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    • Prostate/high PSA self education resources?

      With my high PSA, I have scheduled an appt for starters with a new primary care doc. He's a D.O., his reviews are stellar he's a little younger, and I am hoping he's open minded and progressive, since I'd rather have an advocate first rather than a needle happy uro. So far, based on PSA and free PSA test, I am in a 5% risk category for cancer, which to me means biopsy would be premature without other cancer screening first.

      I have started reading many posts and references here on excel male, but am wondering if anyone has recommendations for references for kinder, less invasive assessment and treatment of prostate issues, both in terms of self study online and any recommendations for uros in the Denver/Golden, Boulder area of Colorado.
      Thanks in advance!

      This article was originally published in forum thread: Prostate/high PSA self education resources?
      Comments 20 Comments
      1. Vince Carter's Avatar
        Vince Carter -
        prior to your PSA tests have you refrained from sex/orgasm/etc at least 48hrs?
      1. Pauly_P's Avatar
        Pauly_P -
        The DRE (digital rectal exam) is the most basic and not super invasive test they do. If your doc determines further investigation is needed the only test that they can do that is non-invasive is an MRI of prostrate. I live in the DFW area, and we have a couple of those high definition MRI machines here. Something like a 3 tesla magnet machine. However that was only offered to me after two previous negative biopsy's.

        Your a long ways away from having to worry about that stuff. Like Vince said, sex 24-48 hours before test, and cycling can also impact the test. They will repeat the PSA test every 3 months or so and monitor it before any other tests are ordered.
      1. Blackhawk's Avatar
        Blackhawk -
        Quote Originally Posted by Vince Carter View Post
        prior to your PSA tests have you refrained from sex/orgasm/etc at least 48hrs?
        Way beyond that issue Vince. Short answer is yes.
      1. Blackhawk's Avatar
        Blackhawk -
        Quote Originally Posted by Pauly_P View Post
        The DRE (digital rectal exam) is the most basic and not super invasive test they do. If your doc determines further investigation is needed the only test that they can do that is non-invasive is an MRI of prostrate. I live in the DFW area, and we have a couple of those high definition MRI machines here. Something like a 6 tesla magnet machine. However that was only offered to me after two previous negative biopsy's.

        Your a long ways away from having to worry about that stuff. Like Vince said, sex 24-48 hours before test, and cycling can also impact the test. They will repeat the PSA test every 3 months or so and monitor it before any other tests are ordered.
        Yes, DRE is expected.

        I disagree however. It is not a long way off, I am quite sure there are some docs who would want biopsy now and to pull me off TRT right away. Already had 2 PSA tests that were high. After PSA 1.6 last July, rapid rise: November PSA over 7 and late January PSA 6.9 with free PSA putting me at 5% risk.

        And, I already know there are a slew of other tests available including but not limited to 4K score, PCA3, Oncoblot and a bunch of more expensive genetic based tests, though some of them are associated with samples from biopsy. I want to know my stuff when confronted with a strong push towards biopsy, including getting my hands on a copy of Morganthaler's work.
      1. Pauly_P's Avatar
        Pauly_P -
        Quote Originally Posted by Blackhawk View Post
        Yes, DRE is expected.

        I disagree however. It is not a long way off, I am quite sure there are some docs who would want biopsy now and to pull me off TRT right away. Already had 2 PSA tests that were high. After PSA 1.6 last July, rapid rise: November PSA over 7 and late January PSA 6.9 with free PSA putting me at 5% risk.

        And, I already know there are a slew of other tests available including but not limited to 4K score, PCA3, Oncoblot and a bunch of more expensive genetic based tests, though some of them are associated with samples from biopsy. I want to know my stuff when confronted with a strong push towards biopsy, including getting my hands on a copy of Morganthaler's work.
        Your right, I did not realize your PSA was that high. I have read about those high tech test, but I'm not sure who does those. Maybe UT Southwestern here where I am. Denver has a strong medical community, so seek those out. I've had 3 biopsy's, the last one the MRI Fusion one. That one hurt like hell, the first two were not nearly as bad.

