TRT and PSA
- 07-24-2007, 08:54 PM
TRT and PSA
I am on TRT using 50mg of test cyp every three days and 250IU of HCG the two days in between. I also use .25mg Arimidex every three days.
I just had to switch Urologists (previous Doc moved) and upon first visit had blood work done. My PSA came out at 2.7 (range 0 - 2.2). He wants to do an ultrasound and biopsy.
From what I have read, the elevated reading could be partly from the DRE (negative) that he did a few minutes (maybe 15 minutes) before the blood draw. I just can't get too excited about going in for a biopsy - it sounds like no fun at all.
I told him that I was going to think about it and get back with him. How does it sound to get retested in a week or two, making sure to not have any prostate stimulation (including orgasm) for a few days before the blood draw?
- 07-24-2007, 11:25 PM
- 07-25-2007, 08:00 AM
Why not repeat the PSA test, do the ultrasound and take it from there ?
07-25-2007, 06:08 PM
If I need the biopsy, I'll jump right in and go for it. I am just not convinced at this point and don't feel any sense of urgency. As always, someone please straighten me out if I am looking at this wrong.
07-25-2007, 08:20 PM
was a PSA done before TRT was started? Are there a few data points to get some sense of acceleration of PSA?
07-25-2007, 08:49 PM
07-25-2007, 10:21 PM
Aug. 06 2.0 (no range provided -just before start of TRT)
Feb 07 2.6 (0 - 4)
July 07 2.7 (0-2.2) (Few minutes after DRE)
Thanks for the replies to all.
07-26-2007, 10:24 AM
07-26-2007, 12:19 PM
The Aug6 reading doesnt have a range specified. Assuming 2.2 its high, 4.0- ok. So reading is meaningless insofaras identifing a trend goes.
Feb7 isnt high either- pretty close to the mean too.
The jly7 reading is the one thats atypical and suspect due to the digital exam at that.
Its possible tht your are over converting the T to DHT and that is responsible for the elevated Jly reading.
So if the next one is high, it might not truly indicate your condition and you might take measures to lower the DHT and retest again after a month.
07-26-2007, 01:59 PM
Researchers at Memorial Sloan-Kettering Cancer Center have pioneered the use of computerized devices to help patients and their physicians decide among the major treatment choices for several cancers.
Rather than relying on general risk groups of patient populations who share similar characteristics, our prediction tools provide specific
Sloan-Kettering - Prediction Tools
Cancer Information > Prediction Tools
Sloan-Kettering - Prediction Tools: Prostate Cancer
PSA Doubling Time
To use and complete the PSA doubling time portion of the nomogram, you will need to know the following information:
at least two PSA test results
the date the tests were taken
For the last, probably, 10 years, every 6 months I go to Sloan Kettering to check on my prostate.
I just graduated to once/year visits, hope it will stick.
I am not telling this doctor about my TRT, we would not understand, but I think TRT may be the reason for my improvement.
My blood is drawn as I come to the office.
Coffe is available, often I have a cup before draw.
Sex could elevate readings.
DRE happens when I see doctor, usually 1/2 hour after blood draw.
% free PSA
Important is rate of increase between each of the two adjacent dates, you may want to repeat your PSA test and if largely different ask doctor to either remove the previous test or make a note next to it.
I had about 6 biopsies, usually 8 shots in each segment of the sphere plus about 4 shots at "suspect" areas at the discretion of a doctor and the guy who operates ultra-sound machine.
I drive back home myself but my wife is present (not really reqd.).
Bleeding for about day or two, usually less.
Bleeding thru seminal fluid up to 3 weeks (use condom, mess).
Morning before biopsy one pill 500mg Cipro
Three more Cipro pills the following three days.
Overall, biopsy is no never-mind in great scheme of things.
OTOH, my friend in Poland had prostate biopsy.
Had to stop half way due to excessive bleeding, 4 days in a hospital.
This was his second biopsy. Prior one done in Germany, no never mind, so he was really surprised with the second one.
Not sure if it is about technology level as the instruments looked similar to him.
He had sewere prostatitis at the time, may contributed.
Currently he is about two years after radical prostatectomy.
