PSA over 5 and now off TRT

[jsr0367]

Been on Test Cyp for 2 years and for the most part my dose has been consistently low. At a trough my T was 297. After complaining to my Uro that I was still fatigued and needing more sleep he bumped me to 180mg weekly from 150...every month i would be increased 10mg to gauge how I feel. Finally at 180mg I inject in the quad muscle with a 22ga needle.

I feel much better....then the bloodwork came in and visit with Uro:

Test: 507 - up from 297 from 3 months ago
Estradiol (not sens) 29 up from 16 from December
PSA: 5.83 up from 3.60 from December
HCT: 50 down from 53 from 3 months ago

I usually hover in the 3.5-3.8 range for PSA for years. I am 50 always had a high PSA except for 2/2015 when I had a round of Cypro which dropped it to 2.70.

Yesterday he told me that we need to stop TRT cold turkey, do 3 weeks of Bactrim and wait 4 weeks and test PSA again.

He said that if the PSA does not drop then biopsy will be required.

These are words I did not like to hear.

Any thoughts on this

 

[user_joe]

Been reading up on this a good bit due to issues my father had similar to yours. He is older. His psa had trended higher gradually like yours. A physical exam revealed there was actually something. They did a biopsy after that and did find cancer. Fortunately it's so minor it's not treated at his age. Kinda hard to wrap your head around that.

Stopping trt trt makes no sense to me u less I'm missing some other factor to consider. It's been proven that test is not the gasoline on the fire that docs thought for decades. Yes, they can shrink tumors by zapping all your test, but to then conclude higher test equals more growth has been proven wrong. I can find the info on this if it's not common knowledge here.

 

[jsr0367]

That was my thinking. He said going off the Test for a month to see if things reduce while on the antibiotic. He did an exam and said it is a little enlarged but I am always enlarged and felt no nodules and felt it was normal. He feels it is an infection. He said that I will feel good for two weeks and then crash. He is hoping to put me back on TRT is the PSA comes down.

 

[Vince Carter]

Having sex/orgasm within 48hrs of a PSA blood test can give a false report...did you have sex.orgasm prior to your test(s)? I would retest given the sudden jump, abstain for at least 48hrs and fast 8-10 prior to your blood draw, and be well hydrated (water only).

I would not panic over one test that suddenly jumped for no other reason.

 

[jsr0367]

Vince,

Thank you so much for your reply. Wife and I were very naughty. Blood was taken on Saturday and we messed around Thursday (2x) and Friday (2x). I am also a cyclist and rode on my bike most of the week for 20 miles each day. Thinking that may contributed. I am going to lay off the bike and the wife for about 4 days before my retest.

My uro refused to retest but I saw my GP who felt a retest was in order to check the wacky result and to put my mind to ease.

My uro is already looking at biopsy because of the jump in PSA but 1st we are treating for infection using Bactrim.

 

[JPB]

Wow congrats that's a lot of sex still happening for you. But that would have almost certainly accounted for the spike in PSA. Unless that's normal for you before each test.

 

[user_joe]

Not saying it can't happen, but I wouldn't put a huge hope in ejaculation being the cause of an elevated PSA. Not saying it doesn't happen, but I've never seen a concerned person follow up with another test after abstinence with better results. I've also not seen a difference on my own tests.

Best of luck to you. If you read the statistics on this stuff odds are very much in your favor of this being a non issue. Then even if it were cancer again odds are it's super early and very treatable.

 

[johndoesmith]

Not saying it can't happen, but I wouldn't put a huge hope in ejaculation being the cause of an elevated PSA. Not saying it doesn't happen, but I've never seen a concerned person follow up with another test after abstinence with better results. I've also not seen a difference on my own tests.

Best of luck to you. If you read the statistics on this stuff odds are very much in your favor of this being a non issue. Then even if it were cancer again odds are it's super early and very treatable.

I think it might be from the bike riding, 20 miles is a lot and putting all that pressure directly on the perineum might cause the PSA elevation.

 

[madman]

Vince,

Thank you so much for your reply. Wife and I were very naughty. Blood was taken on Saturday and we messed around Thursday (2x) and Friday (2x). I am also a cyclist and rode on my bike most of the week for 20 miles each day. Thinking that may contributed. I am going to lay off the bike and the wife for about 4 days before my retest.

My uro refused to retest but I saw my GP who felt a retest was in order to check the wacky result and to put my mind to ease.

My uro is already looking at biopsy because of the jump in PSA but 1st we are treating for infection using Bactrim.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572135/
https://www.ncbi.nlm.nih.gov/pubmed/21246346
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4813236/

 

[lexer]

Age again?
your prostate is a little enlarged?
any issues with urination?
Ever get DHT levels checked? Hair loss issues?

 

[jsr0367]

50....uro said it is slightly enlarged but nothing major...typical for my age. I was experiencing frequent trips to bathroom.
No DHT

 

[jsr0367]

One week in after starting Bactrim. PSA is down to 4.41. My GP ran some other PSA tests: PSA Complex (3.75), PSA Total (4.41), PSA Free (.66) and Percent Free (15.0). Two more weeks of the antibiotic and then another round of tests one week after. Crossing my fingers (and toes).

