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40 years old, high PSA

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Posted 4/27/2017 5:35 PM (GMT 0)
Hi Everyone,

First, thanks for all of the useful information on this board. I really don't have any specific questions at this point since I've found so much information on this board and other sources. I just thought I'd share what my story is so far. Any input, of course, is greatly appreciated.

I just turned 40 and recently saw my GP for a physical. My PSA came back at 1.50.

The biggest variable in my situation is that I was taking 1/2 pill (1/2 mg) of Propecia on and off for many years. I've been very inconsistent and based on my records, I've filled the 30-day script 4 times in the last 18 months. I've also been on testosterone injections for the last 8 years. I don't believe that matters much in this situation but it's the explanations as to why I've had PSA tests before 40 years old. So here are the numbers:

2005- .70 (I don't know why my GP tested at 28 years old but it was already high for my age!)
1/2014- 1.03
7/2015- .78
4/2017- 1.50
4/2017- 1.09 (one week after above, different lab)

Since I knew that PSA is supposed to remain level on Propecia and that the true PSA could be more than 2x the number, I immediately went to see a urologist. It was not a great experience. He felt the prostate and said it felt normal and to schedule a biopsy on the way out. He was very rushed and seemed annoyed in general. I asked him if we should retest the PSA and he said he would but it probably won't matter. Needless to say, I will not be going back to him for a biopsy. I'm not at all trying to get out of one, but he's not the guy I want to deal with!


So, that's about all at this point. Again, thanks for all of the great information on this site. I'll of course post any updates as they emerge.

Post Edited (ShortInterest) : 3/9/2018 8:29:01 AM (GMT-7)

Posted 4/27/2017 7:42 PM (GMT 0)
Hi shortInterest- I'd say your PSA is not too bad but you are smart to be on top of it. I am a long-term user of finasteride (propecia)...20 years. My stats are below in my signature. I have not been able to get any decisive answers about the use of finasteride now that I've been diagnosed. I've chalked it up as a "wildcard" and as such, I will be getting treatment and not doing Active Surveillance.

So should I stop using now that I've been diagnosed? My RO said yes, get off it as it could be fueling the cancer. Uro #1 didn't think it would matter either way. Uro #2 thought I should stay on it as it will remain in my system for at least four months anyway. A confirmation via Best Doctors and Mass General in MA determined I do have Gleason 6. In their view, they would recommend staying on finasteride as going off might fuel the cancer. Per Best Doctors, the small prostate (as a result of the finasteride use) could make any treatment more problematic. I'm going to discuss this with Uro #2 at next appt.

You are right that finasteride use artificially lowers your PSA. So going off it you are most likely going to see a PSA rise whether or not there is anything else going on.
Posted 4/27/2017 7:53 PM (GMT 0)
Welcome to HW.

Highly unlikely you have anything to worry about, other than the question of should you continue with Propecia or not.

Rushing to a biopsy, seems just wrong at this point. More PSA monitoring, sure, just a blood test, but needles up your backside seems like a bit much right now.

Glad you're going to see a different URO. You need someone you can really talk to and will listen to your concerns.

Keep us updated,
Andrew
Posted 4/27/2017 9:56 PM (GMT 0)

AZ Guy said...
Hi shortInterest- I'd say your PSA is not too bad but you are smart to be on top of it. I am a long-term user of finasteride (propecia)...20 years. My stats are below in my signature. I have not been able to get any decisive answers about the use of finasteride now that I've been diagnosed. I've chalked it up as a "wildcard" and as such, I will be getting treatment and not doing Active Surveillance.

So should I stop using now that I've been diagnosed? My RO said yes, get off it as it could be fueling the cancer. Uro #1 didn't think it would matter either way. Uro #2 thought I should stay on it as it will remain in my system for at least four months anyway. A confirmation via Best Doctors and Mass General in MA determined I do have Gleason 6. In their view, they would recommend staying on finasteride as going off might fuel the cancer. Per Best Doctors, the small prostate (as a result of the finasteride use) could make any treatment more problematic. I'm going to discuss this with Uro #2 at next appt.

You are right that finasteride use artificially lowers your PSA. So going off it you are most likely going to see a PSA rise whether or not there is anything else going on.

Sorry to hear about your diagnosis. Best of luck on the treatment. Are you going the radiation route?

