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Posted 3/29/2023 11:54 AM (GMT 0)
Hello,
I had a Biopsy in 2014 it was all clear, been diagnosed with BPH. Have continuous PSA checks and some %free.
Been on finasteride and flomax since 2014, with the last 5 years taking it every other day.
Starting with 4/30/19 PSA=1.9 no %free taken,
= 2.2, 2.5, 2.9, 3.4, 3.3, 3.7, 2.9, 3.3, last one 3/20/23 is 3.8…..
Starting with the 2.2 PSA test the percent free ranged from about 20% to 36% (not in direct order of PSA tests) and after the PSA 3.7 was taken I talked to UCLA and they said not to worry numbers are stable, after that I had the 2.9, 3.3, and now the latest 3.8. Waiting for feedback from UCLA on that 3.8 rise with a %free of 21%.
Just would appreciate suggestions. One note,,,,use a local doctor for monitoring and UCLA for anything out of the ordinary.

Many thanks and Blessings to all,
Rick
Posted 3/29/2023 12:39 PM (GMT 0)
Hi Rick,

Does "... taking it every other day" refer to the Flomax or both? If tamsulosin (Flomax) every other day works for you, that's fine (you can always change to daily if it begins to work less well), but I don't see the point of not taking finasteride daily (the reduction in the incidence of low-grade prostate cancer was seen in men taking daily finasteride, and I don't see why you wouldn't want to ensure its maximum prostate-shrinkage effect as well).
________________________

Deciding how much of a PSA increase can be attributed solely to one's prostate-size increase from BPH with each PSA test can be tricky. I had many (negative) biopsies over a few decades because my PSA went up a bit more than my uro at the time thought cold be from my ever-worsening BPH alone. Urination was OK with tamsulosin and finasteride for many years until my BPH outpaced the meds and I had a TURP.

My last biopsy was triggered by a new nodule felt on DRE and a PSA increase a bit more than my uro expected. The biopsy showed the nodule was benign, but two high-grade cancer lesions were found in another part of the prostate (one G9 and one G10 core). At a visit some time after my surgery, I asked my uro/surgeon if he would have insisted on the biopsy based on my PSA increase alone had he not felt a nodule. He looked at my numbers, shook his head side to side as he thought, and said "We certainly would have discussed it" which I take to mean it would have been up to me to OK the biopsy then or say let's wait to see my next PSA result. Note that after surgery the percentage of my prostate involved by cancer was estimated at only 5%. I attribute my excellence outcome in part because of early diagnosis, the biggest weapon in the cancer-fighting arsenal. (For what it's worth, whenever my uro at the time suggested a biopsy I never once hesitated, even though it would have been easy to say "Another biopsy? No thanks." Fortunately, only about a quarter of prostate-cancer cases are high-grade, but that's hardly an insignificant number.)

There are some other tests that your uro can run to estimate the risk of you having PCa. Any increase in prostate size needs to be taken into account when judging a 3.3 to 3.8 PSA jump, but in my opinion another biopsy at this point isn't a bad idea. Using the "doubling rule" for finasteride, your last PSA increase was about the same as a full point were you not on the medication.

Djin
Posted 3/29/2023 1:02 PM (GMT 0)
Thank you,

Finasteride every other day because of the side effects and yes I understand your thoughts of taking it every day. Prostate 55g per MRI last May.
I have had an MRI and MDX (14% chance of aggressive cancer but was questionable because MDX people didn’t know I was on finasteride and my doctor wrote suspicious about the Dre (Dre was normal) so insurance wouldn’t give me a problem, both points do make a difference on the tests final score) the last year, both tend towards pretty much all OK.
MRI=pirads 2. Have had both hips replaced before MRI, they used a rectal coil to clear up images,,,,pictures were ok but not perfect.
Just hesitant to get the biopsy for several reasons, hip replacements, have a pacemaker since September, and have a bleeding disorder but it is very well controlled.

Honestly biopsies are not conclusive which is annoying.

There’s a gentleman on this site that had his first biopsy positive and the following three biopsies negative. Happy that overall he is doing well.
Posted 3/29/2023 1:11 PM (GMT 0)

rpw612 said...
...Honestly biopsies are not conclusive which is annoying...

That is true, however they are currently the only way to diagnose prostate cancer.

