Saw Uro, opinions please

Hello,

My psa without meds peaked at 8.3 in Oct 2014, going up steadily since Jan. 2014 with a 53cc prostate.(per MRI 9/2014 which was normal but said bph).

Went on proscar and flomax since then. Psa has steadily been dropping to 2.5 as of late Nov. 2015 with a 30cc prostate estimated from DRE.

Appointment today psa 4.0, and still on proscar and flomax.
Dr. Says he's not worried as he has seen this before, but is having me come back in three months instead of six for another psa and he added a % free psa.

DRE was completely normal with a prostate size of 30cc estimated from DRE.

Thank you for opinions.

Yes know about doubling psa to account for the proscar.
The MRI was not multi parametric as I had total hip replacement before MRI.
UCLA said that the type of MRI I had would be more clear due to the metal in the hip. Also from what I understand the radiologist was extremely experienced.

BTW had a biopsy in April 2014 (all clear) when psa was 5.4 with the Uro I saw today which is my local Uro not UCLA.

Thanks

Thanks Intheshop,

I thought being on proscar, lowers psa due to bph, which it has since Oct. 2014, but it doesn't lower psa due to pca.

Just wondering, but thanks. Will keep you informed.

I disagree with this "doubling." It's a rule of thumb with a lot of variance. A better way to think about it is that Proscar helps get rid of the PSA due to BPH but not due to cancer or other things. So it sets a new baseline for you. The only thing that matters now is what your PSA does from this point onwards. If it goes up, another biopsy may be warranted. I think 3 months is prudent, and I assume you know to avoid sex and bike riding for 48 hours before it.

Actually, I think that PHI would be a better idea. It includes PSA and % free PSA, but it also includes another measure (-2proPSA). It is inexpensive and (unlike many other tests like 4Kscore or genetic tests) it is covered by insurance. I don't know if UCLA is offering it, but you can get a list of local uros who do offer it by calling the number in the link below.

Prostate Health Index (PHI)

The other biochemical test that's covered by insurance after a first negative biopsy is PCA3. It's a urine test after prostate massage. The combination of PHI and PCA3 has greater accuracy than either alone.

I agree with your assessment of radiology at UCLA -- Daniel Margolis is the best in my estimation. If you have to have another biopsy, it probably makes sense to have a transperineal template-guided saturation biopsy. It's the gold standard and the only way to make sure they cover every area.

rpw612

They both work the same - here is proscar warning-

http://www.drugs.com/pro/proscar.html

Warnings and Precautions

Effects on Prostate Specific Antigen (PSA) and the Use of PSA in Prostate Cancer Detection

In clinical studies, Proscar reduced serum PSA concentration by approximately 50% within six months of treatment. This decrease is predictable over the entire range of PSA values in patients with symptomatic BPH, although it may vary in individuals.

For interpretation of serial PSAs in men taking Proscar, a new PSA baseline should be established at least six months after starting treatment and PSA monitored periodically thereafter. Any confirmed increase from the lowest PSA value while on Proscar may signal the presence of prostate cancer and should be evaluated, even if PSA levels are still within the normal range for men not taking a 5α-reductase inhibitor. Non-compliance with Proscar therapy may also affect PSA test results. To interpret an isolated PSA value in patients treated with Proscar for six months or more, PSA values should be doubled for comparison with normal ranges in untreated men. These adjustments preserve the utility of PSA to detect prostate cancer in men treated with Proscar.

Proscar=finasteride; Avodart=dutasteride -- related medicines -- both 5-alpha-reductase inhibitors (prevent conversion of testosterone into DHT)

In contrast to that drugs.com site, which presents no evidence for doubling, below is what actual evidence is telling us about about their use. The only useful statistic is a confirmed increase from the new baseline.

Usefulness of prostate-specific antigen (PSA) rise as a marker of prostate cancer in men treated with dutasteride: lessons from the REDUCE study

The Effect of Dutasteride on the Usefulness of Prostate Specific Antigen for the Diagnosis of High Grade and Clinically Relevant Prostate Cancer in Men With a Previous Negative Biopsy: Results From the REDUCE Study

Here's the evidence for PHI in this situation:

PROSTATE HEALTH INDEX PREDICTS UPGRADING OF MEN ON 5-ALPHA REDUCTASE INHIBITORS

- Allen

Probably not. It seems like only sustained pressure on the prostate or contractions make a difference. But PSA results can fluctuate by time of day and from day to day. That's why that study found that confirmation was important.

Is the baseline psa since starting proscar the lowest psa as I have had several test?
If that's the case then the 2.5 in Nov. 2015 would be it.
As mentioned in the first post I started at 8.3. Then progressively lowered, of course till today.

Thanks to all

Well, it's an increase from baseline, but the decrease from the last test tells you that there may be some prostatitis involved. The % free PSA looks fine - did you look into getting PHI? You're probably taking some antibiotics for your surgery - maybe check it after that.

I had a list of maybe a couple of dozen uros in the LA area offering it. Maybe try them again.

www.myinnovativelab.com/prostate-cancer/

I don't think UCLA offers it - they did not the last time I checked a couple of years ago. Maybe try calling innovativelab again. Someone in my support group got it from Patricia Chang, Century City Primary Care, 2080 Century Park East, LA 90087. She used to work with Dr Scholz at Prostate Oncology Specialists.

- Allen

Hello,

Saw my regular Uro had the tests again: psa=3.0

% free psa=20%

Uro did say will need to be on Proscar forever.
I wonder if there is any way around that.

Any input welcome.

Thank You.