PSA levels & TRT

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RM

New Member
I've been on TRT for one year now. About 1cc a week of Test. Everything has been awesome. My blood work every few months has shown in healthy and getting healthier. My GP recently asked me to do start a yearly checkup with a urologist. So I went to the Uro thinking everything is great when he hits me with my PSA levels are high and he is concerned. Now, I've always been open about my family history - my grandfather and uncle have both had prostate cancer. Grandfather died of it at 80 and uncle has had it and had it come back. Healthy now though at 60+. My PSA levels back in 2014 were .84 and .90 in the blood work I could find. Then in 2016 it was .70, .70, 1.1 and finally 1.6 this post March. He really wanted to do a biopsy right then and there. Even after he did a DRE that he said was totally normal. I'm getting my blood work done again this week but it's really got me going mental over this. Is this really a huge spike? Thanks for any help y'all can give me. My age is 37 just to for reference.
 
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cja

Member
mine went from a 1.3 pre-TRT to 1.6 after TRT for 6 months. nobody has mentioned anything yet. but given your situation, I would get further testing for sure.
 

CoastWatcher

Moderator
Assuming that you have been carefully screened to rule out prostatitis, a biopsy makes sense in this situation given your age, the rate of increase (velocity), and family history.
 

RM

New Member
To be honest not 48 hours. I was told 24 and really didn't take it seriously. Mainly cause I didn't know it would skew tests. Full disclosure I'm also a gay man and wonder if that can play into it.
 

CoastWatcher

Moderator
To be honest not 48 hours. I was told 24 and really didn't take it seriously. Mainly cause I didn't know it would skew tests. Full disclosure I'm also a gay man and wonder if that can play into it.

Ejaculation should be avoided for 48 hours prior to having a psa run, it can elevate the results. Sexual orientation has nothing to do with it.

If prostatitis has been ruled out, I'd schedule the biopsy. Yes, infection can occur, it is something you should discuss with your urologist. While you are not near the absolute value where TRT is contraindicated, your family history and the rise in the psa is a matter of concern. I'd think it better to get ahead of the issue, hopefully rule out a serious problem and put this behind you.
 
For some peace of mind just refrain andretest and if you get a normal reading, do another a few months later, and if that's normal then I would relax but keep the PSA in all my blood work. Seems a better move than a biopsy.
 

user_joe

Member
With the number being so low still, would the assumption be that if you found something you found it extremely early?

1.6 without those previous tests wouldn't even be looked at without the family history here, correct?
 

RM

New Member
Yeah would be very early. However, just noticed an error in my numbers. It went .7, .7, 1.1, .8 and finally 1.6. So it dipped before back up. I see a correlation between free testosterone and PSA. I get my retest Friday. Well see what happens.
 

captain

Active Member
Just how bad is this biopsy. Uro told me it can get infected. Also what if my score comes back lower?
From people that told me it's not pleasant. They take 6 each side for total of 12. It's some spring loaded needle device they pull the trigger one at a time. It's been many years they may do it with something else now I don't know.
 

CoastWatcher

Moderator
With the number being so low still, would the assumption be that if you found something you found it extremely early?

1.6 without those previous tests wouldn't even be looked at without the family history here, correct?


It's not simply the numeric value, it's also how quickly that value has risen. A doubling in a short period, as seems to be the case here, .8 to 1.6, calls for closer scrutiny.
 
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Nelson Vergel

Founder, ExcelMale.com
Prostate Specific Antigen Levels during Testosterone Treatment of Hypogonadal Older Men: Data from a Controlled Trial

Glenn R Cunningham, MD, Susan S Ellenberg, PhD, Shalender Bhasin, MD, Alvin M Matsumoto, MD, J Kellogg Parsons, MD, Peter Preston, MS, Jane A Cauley, DrPH, Thomas M Gill, MD, Ronald S Swerdloff, MD, Christina Wang, MD

The Journal of Clinical Endocrinology & Metabolism, jc.2019-00806,


Abstract
Context
Prostate specific antigen (PSA) changes during testosterone treatment of older hypogonadal men have not been rigorously evaluated. The Endocrine Society Guidelines recommendation of urological referral for a confirmed increase in PSA >1.4 ng/mL is not based on PSA changes in testosterone-treated men.

Design
Double-blinded, placebo-controlled trial.

Setting
Twelve United States academic medical centers.

Participants
790 hypogonadal men ≥65 years with average testosterone levels ≤275 ng/dL. Men at high risk for prostate cancer were excluded.

Interventions
Testosterone or placebo gel for 12 months.

Main outcomes
Percentile changes in PSA during testosterone treatment for 12 months.

Results
Testosterone treatment that increased testosterone levels from 232 ± 63 ng/dL to mid-normal was associated with a small but significantly greater increase (p<0.001) in PSA levels than placebo treatment. Serum PSA levels increased from 1.14±0.86 ng/mL (mean ±SD) at baseline by 0.47±1.1 ng/mL at 12 months in the testosterone group and from 1.25±0.86 ng/mL by 0.06±0.72 ng/mL in the placebo group. Five percent of men treated with testosterone had an increase ≥1.7 ng/mL and 2.5% of men had an increase of ≥3.4 ng/mL. A confirmed absolute PSA >4.0 ng/mL at 12 months was observed in 1.9% of men in the testosterone group and 0.3% in the placebo group. Four men were diagnosed with prostate cancer; two were Gleason 8.

Conclusions
When hypogonadal, older men with normal baseline PSA are treated with testosterone, 5% had an increase in PSA ≥1.7 ng/mL, and 2.5% had an increase ≥3.4 ng/mL.
 

M.J

Well-Known Member
before starting trt I was 1.4 after one mont i reached 1.69 and suddenly It came back to 1.46 !!! I read this in many places here in the forum when you start it goes up then come back close to original reading. I will check in 3 month to see where it is, my last test was before two weeks.
 

broker

Active Member
A good Uro doesnt just look at the number, they look at the velocity.
I would get a biopsy. My friend had 2 and said they didnt hurt and its quick. My Uro puts his patients out for biopsies though just to ensure they get one done.
Do not wait, get it done asap. It can be easily treated worse case. Dont worry, you will be just fine.
 
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