If you do the math and take the estimate of a biopsy missing existing cancer at 1/3, you will see that the chance of repeat biopsies missing cancer quickly go to very unlikely. That's why uros who suspect PCa--even after a negative MRI and negative biopsy--want repeat biopsies at some point.
Posted 3/29/2023 1:12 PM (GMT 0)
Saw what you said about the PSA at the end of your thread,,,yes that is a good point but what about the fact that my PSA was 3.7, and next one it went down to 2.9.

All frustrating, Again many thanks.
Posted 3/29/2023 1:18 PM (GMT 0)

rpw612 said...
Saw what you said about the PSA at the end of your thread,,,yes that is a good point but what about the fact that my PSA was 3.7, and next one it went down to 2.9.

All frustrating, Again many thanks.

I, too, had a fluctuating PSA, which can complicate the picture. Again, I never took any of my many negative biopsies as a go-ahead for complacency. What is the situation I wanted to avoid? -- neglecting a biopsy after many years of an increasing PSA to finally have one, be told I now have high-grade prostate cancer--possibly even metasatic--and wonder if my situation would have been different had I biopsied sooner.

Djin
Posted 3/29/2023 1:18 PM (GMT 0)
Just saw your second thread,,,that makes sense.
I just would be more comfortable with the biopsy, if it was other than a blind biopsy.

Do you think your high Gleason was from taking finasteride?
Posted 3/29/2023 1:21 PM (GMT 0)
Just saw your third post😁 true, well said.
Posted 3/29/2023 1:23 PM (GMT 0)

rpw612 said...
Just saw your second thread,,,that makes sense.
I just would be more comfortable with the biopsy, if it was other than a blind biopsy.

Do you think your high Gleason was from taking finasteride?

A "Random" core in a prostate zone isn't always truly random. Abnormal tissue (which may or may not be malignant) appears darker on the ultrasound screen and your uro can aim for that. I asked my uro at a recent visit for an estimate of the percentage of biopsies where he sees at least one shadow somewhere in a patient. He said it's about 50% of the time.

Was my uro just lucky in hitting two lesions with the minute amount of tissue taken in the biopsy when my cancer was only 5% of my prostate tissue (and bilateral)? I think it may have been skill.

The evidence in studies seems to demonstrate that finasteride does not increase the chances of high-grade PCa. Finasteride does not increase risk for prostate cancer death ("Among participants in the trial, 42 died of prostate cancer in the finasteride group compared with 56 deaths in the placebo group.")

Djin

Post Edited (DjinTonic) : 3/29/2023 5:31:22 AM (GMT-8)

Posted 3/29/2023 1:32 PM (GMT 0)
Thank You,,,,,Yes I’ve seen very early Studies say yes it increases high grade chance,,,but the more recent studies have said no it doesn’t.
Actually my local uro thinks it does increase high grade.
We’ll see what UCLA says, and if so I probably will push for the biopsy to be done at UCLA.
Posted 3/29/2023 9:49 PM (GMT 0)
I was on Finasteride for 20 years for hair loss. When my PSA creeped up to 3.3 I had a biopsy that found cancer. Originally diagnosed at a 6 it was upgraded to 4+3=7. Uro thought my psa of 3.3 was really a 6.6 due finasteride.
Posted 3/31/2023 2:17 PM (GMT 0)
I would add that my finasteride use was the wildcard that spurred me to take action I might not have otherwise. Given that I was 3.3 PSA I decided not to wait on a Gleason 6 diagnosis. As it turns out I was correct to take action as I was Gleason 4+3 after pathology. In hindsight I would not have waited 6+ months after diagnosis, but I bought into the very slow-growing cancer, take your time and research your options, not to worry about a Gleason 6, etc....
Posted 3/31/2023 2:27 PM (GMT 0)
Thank you. AZ.
From what I understand finasteride does not increase mortality overall, but I’m guessing it might Increase the chance of higher grade cancer,,,, please correct me if I’m wrong.
Posted 3/31/2023 2:51 PM (GMT 0)
That was the premise I was working on at the time- finasteride may make it less likely that you get cancer, but if you do get it could be worse. Now is that because finasteride masks PSA so its been growing longer or does it otherwise impact severity? I've heard different things so it still seems unclear. I did quit finasteride after diagnosis. My father had prostate cancer so I did have that genetic risk factor. I think maybe given that risk factor I shouldn't have taken finasteride? That is pure speculation and I have never seen a study on that.
Posted 3/31/2023 3:49 PM (GMT 0)
The current consensus is that finasteride reduces the incidence of low-grade cancer by about 25% and does not increase the risk of high-grade cancer or death from cancer.

