Lowered PSA, 2.99 to 0.92, in Three Months

Thread starter #1
As noted in other posts, my PSA leaped dramatically in a little over a year, 1.00 to 2.99. Though still below the magic number of 4.00, the velocity puzzled me and alarmed my doctors. My urologist in Toronto was using words and phrases like “biopsy,” and “suspending your TRT protocol for a while” though he agreed - last January - to stay the course and test again in April.

I had decided I would not biopsy, I would pursue non-invasive testing via the SelectMDX methodology that recently became available in Canada. I spoke with Nelson at some length and was in the process of lining up a second opinion with Dr. Mohit Khera at Baylor University in Houston if one was needed. Best to be prepared.

Tested yesterday, the news was better than I could have imagined. In three months I lowered my PSA from 2.99 to 0.92 (I’m 61 years old). I began taking Turmeric/Curcumin in January: 1000mg twice daily. I did consider the Life Extension prostate supplement that has been taken with success by members here, but opted to keep it as simple as I could.

It is not easy to find oneself walking through the maze of prostate treatment (even if only at the threshold as I was). I read a lot of excellent material and first-hand accounts posted here by @Orrin Israel and @DragonBits. One size certainly does NOT fit all in this area of men’s health. For some, a biopsy may well be a choice they should make if they face such a dilemma. I became convinced, the more I read, that if I came to that fork in the road I’d opt for another diagnostic tool. Frankly, if we’re fortunate, the biopsy may one day be retired from the urologist’s bag of tricks. I really hope so.
 
#4
Beginning to walk the maze with a high and rapid-increase PSA, tentatively committed to biopsy.

I am not trying or wishing to offend anyone by asking this question, but why do biopsies seem anathema for some people? I get that it is another medical procedure, and this one in 2 particularly delicate areas, and that there is a threat of infection. What am I missing in terms of the decision to take a biopsy or not?

Thank you for your thoughts.
 
#5
Beginning to walk the maze with a high and rapid-increase PSA, tentatively committed to biopsy.

I am not trying or wishing to offend anyone by asking this question, but why do biopsies seem anathema for some people? I get that it is another medical procedure, and this one in 2 particularly delicate areas, and that there is a threat of infection. What am I missing in terms of the decision to take a biopsy or not?

Thank you for your thoughts.
Agree. I got one this week on the 18th. Too many guys get all weirded out by the procedure. I’m just going to find out what’s going on. Why wait and risk a bigger problem or live with the worry? I start a course of antibiotics Monday to prep.
 
#6
Beginning to walk the maze with a high and rapid-increase PSA, tentatively committed to biopsy.

I am not trying or wishing to offend anyone by asking this question, but why do biopsies seem anathema for some people? I get that it is another medical procedure, and this one in 2 particularly delicate areas, and that there is a threat of infection. What am I missing in terms of the decision to take a biopsy or not?

Thank you for your thoughts.
Well for some reason I'm somewhat immune to the effects of some anesthesia agents. I don't know what they used when I had my biopsy done but it was one of the most excruciatingly painful experiences of my life. Like someone piercing your anus with a red hot poker 21 times. I almost passed out completely. So yeah, I'm never going to do that again.

I had the same experience when I had a colonoscopy with fentanyl and versed, the fentanyl didn't cut the pain and the versed didn't make me forget it. Next time I had one it was with propofol, a much better experience.
 

DragonBits

Active Member
#7
@CoastWatcher


Congrats on your lower PSA level. You must be relieved.

But I find the whole subject of PSA, prostate and various treatments to be vexing. You would think with BPH affecting 90% of men over 80 science would know more about it.

DHT causes it, but it doesn't, higher estrogen with lower testosterone causes BPH, unless it doesn't, dutasteride can shrink your prostate by limiting DHT, but (everyone fears the possible side effects), raising DHT doesn't increase prostate volume, does that make sense? etc, etc.

Science says that serum PSA levels elevate as prostate volume increases. Though prostatitis can also cause a rise in PSA.

Does that mean your prostate tripled in size when PSA went from 1>2.99 then shrank back to even smaller than a year ago?

I used Life Extension prostate supplement, but I also used Turmeric at the same time. So who knows for sure which (or something else) caused my PSA to decline from 4.2>3.4. I basically threw the kitchen sink at it since my rise from 2.4>4.2 was in 6 months and I just wanted it to stop.

I stopped the LEF supplement since i strongly suspect that was what caused my SHBG to go from 41>66, and 66 is higher than I want that to be. Logically, if logic applies at all, SHBG should go back down.