 

[jsr0367]

So my PSA issues have returned. My recent PSA (today) has be at 4.91. I have noticed a trend that my PSA is up when my estradiol is higher. My doctor dismisses that correlation. Thoughts? He is most likely going to biospy this time.

 

[CoastWatcher]

So my PSA issues have returned. My recent PSA (today) has be at 4.91. I have noticed a trend that my PSA is up when my estradiol is higher. My doctor dismisses that correlation. Thoughts? He is most likely going to biospy this time.

A biopsy may not be an unreasonable course of action at this point, though I am sorry you have to face one. You will answer the question that looms over both you and your doctor. I am not familiar with any link between PSA and e2. Perhaps you could pose the question in Dr. Rotman's thread where he responds to member questions.

 

[OMI100]

FWIW
This is short version
Rising PSA.
I had issues and my thyroid DR put me on Doxy 2Xday for 30 days.
PSA went down.
URO appointment time.
I had rising PSA.
I had an infection.
Bactrium is their first choice.
Did not work.
Lets do biopsy.
No.
Lets do 4K blood test. (look it up)
O.K.
Good results.
PSA went up.
Put on CIPRO 21 days.
Nothing.
PSA still high.
Lets do biopsy.
NO.
Lets do a 3T-MP-MRI of the prostate. (research it)
Nothing big jumped out.
Tried Ceftin.
Tried Bactrim.
PSA still high.
Still have infection. (I think I covered this part in another tread)
Lets try DOXY again as it seemed to work months ago.
PSA 7.9. Started Doxy 100mg 2Xday. (10/11/17)
PSA 5.4 after month. Still on Doxy. (11/16/17)
PSA 4.9 (12/5/17)
PSA 5.8 (12/15/17)
1/12/18 did another PSA. Should get results Monday or Tuesday. Just finished Doxy.
You can order your own PSA test in most states. Cheap. Get results in a few days.
I would ask for a 4K blood test if the meds don't drop it back.
I would also ask for a 3T-MP-MRI of the prostate before a biopsy.
If you do need to get a biopsy understand the different types that are out there.
You can get an MRI guided biopsy based on the 3T-MP-MRI.
You can get a "live" MRI guided biopsy where you are in the MRI and the biopsy is "taken real time" as you are getting the MRI.
a LOT of great info from a LOT of folks at this site:
https://www.inspire.com/
Join the Prostate Cancer Community and look around.
Search 4K blood test.
Search 3T-MP-MRI.
I am sure others here that have more experience with this will chime in.
Bottom line is to do your homework and understand everything before you commit to anything.

 

[BryanW]

I have elevated PSA (~5) and a large prostate (~50cc whereas normal is 15-30cc). A larger prostate will make more PSA, so PSA density can be relevant: for example mine is 0.1 PSA/cc whereas "normal" could be as high as 0.267 (4 PSA/15cc).

Regardless, I'm fairly confident I have an infection in prostate. Heres hoping you are in the same boat.

I did 3 weeks of Cipro with no response, but antibiotics aren't guaranteed to work. Prostate drainage seems like something worth trying, but I can't bring myself to do it and I'm not going to ask my spouse either.

 

[OMI100]

BryanW,
The only antibiotic that seemed to work with me was Doxy.
See if your DR will let you do a test run?
My thyroid DR is an old Air Force DR.
Like the insurance commercial .... He has seen a lot.... And he knows a lot...
Says it is hard to get over an infections due to the makeup of the prostate and the fact it is hard to get the antibiotics into every nook and cranny. Easily takes a month or more of treatment. All you have to do is NOT kill all the infection, and leave a very little behind, and you have recurrence. His experience is that some men end up having new infections, and need to be on a maintenance dose of Doxy at that point to keep it from recurring.

 

[jsr0367]

Doctor called me today and he feels that based upon the DRE back in january and over the last 3 years he feels that I have a pesky infection. My family Hx has no Prostate cancer and my dad has a large prostate and has the recurring prostatitis problem as well...now in his 70s. So for now i am on Bactrim for 3 weeks and a f/u in 4 weeks with labs.

 

[OMI100]

Doctor called me today and he feels that based upon the DRE back in january and over the last 3 years he feels that I have a pesky infection. My family Hx has no Prostate cancer and my dad has a large prostate and has the recurring prostatitis problem as well...now in his 70s. So for now i am on Bactrim for 3 weeks and a f/u in 4 weeks with labs.

If the Bactrim does not lower your PSE try another antibiotic. ONLY one that worked for me was Doxy. BTW 3 weeks was not even close to getting me back down. Last 2 PSA test were:
5.3 (2/14/2018)
5.4 (1/17/2018)
I track my own PSA after that jump to 8.1 now and will retest in a month or so. As noted above you can order your own PSA blood test in most states and the cost is reasonable. If I ever see a sky rocketing rise I will get a bit more concerned.
Also saw my NEW (OLD guy) Uro, and he was not concerned based on the data he saw and the obligatory DRE

 

[Virginian]

Not saying it can't happen, but I wouldn't put a huge hope in ejaculation being the cause of an elevated PSA. Not saying it doesn't happen, but I've never seen a concerned person follow up with another test after abstinence with better results. I've also not seen a difference on my own tests.

I had a high PSA (5) after sex the night before. Since then it has always been back to my normal range (about 2).