Rather extensive cancer, they waited until his PSA was about 20.
I do not think Sloan Kettering doctor would waited that long.
08-10-2007, 09:30 PM
Thanks for the help guys.
I had another PSA done today. I made sure not to have an orgasm for three days prior, made sure I was well hydrated (why not), and did not have a DRE prior to the blood draw. The only thing that I did related to DHT was to lower my T shots a nats ass for the last few shots. I do convert a lot to DHT. My only test for DHT came out well over the range months ago. I can look it up if it is relavent.
Today's test came out at 2.4 (range 0 - 2.2).
So I guess I should go ahead with the sonagram and double check with the doc about what he felt on the DRE as Headdoc suggested - does that sound like a plan? Or is it silly to take it further, since I am just barely over the range?
08-11-2007, 08:33 AM
It is up to 4 (four)
At your PSA level 2.4 and any other lewel, also important is PSA velocity, how quickly PSA changed with time, also (% free PSA).
Sonogram will probably help you very little.
When you have that sensor up your rectum, you may as well go for biopsy.
08-11-2007, 06:10 PM
The doc hasn't mentioned % free PSA. I don't yet understand it if there is much value in getting that test done at this point.
And now that I understand the probe would go up my rectum, I'm no longer thinking that it would be fun with that cute nurse. I was thinking more along the lines of a cute nurse using a vibrator (sonogram probe) between my sack and anus.
08-11-2007, 07:58 PM
08-15-2007, 10:21 PM
The proceedure would be done in central Illinois.
The docs office called today and said that they still recommend the biopsy. I said that I was thinking that the elevated reading was from my TRT. I got no response - not sure if she knew what I was saying.
I said that I didn't understand the range of 0 - 2.2 and that I was used to the range being 0 - 4.0. She said that it was different ranges for different ages. She gave an example (that I don't remember now), but at this point, since I have not heard of differing ranges for different ages, I was pretty much done with talking with her (maybe she was right and I am wrong). I agreed to an appointment next week to talk to the Urologist.
Call me a ***** - I am in this case - I just don't relish the thought of needles being poked multiple times in such a sensitive area. I just am not concerned with the PSA reading at this time. Is that foolish?
My understanding is that biopsies as a result of elevated PSAs are only positive around 30% of the time. I would think that the percentage would be much lower at the 10% elevation that I have - PSA of 2.4 on a range of 0 - 2.2. Am I making sense or just talking myself out of a proceedure that should be done and is not that much torture to begin with?
08-16-2007, 12:03 AM
I looked up my DHT test -
DHT 983 (155 - 553) December 06
This may have been before my test cyp was increased from 43mg to 50 mg every three days. In other words my DHT may be higher now. It has only been tested once. Is this likely to be significantly raising my PSA level?
08-16-2007, 11:38 AM
08-16-2007, 11:58 AM
08-16-2007, 12:58 PM
My convenient central location at cross roads of 4 or 5 major highways, was good for jobs hoping while I was working.
It is still good location, not only for ease of finding local entertainment but also good medical care is at hand.
08-16-2007, 07:46 PM
Is the elevated DHT harmful or does it just elevate the PSA reading?
I get acne on my chest and back and I imagine it is related to the DHT and am certain it has started with the TRT FWIW.
08-17-2007, 04:40 PM
We should start with compounding Pregnenolone cream. It is now a mainstay in all cutting edge HRT programs.
Then when new BW is administered we can see if low dose proscar is needed.
Do not buy into the fear of proscar. Many who have had issues with it was due to driving DHT into the ground. They had no BW to base proscar dosages on and were basically blind in the dark in what to do. Not only does proscar lower DHT but it also acts as a 5 alpha inhibitor, which is a nifty thing to do. 5 alpha inhibition will prevent FT - DHT breakdown in the scalp(balding) skin(acne) and prostate(BPH)
It is very likely that pregnenolone alone will do the trick.
08-17-2007, 09:09 PM
I found with my use of AndroGel that I didn't absorb well. I have to assume that I would not absorb the pregnenolone cream well either.