The TWO THINGS I really want to know?

My PSA had been 2.4-2.8 for twenty years, 5 of which I was on TRT. Suddenly in 6 months it nearly doubled. But this time I added HCG, so that could be it. Or not.

1) So what the hell caused that to happen? (sudden rise in PSA)

2) Is PSA going to stay stable now? Since I don't know for sure what made it go up, hard to tell.

I am also coming around to think the "kiss" prinipal should apply to hormones and some supplements.
Beginning to walk the maze with a high and rapid-increase PSA, tentatively committed to biopsy.

I am not trying or wishing to offend anyone by asking this question, but why do biopsies seem anathema for some people? I get that it is another medical procedure, and this one in 2 particularly delicate areas, and that there is a threat of infection. What am I missing in terms of the decision to take a biopsy or not?

Thank you for your thoughts.
If you don't have insurance or some sort of high deduct plan, a biopsy is going to cost you $800-1700.

Putting that aside, it's my personal opinion that a biopsy is not medically indicated just because PSA rose. If there was an indication of cancer, like a %free test or SelectMDX test, suspect DRE, something else then I would think it's Ok.

A negative biopsy doesn't prove you don't have cancer. A negative result will likely be repeated if your PSA continues to rise.

Also I am not fond taking core samples of internal body parts.

I only got a colonoscopy because everyone said I should, and i only got 1 when I turned 63 and had insurance that would pay 100%. It wasn't bad as they knocked me out, they found zero problems, maybe I will get another for my 75th birthday.
 
#8
Regarding biopsy, I'll be very interested to hear coastwatcher's thoughts, however here's my two cents based on never having gone through such a scare but being superficially aware of potential issues..

- There is a school of thought that says doing biopsies has the the potential to allow a cancer to spread (which is the really dangerous part of most cancers) so I would want to hear really convincing evidence that a biopsy is superior to an MRI and is actually going to lead to an actionable outcome based on my risk tolerance. Aand yes, I know that an MRI doesn't withdraw samples to analyze
- For any test of any kind, my first question is "what actions could I take based on the outcome?". If I thought I had a high risk of cancer I would first go on an even more aggressive anti-cancer program than I already am (such as in questtocurecancer.com) before ever doing any kind of test, since that would be my action if the test was positive, and after having done such a program see if there were still signs of cancer before doing an invasive test
- I would do a decision tree of possible outcomes and if the answer is watchful waiting, then I would watch and wait first.
- Related to the last point, I would get up to speed on current "treatments" and if they all have significant risk of loss of sexual function, I would likely roll the dice and stick to an aggressive anti-cancer program. I am aware of people who followed the standard of care and now have horrible quality-of-life damage so I doubly cautious.
- I am even more distrustful of the urology prostate-chopping industry than I am of the rest of chronic-care medicine industry so I would look for views from outside of that sphere and by no means blindly trust the standard of care.
- As an aside, there was a study several years ago that gave evidence that periodic high pulses of testosterone actually have an anti-PC affect, so if anything, I would add such pulses to my TRT, after researching that further of course.

But most importantly, I'm very happy for Coastwatcher! Congratulations
 
Thread starter #9
Beginning to walk the maze with a high and rapid-increase PSA, tentatively committed to biopsy.

I am not trying or wishing to offend anyone by asking this question, but why do biopsies seem anathema for some people? I get that it is another medical procedure, and this one in 2 particularly delicate areas, and that there is a threat of infection. What am I missing in terms of the decision to take a biopsy or not?

Thank you for your thoughts.
A prostate biopsy is not anathema for me, but in my case - and I only speak for myself - I came to the conclusion that it wasn’t warranted.

I spoke to a classmate, from undergraduate days, who is the head of the urology section at a teaching hospital in Atlanta, a friend, who said that in his own practice he is becoming a stronger advocate for the newer, non-invasive diagnostic tools (one of which I mentioned) for a patient who presents with an elevated PSA that in his clinical judgment is unlikely to result from cancer. No matter how experienced the doctor might be, and using guided MRI support, one can still fire and miss. A cancer-free prostate can not be guaranteed with a pathology report indicating the cores presented showed no malignancy. So...I read and spoke to more people as I waited for the three months to pass before I could run a repeat PSA. The more one learns about the prostate, the more one realizes how the ambiguities associated with the gland and its disorders are maddening. I manage anxiety by learning as much as I can about the challenges I face. In doing so, I end up “owning” my decision and that - in and of itself - limits the fear and uncertainty that health problems can present.