Djin
Posted 3/31/2023 4:36 PM (GMT 0)
I’ve heard both of your statements before,,,,I agree with both.
Seems like nothing really is 100% even in the diagnosing process, MRI, biopsy, other types of tests,,,,we all can just do the best we can, and go from there.
Even showing my Uro that article from above he still thinks that It could increased chance of high-grade cancer.
Blessings
Posted 3/31/2023 5:57 PM (GMT 0)
Added bonus:

Finasteride Use and Risk of Bladder Cancer in a Multiethnic Population (2021)

"Finasteride was associated with a 36% reduction in risk of bladder cancer (HR: 0.64, 95% CI: 0.51-0.80; p <0.0001) among all patients."

Post Edited (DjinTonic) : 3/31/2023 10:02:03 AM (GMT-8)

Posted 3/31/2023 6:04 PM (GMT 0)
Thank You.Dj
Posted 4/2/2023 9:16 PM (GMT 0)
Older study but very interesting, just started this week taking Lipitor for high LDL.
Decided to see if it affected PSA levels because I’m getting one done on Monday took Lipitor Thursday and Friday and decided no more until after the blood work Monday.

Drugs and I think in particular Lipitor have positive effects on PSA, and people with prostate cancer.
Read carefully as my copy and paste of article can be a little confusing.


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Controlled Clinical Trial Acta Med Iran
. 2011;49(12):789-94.
Assessment of atorvastatin effectiveness on serum PSA level in hypercholesterolemic males

Iradj Khosropanah 1 , Siavash Falahatkar, Babak Farhat, Zhoobin Heidari Bateni, Ahmad Enshaei, Ali Akbar Allahkhah, Darya Khosropanah
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PMID: 22174166
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Abstract

The previous large retrospective studies demonstrated that treatment with Statins reduces both the incidence of prostate cancer by 50% and serum Prostate Specific Antigen (PSA) level up to 40%. However the main problem in those studies was the absence of control groups of men with hypercholesterolemia without Statin treatment. We performed a small prospective controlled clinical trial to assess the influence of the treatment with Atorvastatin on serum PSA in men with hypercholesterolemia referred to our educational and treatment center from October 2007 to March 2008. In this study, among the newly diagnosed males with hypercholesterolemia (LDL > 130 mg/dl), 40 patients with LDL more than 190 mg/dl were selected as a case group and were treated with Atorvastatin (20 mg/day). Among the same population and in the same period, another 40 patients with LDL between 130 and 190 mg/dl were selected as first control group and were treated only with low fat diet. Another 40 patients with normal serum cholesterol and without any treatment were selected as second control group. The lipid profile and serum PSA level of patients of all groups were tested at the first and third months after the therapy. After completion of data, the mean serum lipids and PSA level were measured in both visits and compared with each other by paired t-test. Also the mean PSA change in two visits between three groups was compared by ANOVA and Tukey HSD test. There was not any significant difference in mean baseline PSA between hypercholesterolemic and normocholesterolemic patients (P=0.547). In case group, mean PSA and LDL was reduced by 14.1% (P=0.0001) and 30% (P=0.0001) respectively by second visit. In first control group, mean PSA was not changed significantly (P=0.337), whereas mean LDL in this group was reduced by 9.6% (P= 0.0001). Similarly in the second control group mean PSA was not changed significantly (P=0.309) by second visit. In addition, mean change of PSA in case group was compared with first and second control groups that was significantly different (P=0.0001) whereas mean change of PSA between two control groups was not significantly different (P=0.615). The results of this study showed that: 1) Short term treatment with Atorvastatin can reduce serum PSA level, and 2) This reduction is more likely to be due to direct effect and is not related to lowering serum cholesterol levels. Thus, if results of this study are confirmed by large prospective randomized clinical trials with longer follow up period, it will be possible that Atorvastatin could be used in long term as a safe chemoprophylactic agent against prostate cancer in high risk patients.

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Posted 4/3/2023 6:30 PM (GMT 0)
Anyone have any thoughts or knowledge of study directly above?
Posted 4/4/2023 10:29 PM (GMT 0)
Hello,

The 4/3/23 PSA came in at 3.0 down from 3.8 and the %free was 23%.

Rpw612
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