TRT and PSA

[kincaiddave]

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. :sad:

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?

 

[nallepuh]

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. :sad:

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?

Last i heard psa wasent a good marker for prostate cancer but think its best to do what yr doctor think its best. And changing yr daily/weekly pattern to possibly reduce a value in next blooddraw sounds really dumb, its like cheating yrself? if u indeed have values that alerts the doctor wouldent u like to know the end of it?

 

[zkt]

Why not repeat the PSA test, do the ultrasound and take it from there ?

 

[kincaiddave]

Last i heard psa wasent a good marker for prostate cancer but think its best to do what yr doctor think its best.

I have also heard that PSA is not the best to rely on. The problem is that I CERTAINLY don't know enough about it being a poor marker to ignore it.

And changing yr daily/weekly pattern to possibly reduce a value in next blooddraw sounds really dumb, its like cheating yrself? if u indeed have values that alerts the doctor wouldent u like to know the end of it?

I don't believe that I need DRE stimulation for the PSA test to be accurate. It is not a part of my daily/weekly pattern. That area for me is exit only except in the doctor's office. I have read several places that it is necessary to avoid orgasm for 24 hours or more to have an accurate result on PSA. Someone please correct me if I am wrong.

Why not repeat the PSA test, do the ultrasound and take it from there ?

I agree - kinda what I was thinking. If it's a cute nurse doing the ultrasound, it sounds like fun. On the biopsy, it doesn't matter what he or she looks like......

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.

 

[Headdoc]

was a PSA done before TRT was started? Are there a few data points to get some sense of acceleration of PSA?

 

[cpeil2]

I.



I don't believe that I need DRE stimulation for the PSA test to be accurate.

As a matter of fact, I think it would raise your PSA so that the test result would not be valid.

 

[kincaiddave]

was a PSA done before TRT was started? Are there a few data points to get some sense of acceleration of PSA?

May 05 1.26 (0-2.2)
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)

As a matter of fact, I think it would raise your PSA so that the test result would not be valid.

I'm hoping that it raised it enough to explain the higher reading although I can't deny the trend somewhat established before the last test. I know that I can't rest on that hope and just let it go, it's just that I'm not ready for the biopsy based on a possible false test - not after what I've heard about the biopsy from others.

Thanks for the replies to all.

 

[Headdoc]

May 05 1.26 (0-2.2)
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)



I'm hoping that it raised it enough to explain the higher reading although I can't deny the trend somewhat established before the last test. I know that I can't rest on that hope and just let it go, it's just that I'm not ready for the biopsy based on a possible false test - not after what I've heard about the biopsy from others.

Thanks for the replies to all.

I found this as a useful summary of the state of affairs regarding PSA. I hear better tests are on the way. Other test to consider, are free and total PSA. Consider, if you haen't already, getting DHT (some will say this is useless) and better blood and urine evaluation of estrogen and all of its isomer. Rhein lab or ADL do these tests. Ask you doc if he felt anything unusual on the DRE. Ask the doc if there was a noticeable enlargement (BHP). Have you had a case of prostitis? Did you have sex the day before the evalution? Did you exercise the day of the evaluation? Did you drink coffee before the evaluation? Caffeine in signficant amount irritates my prostate. One urologist told me a few years ago to cut back or eliminate caffeine. I've listened and not listened to that advice.:think:


http://www.cancer.gov/cancertopics/factsheet/Detection/PSA

 

[zkt]

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.

http://www.mesomorphosis.com/articles/scally/ask-michael-scally-02.htm

 

[JanSz]

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


Prediction Tools
Sloan-Kettering - Prediction Tools
------------------------------------------------------
Cancer Information > Prediction Tools
Prostate Nomogram
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.
Test shows
PSA
and
% 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.

 

[kincaiddave]

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?

 

[JanSz]

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?

Where from have you got PSA(range 0 - 2.2).

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.

 

[kincaiddave]

Where from have you got PSA(range 0 - 2.2).

It is up to 4 (four).

