PSA Timeline - Feeling Lost

[rlnook1212]

Here are the particulars-

A 42-year-old male and I've been on TRT for 10 years. I am currently on 50mgs a week and test levels 450-500. The first recorded PSA I have is from 5 years ago. Here is my timeline of PSA

Dr A

8/2015 PSA of 1.79 and was using 250 MG a week.

Dr never mentions anything about PSA. I move and start with Dr B

Dr B

5/2016 PSA of 2.20 and was using 100 MG a week

6/2016 PSA of 2.47 and was using 100 MG a week

7/2016 PSA of 2.62 and was using 100 MG a wekk

Dr. B wants to send me for a biopsy immediately

go for a second opinion

Dr C

10/2016 PSA of 2.28 and was using 100 MG a week

Dr. C convinces me to come off trt to which I agree.

I go to a new urologist who specializes in TRT, and I've been off trt for two full months

Dr D

12/2016 PSA of 3.10 and was off trt for two months

1/2016 PSA of 2.50 and was off trt for 3 months

I move again out of state

Dr E

3/2017 PSA of 1.16 and was off TRT for 6 months

Dr E states Test is causing my PSA to grow, and I most likely don't have prostate cancer. Tells me I can go back on test. Sends me to their nurse that handles all TRT. Nurse tells me the Dr is wrong and I should not be on TRT. The nurse tells me if I continue on TRT I will get prostate cancer based on his treatment of other patients. He will not give testosterone.


I find a new Dr

Dr. F puts me on testosterone and agrees that biopsy is being rushed.

PSA grows over multiple visits from 4/2018-8/2020 from 1.16 to 2.47.

I had 4k done (urologist states test is not accurate for my age. It's designed for men in their 60's) and results come back an incredibly low chance of prostate cancer.

During the 8/2020 visit current Dr states, he thinks we are getting close to getting a biopsy, and explains velocity (which I understand), and states let's give it a few more months. He gives an examination in which he states there are no nodules and my prostate however his goal was to try to create the uncomfortable feeling I get when I have to pee but I can't. While examining me he deciphers I am very enflamed as he is pushing all over the place in my ass I think I'm going to piss myself and all over the patient room during this rectal examination.

Dr prescribes flow max which has def helped but I'm still getting up 2-4 times to go to the bathroom. While manageable now there has been a decline in quality of life over the past few months bc of nighttime urination. I can't imagine what this will be like in 5-10 years.

I just had blood drawn yesterday, and go in for results next week. I'm feeling kinda lost right now. In ten years of TRT, I've learned that most of these Dr's have no idea what they are doing. Now in my eyes, I am still near the numbers I was 5 years ago However I cannot deny that my PSA has doubled in 2.5 years.

While I am still active my physique is limited bc I am at a 450-500 test level. I have been thinking of coming off trt again to see what will happen with numbers. I have two very young children and I can't help but think I am playing games with their lives.

Thoughts, insight, and or feedback? Hit me with brutal honesty please

 

[Blackhawk]

Welcome to the PSA/prostate rodeo.

Unfortunately there is not a simple answer FOR YOU. You are going to have to do some homework. However, this EM prostate forum is a good starting place.

I personally have been though this and am a unicorn as to cause of my high PSA which has reached as high as 9.2, but I do not have prostate cancer.

A couple things:

You had 4K. This is important and though not 100% certain based on this result, you have a very low likelihood of PCa (prostate cancer).

That your PSA has not been on a slow steady increase, rather has been a bit up and down is not typical of PCa. Again that's not 100%, just a data point.

The current well founded theory of Testosterone "stimulation" of prostate growth and cancer is a saturation model: At total testosterone levels of around 200-250, your prostate cell receptors are saturated with testosterone. Higher blood levels do not create more saturation. But if you are that low on Testosterone and probably hypogonadal, you are at higher risk for PCa. So if by stopping TRT your TT drops that far. there may be a bit of turning the receptor effect on and off. So the question is, when you are off TRT what's your TT level?

You have had a wide range of input from a range of doctors, I believe the take home point here is that you can see by how different their opinions are. This reflects how potentially up to date vs archaic their knowledge is. Any doctor who is screaming biopsy at you when your PSA is in the 2's to me is not up to date. Find the Morgentaler videos linked from this forum, and here is another that is quite comprehensive and very much worth watching in its entirety:

This more specifically pertains to the TT vs biopsy question:

Also, it appears that this situation has developed slowly for you. That is good. Don't take any alarmist attitudes form doctors or nurses as a reason to feel rushed in your research or decision making.

I think reading @Orrin Israel 's story could be pretty illuminating for you.

Read @Nelson Vergel 's posts about causes of prostatitis as well.

 

[broker]

Normally your psa wont go up and then down with pc. I am guessing you have an enlarged prostate and your prostate is very sensitive to dht.
think about this: some men go bald with a T level of 250 ng while others dont see any hair loss until their T levels are over 600. The same applies to the prostate because its all about DHT. Finasteride proves this. How ? your prostate shrinks after using finasteride for 3-6 months and finasteride significantly lowers dht and nothing else.
also, the fact that flomax works tells you your prostate is enlarged. Going on T prematurely enlarges the prostate in some people. Some men who ordinarily wouldnt go bald until 50, start losing their hair at 40 when usung T, again, same with the prostate ( in some men ). Prostate enlargement is manageable. the larger your prostate gets, the higher the Psa.
how big did your Uro say your prostate was ?