        My doc wants me off TRT as well. I watched a podcast with Jay Campbell and a researcher, they talked about Morgantalers work quite a bit. I need to read his report.

        Sorry you having to deal with this. It definitely sucks.
      1. blackebob's Avatar
        blackebob -
        What does it do to your reading level if you do not refrain 24 to 48 hours in advance does it go higher or does it go lower. I did not know that so I have never refrained.
      1. Vince Carter's Avatar
        Vince Carter -
        Its thought that sex in that 48hr window can cause a false positive, if you will, skew your numbers upward.
      1. CoastWatcher's Avatar
        CoastWatcher -
        A Canadian, I have no personal history with urologists in Colorado, but Dr. Derek Zukosky practices in Denver and treated a very close friend - ruling out prostate cancer. Like more and more urologists, he makes a point of stressing terms like "minimally invasive" and I've been told offered my friend a number of options as they worked to determine what his prostate issues were. I offer his name with all the usual caveats, and wish you the best.
      1. Blackhawk's Avatar
        Blackhawk -
        Quote Originally Posted by CoastWatcher View Post
        A Canadian, I have no personal history with urologists in Colorado, but Dr. Derek Zukosky practices in Denver and treated a very close friend - ruling out prostate cancer. Like more and more urologists, he makes a point of stressing terms like "minimally invasive" and I've been told offered my friend a number of options as they worked to determine what his prostate issues were. I offer his name with all the usual caveats, and wish you the best.
        Thank you! I'll look him up.
      1. Orrin Israel's Avatar
        Orrin Israel -
        Quote Originally Posted by Blackhawk View Post
        Yes, DRE is expected.

        I disagree however. It is not a long way off, I am quite sure there are some docs who would want biopsy now and to pull me off TRT right away. Already had 2 PSA tests that were high. After PSA 1.6 last July, rapid rise: November PSA over 7 and late January PSA 6.9 with free PSA putting me at 5% risk.

        And, I already know there are a slew of other tests available including but not limited to 4K score, PCA3, Oncoblot and a bunch of more expensive genetic based tests, though some of them are associated with samples from biopsy. I want to know my stuff when confronted with a strong push towards biopsy, including getting my hands on a copy of Morganthaler's work.
        My PSA hit 8.1
        First words out of the DR was BIOPSY.
        I have done the 4K and the 3T-MP-MRI.
        No biopsy yet.
        I had a prostate infection and my PSA has moved back to around 5 where it had been (long story and a LOT of antibiotics).
        I have a post about it on the board.
        I am guessing your DR checked your urine for signs of infection?
        Go to https://www.inspire.com and sign up for the Prostate Cancer community.
        A LOT of good info there from a lot of great folks. You can find detailed post on 3T-MP-MRIs, types of biopsies if you need one, best places to get a 3T-MP-MRI by DRs that have a exceptional track records reading them, different protocols, and so much more.
      1. Blackhawk's Avatar
        Blackhawk -
        Thanks Orrin!

        Yes, Dr Saya ordered urinalysis with reflex culture... Negative
      1. Orrin Israel's Avatar
        Orrin Israel -
        Sounds like you might want a 3T-MP-MRI.
        Research that one.
        Then if you do need a biopsy, based on the results of the 3T-MP-MRI, get a MRI guided one.
        There are 2 types. One is live real time in the MRI tube (as I understand the procedure) and the other uses the MRI image overly to guide where the needles take samples.
        Inspire has some good discussions of the 2 and a much better explanation than that what I just gave.
        Might have someone on this board that has been through it and can add.
      1. Blackhawk's Avatar
        Blackhawk -
        Thanks Orrin!

        I'm back at home and researching. I'll try requesting a 4K score as next step.