I’ve had bladder biopsies and anal fissures repaired without anesthesia. It’s not the discomfort associated with a prostate biopsy that made me question the procedure. I simply concluded that it would not be necessary for me should further investigation be required. That’s my decision, and others may well reject it with excellent reasons. I don’t know the future, and I may one day find a biopsy is indicated.
 
#10
My #1 reason to avoid biopsy: Inaccuracy;

"As vividly described in a 2002 bulletin from Johns Hopkins University, prostate tumors are like a few small seeds scattered on a large strawberry. Whether a surgeon takes six biopsy samples, or a dozen or more, there's a chance that the cancer will be missed. In a study published in the September 2001 issue of the Journal of Urology, researchers performed biopsies on 820 men who had recently had negative biopsies. In 10 percent of the cases, the second biopsies turned up cancer. According to researchers at the Oregon Health and Science University Cancer Center, however, up to 25 percent of prostate biopsies give a false negative."

Prostate Biopsy

Also, If you have a positive biopsy result, you only have definitive information about the biopsy cores taken, not the other 99.9% of the gland, so Gleason scores are also pretty fickle in diagnostic terms if the biopsy cores miss the worse areas of the gland.

https://www.onlinelibrary.wiley.com/doi/full/10.1002/1097-0215(20001220)90:6<326::AID-IJC3>3.0.CO;2-J

Plus, if your PSA remains high despite a negative biopsy, many uros put you on a repeat biopsy train since they may have missed the first time... or second... or third etc.. I am not ready to submit to that when SelectMDX has 98% negative predictive accuracy.

And, MRI prior to biopsy allows a more accurate "fusion" biopsy where imaging is overlayed with the ultrasound in situ. Well read MRI is better at identifying small tumors, then biopsy can actually target suspect tissue.

MRI–ultrasound fusion for guidance of targeted prostate biopsy
 
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Thread starter #12
Regarding biopsy, I'll be very interested to hear coastwatcher's thoughts, however here's my two cents based on never having gone through such a scare but being superficially aware of potential issues..

- There is a school of thought that says doing biopsies has the the potential to allow a cancer to spread (which is the really dangerous part of most cancers) so I would want to hear really convincing evidence that a biopsy is superior to an MRI and is actually going to lead to an actionable outcome based on my risk tolerance. Aand yes, I know that an MRI doesn't withdraw samples to analyze
- For any test of any kind, my first question is "what actions could I take based on the outcome?". If I thought I had a high risk of cancer I would first go on an even more aggressive anti-cancer program than I already am (such as in questtocurecancer.com) before ever doing any kind of test, since that would be my action if the test was positive, and after having done such a program see if there were still signs of cancer before doing an invasive test
- I would do a decision tree of possible outcomes and if the answer is watchful waiting, then I would watch and wait first.
- Related to the last point, I would get up to speed on current "treatments" and if they all have significant risk of loss of sexual function, I would likely roll the dice and stick to an aggressive anti-cancer program. I am aware of people who followed the standard of care and now have horrible quality-of-life damage so I doubly cautious.
- I am even more distrustful of the urology prostate-chopping industry than I am of the rest of chronic-care medicine industry so I would look for views from outside of that sphere and by no means blindly trust the standard of care.
- As an aside, there was a study several years ago that gave evidence that periodic high pulses of testosterone actually have an anti-PC affect, so if anything, I would add such pulses to my TRT, after researching that further of course.

But most importantly, I'm very happy for Coastwatcher! Congratulations
Thank you for the kind words. They are much appreciated.

As I referenced in an earlier post, I find the only way to deal with the anxiety that follows in the wake of concerning medical news is to become as knowledgeable as I can about the issues I face. I read any and everything I can and make a serious effort to talk to people who know more than I do about the subject, I’m always pleased when genuine experts take a few minutes to respond to a carefully crafted email. Knowledge helps tame the demons.

It’s damned difficult to sort the answers out when discussing these subjects. @DragonBits was not exaggerating by much when he wrote that every statement made about PSA elevation and prostate cancer can be contradicted by another authoritative statement. It would be funny if men weren’t looking for answers to haunting questions.

I understand why a man chooses to undergo a biopsy. I can imagine a situation where I would agree to one. But, as I dug deeper, I realized I was not convinced, not convinced at all, that a biopsy was superior to the newer, emerging diagnostic tools for men in my situation at the present time. Too few positives and far too many known and/or potential negatives.

Of course, I was released from Purgatory’s waiting room - the PSA slid down dramatically. But I may well be back here again.
 
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