1. #1

    Question Carnitine for PSA

    There seems to be some conflict on the web with regards to L-Carnitine and PSA levels. Some websites to avoid Carntine and others do not.

    One of my sport supplements Alpha Jym has 1500mg Acetyl L-Carnitine.

    Anyone hear this correlation?


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  3. #2
    I haven't heard of that. What we do know is that you shouldn't have an orgasm within 48 hours of getting a PSA lab test (blood test) If you do you artificially raise your PSA value. Also if you are taking Biotin (in some supplements) be sure to stop taking it 72 hours before your blood tests as it compromises the lab work for most hormones including the PSA test.

  4. #3
    My PSA has been rising since December. I am on TRT. 3.8, 4.8 and now 5.8 I am am curious to see what my urologist will say. I have a guy feeling I know what it will be. No sex, no bike...nothing a week before the lab test.!!! Grrrrr!

  5. #4
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    Quote Originally Posted by jsr0367 View Post
    My PSA has been rising since December. I am on TRT. 3.8, 4.8 and now 5.8 I am am curious to see what my urologist will say. I have a guy feeling I know what it will be. No sex, no bike...nothing a week before the lab test.!!! Grrrrr!
    ((( Yeah ))) another biker I though I was the only one.
    IMO if your PSA has steadly climbed as you posted I would really want to get to the bottom of that.
    High PSA numbers can mean so pretty bad shit could be happening.

    No sex no bike I'd even stop supplementing just to rule everything out.
    In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man's PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate).

  6. #5
    So it seems I should expect a biopsy?

  7. #6
    Quote Originally Posted by jsr0367 View Post
    So it seems I should expect a biopsy?
    Any PSA value in excess of 4.0 is a blinking red-light for men on a TRT protocol. Total value and rate of rise are factors your doctor will look at and, it would be no surprise if a biopsy was ordered. As was noted above, there are multiple reasons a PSA may be high. You just need to find out what's going on. Keep us posted.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  8. #7
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    Quote Originally Posted by jsr0367 View Post
    My PSA has been rising since December. I am on TRT. 3.8, 4.8 and now 5.8 I am am curious to see what my urologist will say. I have a guy feeling I know what it will be. No sex, no bike...nothing a week before the lab test.!!! Grrrrr!
    I wouldn't blame L-Carnitine for your rising PSA levels, it is something I would see a doctor for. I do know men that had biopsies and I hear they are very unpleasant.
    Last edited by Vince; 02-19-2018 at 06:14 AM.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  9. #8
    I will be contacting my urologist today. He oversees my TRT. Hoping it is just BPH and not cancer.

  10. #9
    Expect a DRE for sure. Assuming the DRE doesn't rule anything out, I'd lobby for a prostate MRI before ever considering a biopsy.

    I did the biopsy before the MRI (stupid, I know). Biopsy was negative (18 cores, ouch), and the MRI showed a very large prostate (almost 50cc). Larger prostates make more PSA, so my density is actually in line with "normal" values. I probably also have a deep-seated infection (didn't repond to Cipro).

  11. #10
    Quote Originally Posted by BryanW View Post
    Expect a DRE for sure. Assuming the DRE doesn't rule anything out, I'd lobby for a prostate MRI before ever considering a biopsy.

    I did the biopsy before the MRI (stupid, I know). Biopsy was negative (18 cores, ouch), and the MRI showed a very large prostate (almost 50cc). Larger prostates make more PSA, so my density is actually in line with "normal" values. I probably also have a deep-seated infection (didn't repond to Cipro).
    Bryan
    What is your age and when did you first notice bph symptoms?
    Do you have BPH symptoms? Weak urine stream, waking up at night?
    Any meds for BPH ?
    did T replacement make your bph symptoms worse?

  12. #11
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    I am a MedOnc specializing in prostate cancer x 35 years and also am very comfortable in discussing (acetyl L-carnitine (ALC) having been the principal investigator for ALC as far back as 1984. I know of no correlation between ALC and PSA, be it rise or drop.

  13. #12
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    This forum is terribly sophisticated re the replies; I am actually blown away by the high level of knowledge of forum members. I am not being sarcastic but sincere. I am a medical oncologist with a subspecialty in prostate cancer. I will bookmark this site. As they say down under "good on you".

