I started out back in 2014 with my PSA at 1.4. I was 59 and my testosterone level was 150. So, I went to a TRT clinic and I started at 100 mg per week. I eventually adjusted to 60mg per week, a very low dosage, but it got my testosterone up around 600 and I felt fine. My PSA jumped to 2.2, but it was 3 years later, I was 62, my DRE was normal, I had no family history of cancer at all and my Urologist was not concerned. He is on TRT as well, and does not buy into all the TRT causes Prostate cancer hype.
That said, I was cruising along until about a year ago. My PSA suddenly jumped from 2.2 to 5.1. A retest had it back to 2.4. The next draw a couple months later had it up to 5.8, then back down again after that. Mind you, ALL of those tests were 4K tests and each one kept saying I had less than a 5% chance of finding prostate cancer on biopsy. I had no BPH symptoms and prostatitis was ruled out on testing.
Finally, my Urologist ordered an T3 MRI for me to see WTF was actually going on. Sure enough, there were 3 small areas, two at PIRADS 3 (maybe cancer, maybe not) and one at PIRADS 4 (most likely cancer). That, of course, triggered a biopsy--thankfully, a fusion biopsy, using the MRI image for guidance (most guys get a blind biopsy which could miss things) which returned a finding of Prostate cancer, low intermediate risk or Gleason 7, for those who know what that means (3+4).
My Urologist told me straight away that the TRT did not cause my cancer. However, with a positive finding, it COULD possibly fuel it, so I should stop. But I was way ahead of him, and had quit cold turkey right after the biopsy, about 5 months ago now. No sense possibly making things worse.
I'll be seeing a Radiation Oncologist next week to set up Cyberknife as my treatment of choice. Thankfully what I have is not very aggressive and is contained to the Prostate, so I should be fine. My Urologist said that if I show steadily low PSA numbers for 9 moths to a year following treatment, I could possibly go back on TRT if I so wished. I don't know. I'll see. Frankly, I don't feel all that bad, probably because my dosage was so low for so long anyway. My motivation in the gym is a little lower and my libido is definitely lower, but it's hardly the "living hell" I was expecting.
TRT does NOT cause Prostate cancer. It MIGHT, however, fuel it if you already have it. In my case, at least in the short term until I muzzle this rabid dog inside me, I decided not to hedge my bets. Make sure you are getting your PSA checked at least every 6 months and a DRE every year, especially for you over 50 types. Ironically, had I NOT been going to a TRT clinic, I STILL would not know I have cancer because my Doctor back 6 years ago was one who bought into that "PSA test unnecessary" bullshit from 2012. I'd still be going to him and still not getting a PSA test or DRE since I am totally a-symptomatic and have zero family history of ANY cancer at all--and that's with 3 of 4 grandparents living into their late 90's, my mom in her 90's and my dad never even having BPH symptoms before he passed at almost 80.
PSA tests are notoriously sketchy, but they are still the first alarm that something may be up. If this is caught early, you have a 95% chance of living at least another 15 years, probably more. Don't get spooked by a high PSA, but don't ignore it either. It doesn't necessarily mean cancer, but it could. Be smart. Get tested.