Slightly elevated PSA, ADT, and PC

[evansjamesk]

64yo male, 210 lbs, no ED issues.

For about a year my PSA has been hovering around 4.22. Both my PCP and Defy will not continue to prescribe testosterone unless testing shows me clear of prostate cancer (PC). I was referred to a urologist and had my appointment today.

The NP stated "Testosterone does not cause prostate cancer, but giving someone testosterone who has prostate cancer is like throwing gasoline on a fire." I told her that current research shows little to no relation between TRT and PC, but she unequivocally stated that all of the current meds rely on androgen deprivation therapy (ADT) to stop prostate cancer, and admitted that it's a type of castration. She was open-minded enough to give me her email address so I can send her some research articles refuting her claim. She said that I'm welcome to send her the studies but she doubts it'll change their approach.

I have scheduled an MRI for late December, with the results leading to a possible prostate biopsy. I'll go along with the MRI, but am unwilling to submit to a biopsy for several reasons. It's not entirely accurate, risks allowing escaping cancer cells to enter the bloodstream, can lead to ED, and can lead to incontinence. When 75% of prostate biopsies come back negative, it seems to me that the risks outweigh the potential benefits.

In the event the MRI indicates I need a biopsy, and I'm reluctant to have it done, what are my options and what should I tell my urologist and PCP?

 

[aneuman]

I have BPH. 1 month after starting TRT (TCyp. 100 mg/wk) my PSA jump from 2.6 to 3.14, 3 months later it was 4.05. Went to the Urologist and the NP told me "you have to stop TRT", I told her that TRT was not for fun, that it was a medication I took for a reason and the decision to stop it should be taken that lightly, as there other problems associated with stoping it. She told me "talk to the doctor" and went out of the exam room. Doctor came in the office and said, "don't stop. Let's do a course of CIPRO, 500 mg 2 x day (a heavy dose) for 15 days". He advised me not do do exercise or have sex 48 hours prior to the next test. When I repeated the test PSA was 2.89.

In her defense, he told me: "If this was a urology exam, her answer is correct, that's the standard protocol, but you're probably not the case, and I also have people with PCa on Testosterone, let's do this first, if PSA doesn't go down, then we need to look more into it and it may be possible that you have to stop, but let's wait until we get there."

Just an anecdote, but it shows the similarities and course taken, FWIW.