        As backup depending on how the Doctor's appt goes in a couple days, I found a 3T-MP-MRI in Omaha NB for $600 cash. It is extremely likely that my insurance will not cover it, they typically only approve them as followups to biopsies.

        And CW, unfortunately though his reviews look excellent, Derek Zukowsky is not in network for me.
      1. Nashtide's Avatar
        Nashtide -
        I had my yearly physical last week. PSA went from less than 1 to 4.4 this time. I have an appointment with a urologist on Monday. Like you, I'm determined to exhaust benign causes for this rise in my PSA level before entertaining a biopsy. I am having some symptoms of BPH. Frequent urge to urinate. Slower urine stream. Stopping and starting flow. So I'm hopeful but a little concerned. Best of luck to you. Keep us updated.
      1. Orrin Israel's Avatar
        Orrin Israel -
        One other area that might be an issue:
        https://www.excelmale.com/showthread...s-did-you-know
      1. Nashtide's Avatar
        Nashtide -
        Quote Originally Posted by Orrin Israel View Post
        One other area that might be an issue:
        https://www.excelmale.com/showthread...s-did-you-know
        Yeah. Sounds bad, but better than cancer. Thanks.
      1. FeelingLost's Avatar
        FeelingLost -
        Quote Originally Posted by Nashtide View Post
        I had my yearly physical last week. PSA went from less than 1 to 4.4 this time. I have an appointment with a urologist on Monday. Like you, I'm determined to exhaust benign causes for this rise in my PSA level before entertaining a biopsy. I am having some symptoms of BPH. Frequent urge to urinate. Slower urine stream. Stopping and starting flow. So I'm hopeful but a little concerned. Best of luck to you. Keep us updated.
        Hi Nashtide, sorry to hear about the PSA. I have BPH which got a little worse when I went on TRT.
        However I've been taking a NO stack of low dose cialis(5mgx2) an Alpha blocker (1mg x2) L-Citrulline DL-Malate 2-1, 2 teaspoons
        Beta Alanine, 1/2 teaspoon, L-Norvaline, 1/2 heaping teaspoon. This has improved my BPH but it has not gone away.

        I've been experimenting with viagra in place of cialis and it is not working out as well.
      1. Nashtide's Avatar
        Nashtide -
        Quote Originally Posted by FeelingLost View Post
        Hi Nashtide, sorry to hear about the PSA. I have BPH which got a little worse when I went on TRT.
        However I've been taking a NO stack of low dose cialis(5mgx2) an Alpha blocker (1mg x2) L-Citrulline DL-Malate 2-1, 2 teaspoons
        Beta Alanine, 1/2 teaspoon, L-Norvaline, 1/2 heaping teaspoon. This has improved my BPH but it has not gone away.

        I've been experimenting with viagra in place of cialis and it is not working out as well.
        Thanks. The symptoms are not bad enough for me to seek treatment. I'm going to the urologist for a diagnosis and to hopefully rule out prostate cancer.
      1. Blackhawk's Avatar
        Blackhawk -
        Quote Originally Posted by FeelingLost View Post
        Hi Nashtide, sorry to hear about the PSA. I have BPH which got a little worse when I went on TRT.
        However I've been taking a NO stack of low dose cialis(5mgx2) an Alpha blocker (1mg x2) L-Citrulline DL-Malate 2-1, 2 teaspoons
        Beta Alanine, 1/2 teaspoon, L-Norvaline, 1/2 heaping teaspoon. This has improved my BPH but it has not gone away.

        I've been experimenting with viagra in place of cialis and it is not working out as well.
        Hey FL, can you provide references regarding these supps effectiveness on BPH? I'm after anything that could help, but have to vet them for my own use.
      1. Blackhawk's Avatar
        Blackhawk -
        Saw new Dr yesterday (PCP) and had DRE. Right side is enlarged which is not consistent with typical BPH, but no nodules. Going to pull PSA + free PSA again in another few weeks. HE also referred me to a uro who looks to be quite progressive, but it's unclear whether she is in my insurance network.
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