PSA at 5.3

Thread starter #1
I started TRT (200mg/week) on 8-1-2016 and PSA was 1.2.

On 8-10-18 PSA was 3.6
On 4-8-19 PSA was 5.3

My doctor gave me a urine test for protein and sent me to a Urologist. Urologist did a DRE and found no lesions, masses, cysts etc. of course prostate was enlarged. Urologist prescribed Uroxatral 10mg (which I didn't take) and requested a prostate biopsy and was scheduled for June 3.

I came to this site and started reading and learned about the selectMDX test and called the Urologist and they don't do that test, so I got referred to another Urologist that does do the selectMDX test and scheduled to see him tomorrow.

I did a few 12 week cycles of 500mg of test in the last 3 years with 300/mg of trenbolone for 6 of those weeks.

Any thoughts?

Thanks!
 
#2
No reason to panic at this time. Take this additional test and see what comes of that. I think speculating on anything is just not going to be fruitful for you at this time.
 
#4
I don't remember how accurate the selectMDX test is compared to a biopsy.
Blind and TRUS biopsy misses over 90% of the prostate but level of error is generally considered to be around 25% inaccurate in terms of false negative. Also, there is still controversy over what stage of cell change/mutation qualifies as cancer, maybe cancer or maybe kinda sorta cancer, but classified as abnormal but not cancerous cells.

SelectMDX claims 98% negative predictability accuracy. With positive results it gives some differentiation of indolent vs aggressive.

I am a member of the high PSA club as well. I chose SelectMDX with PSA 9.3, and it came back negative, so still watching... If I am pushed to a next step, my choice would be 3T MP MRI and if subsequent biopsy The MRI imaging provides an overlay for fusion biopsy which is much better targeted than a 12 needle TRUS. The next better level would biopsy under active MRI monitoring. It depends on what the initial MRI would find.
 
#7
@Mountain Man, I'll admit for me there is some fear of the procedure itself, but that is not the reason I went with SelectMDX... My urologist recommended this course of diagnosis:

1-get Select MDX
2- if positive, get MRI and if positive, do fusion biopsy
3- If negative continue to monitor PSA and consider future MRI as next step.

He did not advocate a TRUS biopsy at all.

I am glad to have this kind of more up to date thinking regarding my care.

Edit: to the OP, I also recommend joining the Insprie prostate discussion groups: Search results for prostate - Inspire

That forum is not user friendly to me, the website code is cumbersome. And the input from members ranges from very informed to absurd, but it is a HUGE resource unto itself and there are many links to studies, articles etc regarding the prostate industry, new developments etc . It is comprehensive in that every subject and option in prostate care are touched upon.
 
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Thread starter #9
Ok I saw the other Urologist today. He said he could do the selectMDX test but would still recommend the biopsy. I think I'm going to go with the first Urologist as he graduated from Dartmouth, been in practice over 20 years, and written multiple publications.

% Free PSA = 9.4, which gives me a 56% chance of having cancer. Basically it's a coin flip.
 
#10
Ok I saw the other Urologist today. He said he could do the selectMDX test but would still recommend the biopsy. I think I'm going to go with the first Urologist as he graduated from Dartmouth, been in practice over 20 years, and written multiple publications.

% Free PSA = 9.4, which gives me a 56% chance of having cancer. Basically it's a coin flip.
In terms of decision making, that is a different circumstance than mine, my Free% risk never has been above 10%.

With Free % that high, I'd choose MRI then fusion biopsy. Many insurance policies won't pay for the MRI prior to TRUS though so could depend on your means and your particular uro's outlook. Please let us know what type biopsy you get and how it goes for you.

Good luck!
 
Thread starter #12
1-get Select MDX
2- if positive, get MRI and if positive, do fusion biopsy
3- If negative continue to monitor PSA and consider future MRI as next step.

He did not advocate a TRUS biopsy at all.
From what I've been reading, the TRUS biopsy is the old standard of care. I think your steps 1 & 2 make a lot of sense, just not sure how my insurance will handle the MRI.
 
Thread starter #13
I'll admit for me there is some fear of the procedure itself, but that is not the reason I went with SelectMDX... My urologist recommended this course of diagnosis:

1-get Select MDX
2- if positive, get MRI and if positive, do fusion biopsy
3- If negative continue to monitor PSA and consider future MRI as next step.
Ok, change of plans!

I talked to a friend at work today, his PSA is at 9.7, prostate is 110 grams, he's had 2 TRUS biopsies, 10 & 12 core samples. His doctor now does the mpMRI and there's no cancer.

I just cancelled my biopsy and scheduled a SelectMDX test for June 20.

Will keep you posted!
 
#14
Blackhawk, you input on this just struck me as to how well crowdsourcing of health information can work. So much info out there that we can't all be aware of every option all the time. Intelligent and accurate information with proper vetting can be crowdsourced. And, can change someone's course of treatment for the better in partnership with their enlightened medical providers.
 
#15
200 mgs per week of testosterone is not TRT, its a mild steroid cycle.
That is NOT good for the prostate. Because your doc says its enlarged and it probably is based on your psa, you would be smart to take the uroxatral or flomax. If you dont, you run the risk of damaging both your bladder and kidneys.
How old are you?
Any urination issues such as a weak stream or urination frequency?
 
#16
Prostate biopsy is not the big deal guys say it is. Get one and see what’s up.
I am not afraid of the prostate biopsy, just that I felt it was less than accurate and just something they like to do when they see a PSA above 4.0. And there is about a 17 percent risk of complications.

Sure, if a biopsy shows cancer, then it's very useful. But if it comes back negative and your PSA still goes up, they will want to do another biopsy.

My PSA went from 2.4>3.9>4.2, in a less than 6 months, but I strongly felt it was due to my protocol causing prostate growth and nothing else. No one in my entire family including aunts and uncles has had any sort of cancer, which also influenced my thinking.

My URO first wanted to do a biopsy, but I was reluctant to do it. Because I felt it would be negative, if my PSA didn't go down they would want to do another one. I got a %Free PSA that was 3.9 and 24.3%, say about 11% chance of cancer.

Heck, the only reason I have an urologist is because I wanted some local Doc to prescribe TRT. He wouldn't prescribe TRT, but is perfectly OK with my being on TRT.

Absent a biopsy, he suggested SelectMDX, I agreed, it came back negative. After the negative result, the URO wrote a letter OKing me to continue on with TRT.

Costs, not sure, the doc submitted it to medicare care, selectMDX billed medicare $500, they rejected it and paid $0, I never got a bill, that was Dec 2018.

I changed my TRT protocol, after 3 months my PSA has come back down to 3,4. then 3.2. That was in 4/12/2019. My guess is PSA will be between 3.0-3.5 next time i test it. Higher or lower I will be surprised.

So if I were concerned about PSA and cancer, I would first go for SelectMDX, bearing in mind the possible costs.
 
Thread starter #18
Got a call from the Urologist, he said I should stop any TRT or Testosterone Boosters until I do the SelectMDX test on 6-20-19.
 

fifty

Well-Known Member
#19
You canceled your biopsy. Are you going to stop TRT?

I never understood why people will try to avoid their doctor's wishes just because of the internet or "my friend did xyz". That's like listening to squating tips from some guy at LA Fitness instead of Ed Coan.
 
#20
Well studies all indicate it wouldn’t matter if you were on 400/wk. the prostate regulates how much DHT it uses.

It’s the fact that men are deficient in DHT that the PSA goes up a bit once they start TRT. It’s not dose dependent. You just need normal, healthy levels for that to happen.

It’s generally a point or so give or take though, and it happens early and once in my experience.
 
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