I have pregnenolone in 10mg tablets. How should it be taken - dosage/frequency - to be effective at reducing DHT in the prostate?
I have also been considering Saw Palmetto. Would that be good in my case?
08-17-2007, 10:55 PM
what is the dose of pregnenolone recommended or is it matched to the level of DHT?
08-18-2007, 06:42 AM
Androgel vs shots
Pregnenolone cream vs pills
I still bet on pregnenolone cream.
Hopefully I will know better on my next blood test.
Previously, on pills, I was low
Pregnenolone=23 ng/dL(10–200) LEF’s Optimal Range: (100–170) ng/dL
your absorption may be not as you wish it should be, but it still should be better than on pills.
I was also low on DHEA, while eating over 300mg/day DHEA pills for couple of years.
That changed to 3x over the range in DHEA after I went on prescription compounded pregnenolone cream
100mg/1gram, used 1gram/day
09-04-2007, 07:49 PM
I had the follow up with doc today. He is OK with waiting four months (his idea) and doing the PSA test again and I told him that I was going to back way down on my test cyp. dose before the PSA test. He was OK with that as well. He didn't comment when I said that I had heard that high DHT can cause an elevated PSA reading.
That's the end of the good news. He said that he looked up that web site that I gave him - www.allthingsmale.com - and said that he was not comfortable with the treatment at all. I asked what he was not comfortable with. He said all of it. I said that he had just said that he was OK with prescribing test cyp. He said yes, but he was not comfortable with the rest of it. Well the rest of it is Arimidex and HCG. I said that I could not tell that the HCG was doing anything for me, but that I wanted to keep using the Arimidex to keep my estradiol down that I had read that elevated estradiol can cause cancer. He said that he wasn't aware of that.
He wants me to see an endocrinologist. There's only a couple in town. I said how about me finding one in St Louis and he is OK with that. Anyone know a good hypogonadism doc in St. Louis? Not at all necessarily an endocrinologist.
09-04-2007, 09:13 PM
you have got doc who is going to give you script for Depo_test.
If he is going to give you a script for all the blood tests that you ask for, you have made it.
HCG, you do not really need, Anastrozole, hey, you got the best price in town on that one.
Same goes for Armour, if you need that one.
I did not follow the PSA discussion.
I have PSA=4.2
Was scared sh** less, went thru few prostate biopsies just to ease my own mind.
I newer told my urologist at Sloan Memorial that I plan on using testosterone, he would have had heart attack.
09-04-2007, 09:25 PM
The problem is that he wants me to find another doc. I guess I could just accept his treatment on the test cyp and not mention the estradiol control. The only test for estradiol under his care has been at my request. He wouldn't know or care any different.
09-05-2007, 08:43 AM
Hi have given me as much Androgel as I asked for and any blood test I asked for. And that was it, no injections no nothing else. But I still say that that was a lot, it helped me to pull thru these years. Luckily I respond wery well to Androgel and have a prescription plan that pays for it, so I did not went broke buying it.
Just do not bother him anymore with requests that you already know he will not help you with.
Keep smile on face and have a printed list with blood test request.
Last time, new doctor, I e-mail my request for blood test, exactly as I want,
he just printed it on his stationary and signed.
He also put words "Blood test" on blue script form and signed.
Two minutes of work for his nurse and 10 sec for him.
This is how it looks:
C-reactive protein CRP
Lipoprotein (A) Lp(A)
Estradiol, Free, LC/MS/MS (36169X)
Estrogens, Fractionated, LC/MS/MS (36742X)
Estrogen, Total, Serum (439X)
Testosterone, Free, Bio/Total (LC/MS/MS)
Dihydrotestosterone, Free, Serum (36168X)
257.2 Other testicular hypofunction
272.4 Other and unspecified hyperlipidemia
601.9 Prostatitis unspecified
780.4 Dizziness and giddiness
780.79 Other malaise and fatigue
788.41 Urinary frequency
253.3 Adult Onset Growth Hormone Deficiency
255.8 Other specified disorders of adrenal glands
253.3 Adult Onset Growth Hormone Deficiency
I had blood drawn for this test last Thursday at Quest (my day of T+hcg shots).
Was there before shots.
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