRT that I am suffering from is polycythemia. My hematocrit level nine months after starting TRT had risen to 63. Over the next nine months I had a total of 2 gallons of whole blood removed using medical phlebotomy. My hematocrit levels are now normal, and since the beginning of 2014 I donate two units of RBC every 16 weeks, in order to keep it that way.

There is no history of prostate cancer in my family, but my father (age 88) suffers from an enlarged prostate.

My concern is that my PSA level rose dramatically this year. MY PSA speed more than doubled in the past year, and is >1.00ng/ml. I have had PSA measured annually, in November of every year, as part of my routine physical. My GP has not done a DRE since starting TRT, and states he feels DRE's are not needed and that PSA tests are enough as long as PSA is in the "normal" range (<4ng/ml). I have asked him to at the very least do a DRE and another PSA test to be sure the lab did not make an error, and so far he has rejected the suggestion.

My PSA test results (in ng/ml) are as follows:

11/09: 1.15
11/10: 0.79
11/11: 0.59
Initiation of TRT 06/12
11/12: 1.29
11/13: 1.01
11/14: 2.32

Do you feel that a Urology consult is in order? Would you recommend a bi-annual DRE and PSA screen, given my rising PSA Score?

You're Doctor is correct in his position.

IMO, you don't need so see a Uro or any specialist as this value is still in a very safe range.

Remember, blood work is just a snapshot in time and nothing more. There are a ton of normal biological reasons for these slight variables in your serum levels.

Hell, just having sex or masturbating 48 hours before the test will elevate PSA even riding a bike can elevate PSA.

Relax, if you had any type of pathology that was androgen dependent it would have flared up as soon as you started your TRT protocol and your values would be a lot higher than this.

Finally, it's not uncommon for PSA to rise somewhat when on TRT; it's normal in a lot of men and nothing to freak out about.

Peace.

G

Two of the past three years my PSA number has doubled. I don't see that as a "somewhat" rise. If it doubles again next year, I'm at 4.64 and that is outside the normal range. I read that over 20% of all men have prostate cancer with a PSA number >2.40.

At my insistence, my GP will perform a DRE on Wednesday afternoon. I also want them to re-run the PSA test. I'll update this thread with the results.

Peace of mind is worth everything if you are this concerned.

Post your results after your new PSA and DRE here in this thread.

I am sure you will be fine.

Follow-Up Comments

Had the DRE done today. Doctor thought the prostate felt enlarged, but did not detect anything that felt abnormal/cancerous. She thought a PSA re-test was unnecessary at this point in time. She agreed to a 6 month PSA test, as my PSA velocity implies I could be over 4.00 in the next 6-18 months. She said if my PSA was >4.00 she would do a DRE and most likely give me a urology consult no matter how the DRE turned out. Right now she feels BPH is a possibility, but not prostate cancer.