What you mentioned about stopping versus continuing the Propecia is very interesting. I hadn't even thought about the ramifications of stopping. What's more interesting are the different responses you received. I guess it really is a wild card. I'm sure you've seen the finasteride study that showed lower PC in the finasteride group vs. the placebo yet higher-grade disease in the same group. But, based on all my reading, it appears that the results of the study are interpreted differently between Dr's. Also, I've not seen any studies indicating that finasteride could 'fuel the fire'. You've given me a great question to ask at my upcoming appointment and I'll let you know what he says.
Posted 4/27/2017 10:01 PM (GMT 0)

InTheShop said...
Welcome to HW.

Highly unlikely you have anything to worry about, other than the question of should you continue with Propecia or not.

Rushing to a biopsy, seems just wrong at this point. More PSA monitoring, sure, just a blood test, but needles up your backside seems like a bit much right now.

Glad you're going to see a different URO. You need someone you can really talk to and will listen to your concerns.

Keep us updated,
Andrew

Thanks, Andrew. I'm hoping a biopsy is not in my future but I'll just have to wait and see. I'm not too worried but there's definitely reason for some concern.
Posted 4/27/2017 11:42 PM (GMT 0)
The Uro doctors seem to be of the opinion that finasteride does not cause higher risk cancer, but as a masking agent it holds down PSA's so that when discovered the cancer is further along. The RO thought that finasteride does cause higher risk cancer. It would be interesting to hear what your doc thinks. I have accepted that it is a wild card and takes Active Surveillance off the table. I think I'm leaning toward the Robotic Surgery.
Posted 4/28/2017 1:00 PM (GMT 0)
Shortinterest...

Good for your focus on even small anomalies...I think the most reassuring thing from your numbers is the up and down nature of the numbers...there is no trajectory upward but rather bouncing...which I have...perhaps a bit of prostatitis (my diagnosis)...if your MD is near a major medical center (would not want to rely on this at a community hospital) you could perhaps suggest a 3T MRI instead of a biopsy at this time...which is what I had done (I luckily went to a huge teaching hospital with radiologists in the Harvard system that read these regularly). I did see some articles, I know that others will differ, on MRI being the new initial screening for certain cases like yours and mine...and one thing that we can all agree on is that sitting in a scanner for an hour listening to music is better than a biopsy...MRI's have no side-effects like radiation from a CT...so just a suggestion.
Posted 4/28/2017 3:59 PM (GMT 0)

AZ Guy said...
The Uro doctors seem to be of the opinion that finasteride does not cause higher risk cancer, but as a masking agent it holds down PSA's so that when discovered the cancer is further along. The RO thought that finasteride does cause higher risk cancer. It would be interesting to hear what your doc thinks. I have accepted that it is a wild card and takes Active Surveillance off the table. I think I'm leaning toward the Robotic Surgery.

The masking agent theory makes perfect sense. If I understand correctly, though, they did adjust PSA's for the finasteride group. One thing is for certain--there are definitely a lot of questions and disagreements about the drug. Anyway, best of luck on your ultimate decision and treatment. Hope all goes well.



Bob321 said...
Shortinterest...

Good for your focus on even small anomalies...I think the most reassuring thing from your numbers is the up and down nature of the numbers...there is no trajectory upward but rather bouncing...which I have...perhaps a bit of prostatitis (my diagnosis)...if your MD is near a major medical center (would not want to rely on this at a community hospital) you could perhaps suggest a 3T MRI instead of a biopsy at this time...which is what I had done (I luckily went to a huge teaching hospital with radiologists in the Harvard system that read these regularly). I did see some articles, I know that others will differ, on MRI being the new initial screening for certain cases like yours and mine...and one thing that we can all agree on is that sitting in a scanner for an hour listening to music is better than a biopsy...MRI's have no side-effects like radiation from a CT...so just a suggestion.

Thanks for your input, Bob. Fortunately, I'm in a big city so there are lots of options. I should mention that the first URO appointment was at one of the top hospitals in the country. Oh well, maybe I just caught the doc on a bad day. Nonetheless, I'd want a second opinion anyway before a biopsy. I'll make sure to ask about the 3T MRI. I agree--I'd much rather sit in a scanner that a bunch of needles up my behind!
Posted 6/7/2017 3:06 PM (GMT 0)
Hi everyone, just an update on my recent URO visit. Thankfully, he was very cool and was happy to answer all of my questions. Also, he asked me lots of questions unlike the first URO whose only question to me was "are you healthy?"--whatever that means.

