Elevated PSA at 32 years old, Should I stop?

[Ken0449]

I have been doing TRT for about 4 years. I started using it because the VA said my total test was around 400 and my free test was 6. I was down to 145lbs and was told I looked like I had cancer and I had no sex drive or energy. I was working out 6 days a week and eating a healthy diet. The VA didn't want to do anything so 3 years later I finally decided to start TRT. The results were great and my sex drive has been amazing since and I've held at 175lbs. My PSA has always been under 1.0. However, 8 weeks ago it went to 4.0. I went in to have it tested again 3 weeks later and it was 6.9. I stopped TRT with no post cycle and I'm a miserable POS with no sex drive, anxiety/depression, lost 12lbs in 4 weeks, and feel like crap. I went to a Urologist and my PSA has went down to 4.0. He said it's' trending down which he wants to see but that he believes TRT treatment was elevating my levels. When I told him I'm considering children and would like to look into alternatives such as Clomid or HCG he was not receptive and asked why I wanted performance enhancing meds... I think I made him angry and he said he could refer me to someone else. I track macro's (50C/30p/20f) Run 30 miles a week, lift 3 times a week, and get a full 8 hours of sleep every night but this is ruining my relationship as I've been able to have sex once in the last month and could hardly maintain an erection. I've also lost strength, muscle and put on noticeable fat. So the questions are:

1. What are the alternatives and are they safe with elevated PSA?
2. What alternatives are safe to use long term or have long lasting effects?
3. Should I consider staying on TRT?
4. Are these elevated PSA numbers serious? (The urologist didn't seem to care)

I'm also posting lab results that I could find starting with the most recent results first. Most recently I've been on:
200 injection 2X weekly
.5 mg anastrozole with shot
500iu HCG 2 X weekly
I've never missed an injection.

 

[Vince]

These threads should help.

Seven causes of a high PSA that are not cancer

What Every Man Should Know About Prostatitis

Interview with NYC Urologist Dr. Michael Rotman

 

[Ken0449]

Thank you. I read over those and it makes me wonder why after 2 appointments with 2 different doctors at my urologist they have no answers and have not even tried to find the issue. They gave me no antibiotics and after an exam said it was slightly inflamed. I feel like I wasted my money on co-pays and blood work to get no answer besides, "You're young and it shouldn't be that high, stop TRT". He then told me, "Well you can go see "the professor" at the University of Nebraska Medical Center if you want me to write a referral". He left and I asked the nurse if I should come back for another panel and she said, "He's handing it off to someone else". Prior to all of these panels I had no sex/ejaculation 48 hours prior and took the day prior off of working out.

 

[slicktop]

Well, since you've already stopped TRT the ideal circumstance doesn't exist anymore, in my opinion. Personally, I would have stayed on TRT and taken a full week off from exercise, abstain from sex for three days, and then re-test PSA to see what that result was. At this point, any change you make will take a few weeks for you to adjust to. I'm very interested to see how you proceed and wish you the best.

 

[DragonBits]

Thank you. I read over those and it makes me wonder why after 2 appointments with 2 different doctors at my urologist they have no answers and have not even tried to find the issue. They gave me no antibiotics and after an exam said it was slightly inflamed. I feel like I wasted my money on co-pays and blood work to get no answer besides, "You're young and it shouldn't be that high, stop TRT". He then told me, "Well you can go see "the professor" at the University of Nebraska Medical Center if you want me to write a referral". He left and I asked the nurse if I should come back for another panel and she said, "He's handing it off to someone else". Prior to all of these panels I had no sex/ejaculation 48 hours prior and took the day prior off of working out.

FWIW: My urologist said he doesn't routinely give antibiotics when there is an elevated PSA with no other syndromes.

Your key and really only questions is, what was the reason for your elevated PSA and do you have prostate cancer?

How you feel on or off TRT isn't really relevant to that question. If you have cancer, treatment will make you feel even worse. IF you have cancer, clomid, hcg wouldn't be recommended, if you don't have cancer but some other problem then all of those are on the table.

Your urologist must have done a DRE, what was that result? Did they give an estimate of prostate size? Size matters, because a larger prostate will naturally produce more PSA. How did they determine your prostate was inflamed?

You should get some of these tests, a PSA % free, maybe a 4k test, Select MDX test, MRI, prostate PHI test, urinalysis, prostate biopsy etc.

If you have cancer, then reducing your testosterone is likely to reduce at least temporary, your PSA. It doesn't cure cancer, it will still be there.

PSA isn't a definitive test, there are several reasons PSA may be elevated. Your experience and labs so far don't indicate what that problem was or is.

IF your PSA had gone down even with higher levels of total testosterone, then have would be more indicative of prostatitis . Going down when you quit TRT means you don't really know if it was the T or something else.

Another piratical matter, I don't think you will be able to find a doctor that will prescribe TRT if your PSA is above 4.0, especially if you are young. I am sure you can find a semi-legal way around that, but then you are really flying on your own.

 

[Ken0449]

I don't mind waiting and finding an answer and quitting TRT for the time being. This doctor (the only urology clinic in Lincoln, NE) only did another PSA screening and nothing else. He only went on to say, "I've never seen anyone your age with prostate cancer". He ordered no other labs and just said he would refer me to someone else and never told me who, where, when, etc. It's nerve racking wondering if there is something wrong and getting no answer from the specialist. A DRE was done and he said it was slightly enlarged due to what he thought was irritation?

 

[CROM]

When I was between 32 and 34 years of age my PSA went from 1.9 to 1.2 to 1.4 to 1.7 then to 5.6

My Urologist knew I had a history of steroids so he did a biopsy. Turned out to be nothing. He put me on high-dose of antibiotics and my PSA went back down to 1.0 where it has remained for 12 years.

My theory is that I had a small infection that was incapsulated within the prostate. The doctor did a DRE and it probably spread the bacteria to other parts of the prostate. After the DRE the doctor put me on low dose antibiotics.

Since antibiotics don’t penetrate the prostate well, the bacteria probably rebounded with a vengeance after the course was completed. 2 weeks after the low-dose antibiotics I did PSA again and that was when it was 5.6, and did biopsy.

After biopsy was negative the doctor did high-dose antibiotics and my PSA went down to 1.0

Sex usually doesn’t elevate most peoples PSA more than 0.1 although anal sex probably make it go up a lot (that was the Urologist words).

Statistically you do not have cancer but anything is possible. Most likely prostatitis. Either way, from my understanding infection gone untreated can lead to prostate cancer, so if it were me I’d do antibiotics then retest PSA.

 

[Vince]

No. Prostatitis is a benign ailment, which, while not always curable, is almost always treatable with antibiotics. Occasionally, inflammation due to prostatitis can raise your PSA level (prostate-specific antigen). However, it does not lead to cancer.
PCF-Curing Together | PCF | Prostate Cancer Foundation | Prostate Cancer Symptoms › prostate-gland
What is Prostatitis? - Prostate Cancer Foundation

 

[theoneguy]

Not sure why no one else has said this yet but 200 2x a week seems like a CRAZY high amount. If you look at your tests when your testosterone was 600-700 your psa was low now your testosterone is over the max and free testosterone over the max as well and your PSA is elevated....Why not drop your testosterone back down to 700 and see if your PSA falls back to normal too?