The lab is where the range came from. I am now wondering if the range is lower because of the way that they test or if it is because they have lowered the range because of a new philosophy that believes that use of the lower range will lead to more cases of cancer found earlier as discussed in one of the above links.

At your PSA level 2.4 and any other lewel, also important is PSA velocity, how quickly PSA changed with time, also (% free PSA).

As far as velocity, I am within the .75/year suggested in the above links.

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.

Sonogram will probably help you very little.
When you have that sensor up your rectum, you may as well go for biopsy.

I think I am understanding this better now. The sonogram by itself is of no value. It is used to guide the doc when doing the biopsy. Is this correct?

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.

 

[JanSz]

The lab is where the range came from. I am now wondering if the range is lower because of the way that they test or if it is because they have lowered the range because of a new philosophy that believes that use of the lower range will lead to more cases of cancer found earlier as discussed in one of the above links.



As far as velocity, I am within the .75/year suggested in the above links.

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.


I think I am understanding this better now. The sonogram by itself is of no value. It is used to guide the doc when doing the biopsy. Is this correct?

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.

If there are any doubts I would favor biopsy.
I want to repeat, in USA it is not a big deal.
What country would you have this biopsy done?

Western----Yes
Eastern----NO, NO, NO

 

[kincaiddave]

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 pussy - 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?

 

[kincaiddave]

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?

 

[plymouth city]

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?

Yes.

What steps are you taking to reduce DHT to safe levels?

Preg cream + Low dose proscar is first choice

 

[cpeil2]

Western----Yes
Eastern----NO, NO, NO

If the technology and the procedure are the same, the variable is the doctor's skill and experience.

Assuming the same technology, the butchering your bud in Poland got was because the biopsy was being done by an unskilled practitioner.

 

[JanSz]

If the technology and the procedure are the same, the variable is the doctor's skill and experience.

Assuming the same technology, the butchering your bud in Poland got was because the biopsy was being done by an unskilled practitioner.

I am retired, I can make my residence anywhere I want.

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.

 

[kincaiddave]

Yes.

What steps are you taking to reduce DHT to safe levels?

Preg cream + Low dose proscar is first choice

I am currently taking no steps to reduce my DHT. I haven't felt the need or desire to lower it. Is that a mistake? I have a lot to learn on DHT!

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.

 

[plymouth city]

I am currently taking no steps to reduce my DHT. I haven't felt the need or desire to lower it. Is that a mistake? I have a lot to learn on DHT!

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.

Pregnenolone - Pregnenolone is now added in most cutting edge HRT programs like Dr John uses. Pregenelone causes a small rise in progesterone, which helps prevent T to DHT conversion, so with the addition of preg, DHT is kept in check. Pregenelone also fills in metabolic pathways and causes a rise in not just T, but an increase in other androgenic hormones such as the various andros, DHEA and others. Very ingenious.

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.

 

[kincaiddave]

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?

 

[Headdoc]

what is the dose of pregnenolone recommended or is it matched to the level of DHT?

 

[JanSz]

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?

All is relative. Road to the blood stream is important.

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
--------------------------------------------------------------------
Relatively,
your absorption may be not as you wish it should be, but it still should be better than on pills.
Increase dose.
=========================================================
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

 

[kincaiddave]

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.

 

[JanSz]

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.

Hey, Dave;
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.

 

[kincaiddave]

Hey, Dave;
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.

I guess you have a good point.

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.

Thanks,

Dave

 

[JanSz]

I guess you have a good point.

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.

Thanks,

Dave

That is exactly what my GP was doing for over three years.
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:
------------------------------------------------------------------
Copper, serum
Ferritin
C-reactive protein CRP
Fibrinogen
Hematocrit
Hemoglobin A1C
Homocysteine, cardio
Lipoprotein (A) Lp(A)
T3, Free
T4, Free
Aldosterone
DHEA sulfate
Prolactin
Progesterone, LC/MS/MS
Pregnenolone
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)
------------------------------------------------------------------------
ICD-9 codes
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.