He told me he was not worried at this point and recommended against a biopsy for the moment based on all of my numbers and medical history. Regarding the Propecia, he could not be sure if it was having any effect on my PSA since my usage was a little sporadic and that I was only taking a half dose. Also, he did say that testosterone will likely raise PSA but he was not at all against its use. He did recommend, though, trying to stay off the TRT until my next appointment in 6 months so we can get an 'real' reading on PSA. But, if the side effects of stopping were too much, he said to resume. So far, after stopping for 2 months, I still feel great overall although I'm worried about losing muscle/gaining fat. Too early to tell on that front.

Sorry, AZ Guy, I forgot to ask about whether he thought stopping Propecia would speed up progression in someone with PC.

I wish everyone well and I'll update in 6 months.
Posted 9/18/2017 2:26 PM (GMT 0)
Just a quick update-- My latest PSA came back at .80. This is after discontinuing testosterone & Propecia for almost 5 months. My testosterone level is at 160. The blood work was through a work wellness program so I sent it to the URO and he said to come back to see him in a few months. Overall, I'm not too concerned at this point. However, he did mention last time that low T can sort of 'mask' the PSA level-- kind of like how Propecia does. So who knows???
Posted 9/18/2017 5:05 PM (GMT 0)
good news on the PSA.

The low T might be a concern, but like you say, I wouldn't be that concerned right now.

Andrew
Posted 9/18/2017 6:13 PM (GMT 0)
I'm surprised, and disappointed, that you are getting information from "doctors" about finasteride "fueling" prostate cancer. They are out-of-date. In fact, they are reacting to old information which was prematurely released from a study which looked into whether finasteride could be used as a preventative medication for PC.

The conclusion, when the study was all said-and-done, was that men who took finasteride had increased diagnosis of higher-grade PC due to the effectiveness in shrinking enlarged prostates. Increased diagnosis, not increased incidence. If you take finasteride for 6 months and it halves the size of your prostate, any possible prostate cancer inside your prostate does not shrink. When a doctor performs a biopsy on a smaller prostate, he is more likely to hit that cancer. But the ultimate, telling bottom line was that use or non-use of finasteride did not affect survival rates..no difference.

Since finasteride does not affect survival rates, its true value may lie in impacting the finding of minor (3+3) prostate cancers what should not be treated at all, said Dr. Ian Thompson...internationally known PC guru who also happens to be PC care-giver to many men here at HW/PC.

The rule-of-thumb for Proscar (5mg of finasteride) is that after months your PSA which comes from your prostate itself will be about half--half the size, half the PSA...so you should double the PSA value for a relatively close non-medicated result. The daily dose of Propecia (1mg finasteride), and especially if you are taking 1/2mg daily, and intermittently at that, will barely move the PSA needle.

TRT "fueling" PC is another myth that was solidly busted...

Post Edited (NKinney) : 9/18/2017 12:39:03 PM (GMT-6)

Posted 9/18/2017 6:29 PM (GMT 0)
I think the evidence is pretty good that finasteride prevents prostate cancer.

You were taking the very low dose form (Propecia) rather than the form that men with BPH take (Proscar). So don't count on it cutting your PSA in half -- it only does that when there is significant BPH causing PSA to increase. Especially not with your intermittent usage. What men should do, rather than imagining what their PSA might otherwise be, is just take the PSA as the new baseline and see where it goes from there.

I think you've worked yourself into a lather over nothing. No, I do not agree that you have any cause for concern.
Posted 3/9/2018 3:28 PM (GMT 0)
Just a quick update--After resuming testosterone injections for the last 3 months, my latest PSA came back at 1.4. So, not a great number but at least it's unchanged from one year ago when it was 1.5. And, I think I can now rule out that Propecia was having any effect on my numbers. I also now know that since my PSA was .80 in August after stopping injections, it's obvious that testosterone is having a big impact on my prostate. Back to see the URO in May.

Post Edited (ShortInterest) : 3/9/2018 8:41:02 AM (GMT-7)

Posted 3/9/2018 6:30 PM (GMT 0)
Glad that your PSA is still low, and that there is still no cause for concern.
Posted 3/9/2018 7:08 PM (GMT 0)
Good to hear the PSA is low.

You're doing just fine.

Andre
Posted 3/12/2018 1:45 PM (GMT 0)

Tall Allen said...
Glad that your PSA is still low, and that there is still no cause for concern.

InTheShop said...
Good to hear the PSA is low.

You're doing just fine.

Andre

Thanks, guys. Appreciate the input.

But, I have to say I'm a little surprised to hear both of you say that 1.4 is a good number. My individual situation aside, it's definitely higher than the majority of guys in their early 40's. Regardless, I'm comfortable at this point. Nothing to do but keep an eye it going forward.
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