  14. #13
    I am 51. Symptoms are very mild. I wake up once per night but it could be due to the water in my protein shake before bed and all the water I drink during the day. About a gallon. If I hold my urine too long I get a huge urgency to go.

    My last visit I had 200cc in my bladder after voiding 3x at doctor. I already consumed about 75 Oz water before my appointment. He did give me alfluzosin but I don’t need it. DRE reveals a normal and slightly enlarged prostate. Have had PSA over 3 for 5 years now. Did go up into high 3 and 4 since TRT.


    My Estradiol is always in high 30s to 50s. I heard that could cause PSA to spike.
    Last edited by jsr0367; 02-19-2018 at 02:00 PM.

  15. #14
    Quote Originally Posted by lexer View Post
    Bryan
    What is your age and when did you first notice bph symptoms?
    Do you have BPH symptoms? Weak urine stream, waking up at night?
    Any meds for BPH ?
    did T replacement make your bph symptoms worse?
    check your inbox. If you don't see a msg, let me know.

  16. #15
    Quote Originally Posted by BryanW View Post
    check your inbox. If you don't see a msg, let me know.
    K..saw it, just replied.

  17. #16
    Quote Originally Posted by jsr0367 View Post
    I am 51. Symptoms are very mild. I wake up once per night but it could be due to the water in my protein shake before bed and all the water I drink during the day. About a gallon. If I hold my urine too long I get a huge urgency to go.

    My last visit I had 200cc in my bladder after voiding 3x at doctor. I already consumed about 75 Oz water before my appointment. He did give me alfluzosin but I don’t need it. DRE reveals a normal and slightly enlarged prostate. Have had PSA over 3 for 5 years now. Did go up into high 3 and 4 since TRT.

    I came across a prostate massager called aneros and it seems to be something some men use for BPH. I did try it back in November for a few months but it didn’t work and my urologist told me to stop using it.

    My Estradiol is always in high 30s to 50s. I heard that could cause PSA to spike.
    You dont want to retain urine. That can effect your kidneys over time. Your prostate is squeezing/ constricting your urethra and not letting all of your urine to pass. Even a slightly enlarged prostate can do that. Ask for flomax. That relaxes the muscles in the prostate and allows urine to pass. I get no sexual side effcts at all from flomax. Its not like proscar which can but not always cause some sexual sides.

  18. #17
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    I am very familiar with TRT (testosterone replacement therapy) and the potential pitfalls. I call TRT a "stress test" for prostate cancer. The fact that you have had a serial ↑ in PSA is of course highly suspicious for you having occult prostate cancer (PC). Key caveats re this interpretation include:
    1. Using the same PSA assay for each test.
    2. Not obtaining a PSA if any ejaculation within 48 hrs prior to the test.
    3. No DRE prior to PSA testing.

    If a patient under my care had this history I would (a) want to know if any family history of PC, breast cancer or colorectal cancer (CRC) since these are genetically linked (b) would certainly want to know what a DRE (digital rectal exam) showed, (c) would consider a urine test for PCA3 and (d) might consider a multi-parametric MRI (mp-MRI) done at a creditable imaging center if biopsies were being considered. I would not let this ongoing rise continue re PSA without major intervention. This is prostate cancer until proven otherwise. And this may be a blessing since most patients I have seen diagnosed in this manner will have ↓ in PSA once the TRT is dc'd. And in most we could not find PC on subsequent biopsies. So the TRT appears to make known occult PC. Of importance would be to know what your total and free testosterone were prior to any TRT.

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    Even more important to me is the rate of change of PSA over time (i.e., PSAV (PSA velocity) and PSA doubling time (PSADT). I have had patients diagnosed with PSA total values < 4.0. A healthy prostate gland that is not involved with BPH nor prostatitis and of course not with prostate cancer (PC) usually is associated with a PSA of ≤ 1.0.

  20. #19
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    Your MD should have known better re the sequencing of multi-parametric MRI (mp-MRI) versus the timing of a biopsy (if indicated). It takes 5 weeks after a biopsy for any bleeding due to the biopsies to resolve. If the mp-MRI is done in a shorter interval of time it will compromise the interpretation of the study. Moreover, and this is important re a flaw in current care of men in such a context, many urologists use ultrasound to "target" the prostate and do not have the skill or the quality of equipment to target the lesions seen on ultrasound. Therefore, in such a situation many biopsies may miss prostate cancer (PC). The prostate MRI should not be confused with mp-MRI. These are not synonymous. The official report, and not the dummied-down patient version (DDPV) on so-called patient portals, should say: Multi-Parametric MRI. And the reading should relate to Prostate Imaging Reporting and Data System (PI-RADS) scoring of the study. Moreover, the strength of the MRI magnet, measured in Tesla units should be 3.0, and not 1.5.

