Proscar Questions

Hello, all!

I'm a 40 yo male with a family history of cancer. about a yr and half ago, rising PSA numbers led me to MD Anderson. After a parametric MRI showed three lesions, my Dr prescribed Proscar and asked that I return in a year.

I was on myrbetriq for urinary issues a few months before starting Proscar (frequent trips to bathroom, dribble, etc.).

Everything was great for about five months taking meds.... No issues with urination at all. For the past month, though, I've started to dribble regularly after urination or bearing down.

While my PSA was rising, it never broke 7.0... Just a steady climb from 2.1 to 6.8 over the course of a year... ConfirmMDX was negative, and biopsy was negative. MD Anderson dr suggested little chance of cancer (hence the return in a yr request for another MRI).

How concerned should I be with the return of symptoms while being on myrbetriq and Proscar for over six months?

Thanks for your advice.

You may find that an alpha-blocker, like Flomax or Rapaflo, helps with your urinary issues. Also, Cialis (it's not just for ED anymore).

The Proscar should help reduce the size of your prostate - How big was it then? How big is it now? It will help reduce the PSA coming from BPH, but not from other causes. So a continued rise while on it, if it has indeed reduced your prostate size, is a cause for further investigation. PSA can also rise due to urinary retention and prostatitis. A cystoscopy may reveal some blockage that may be the source of urinary problems and the PSA rise.

Because your mpMRI-targeted biopsy at MDAnderson showed no significant high grade cancer (and MD Anderson has a great reputation for reading the MRI results), there may be small amounts of low grade cancer that were missed by the biopsy. His recommendation to have it re-done in a year seems prudent.

You can also have the new PHI (blood) test and the PCA3 (urinary) test, which may be more telling than a simple PSA.

- Allen

Dewayne - no you don't double the number while on Proscar or Avodart in my opinion, although I know there are clinicians who do this. While it's true that they reduce PSA by about half, on the average, because they reduce the PSA from BPH, there is quite a bit of variance in that average. More importantly, they improve the diagnostic accuracy of the PSA test -- we don't want to undo that accuracy improvement by just doubling a number. What it does is re-set the baseline PSA so that PSA kinetics then become more useful.

That is a small prostate, only 20 g - how enlarged can that be? And it means your PSA density is .34 - twice the average. I think this is unusual for BPH -- what does your Uro say about it? It may be you have some blockage up there, or prostatitis. Maybe ask him about PHI and PCA3 as well.