    Your gland size of 50cc is not very large pending your age. And yes, you are perfectly correct in calculating the PSA density (PSAD) = weight per unit volume or in this case PSA ÷ gland volume. The threshold of concern for PSAD is ≈ 0.15. Much lower PSAD readings are of less relative concern. The PSAD also correlates with volume of PC when PC is indeed present. The biopsies you had done would show chronic inflammation in the detailed description of the pathology report indicating that prostatitis is likely been or is still present.

  21. #20
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    Of concern in your post is the result you show for what I presume to be a post-void residual urine volume. In the best of worlds the urologist uses an ultrasound to do a pre- and post-void volume. Any post-void volume > 50cc (same as ml) is of concern for retaining urine due to bladder outlet obstruction (BOO). You are on an alpha blocker Alfluzosin, and that is fine. Flomax is in the same general category. Below is a list of alpha blockers:

    Cardura -- doxazosin
    Hytrin -- terazosin
    Flomax -- tamsulosin
    Uroxatral -- alfuzosin
    Minipress -- prazosin

    Your getting up at night (called nocturia) is related to possibly many factors:
    1. consuming liquids close to bedtime.
    2. diuretics in your diet or prescription
    3. BOO due to any cause
    4. excessive salt consumption which leads to renal elimination mostly at night due to ↑ renal blood flow while lying supine.

    A baseline scoring system is called the AUA Symptom Score. I will see if I can attach it to this email.

    A downside of any internet forum is that all the facts are always not in evidence. Any strategy that we impose relating to living aka biological issues, should have full diligence (complete) assessment. In other words, Status Begets Strategy (SbS) if we wish not to make major mistakes. Otherwise you end up with: Yep, weapons of mass destruction → invade.

    Lastly, sexual adverse side-effects from alpha blockers and from 5-alpha reductase inhibitors like finasteride (Proscar) or dutasteride (Avodart) are not uncommon but usually of low frequency. Here is where communication between physician and patient is so important. Combination use of dutasteride (Avodart) and an alpha blocker is not unreasonable for men with BOO as a first approach.

  22. #21
    Quote Originally Posted by sbstrum_MD View Post
    Your MD should have known better re the sequencing of multi-parametric MRI (mp-MRI) versus the timing of a biopsy (if indicated). It takes 5 weeks after a biopsy for any bleeding due to the biopsies to resolve. If the mp-MRI is done in a shorter interval of time it will compromise the interpretation of the study. Moreover, and this is important re a flaw in current care of men in such a context, many urologists use ultrasound to "target" the prostate and do not have the skill or the quality of equipment to target the lesions seen on ultrasound. Therefore, in such a situation many biopsies may miss prostate cancer (PC). The prostate MRI should not be confused with mp-MRI. These are not synonymous. The official report, and not the dummied-down patient version (DDPV) on so-called patient portals, should say: Multi-Parametric MRI. And the reading should relate to Prostate Imaging Reporting and Data System (PI-RADS) scoring of the study. Moreover, the strength of the MRI magnet, measured in Tesla units should be 3.0, and not 1.5.

    Your gland size of 50cc is not very large pending your age. And yes, you are perfectly correct in calculating the PSA density (PSAD) = weight per unit volume or in this case PSA ÷ gland volume. The threshold of concern for PSAD is ≈ 0.15. Much lower PSAD readings are of less relative concern. The PSAD also correlates with volume of PC when PC is indeed present. The biopsies you had done would show chronic inflammation in the detailed description of the pathology report indicating that prostatitis is likely been or is still present.
    Thank you Doctor! I just sent you a direct message.

  23. #22
    Urologist called me. He is prescribing Bactrim again for 3 weeks and a f/u with labs in 4 weeks. He feels that I have a recurring or deep infection since my prostate always seems normal on DRE. He did say that I respond well to the antibiotics which drops my PSA down to a level which is normal for me. He also lowered by Test dose from 140mg (.7cc) to 100mg (.5cc) to lower the HCT and Estradiol.

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