Posted 11/22/2009 4:16 PM (GMT 0)
I am new here. Great forum. My family history and psa history are in my signature. I did free psa test only in the most recent test, and it was 27%, but given my total psa score, I am not sure free psa is relevant. I am concerned about p ca, given my family history and high psa scores relative to my age, and would like to take prudent actions to try to prevent it. My diet is good (very little meat, very little dairy, lots of fruit and veg, etc.). I am considering taking finasteride or dutasteride for prevention purposes (not for BPH -- though I do have some mild urinary symptons, my estimated prostate volume is 25-30 grams). I was encouraged by the reported results of the REDUCE study. I consulted two urologists about finasteride/dutasteride for chemoprevention. The first was on the fence but said on balance probably a good idea and gave me prescription. The second -- one of the leading urologists in the country -- recommended against it (and said he does not take it himself, despite his own family history of lethal p ca). I have read other well-regarded urologists also recommend against it, including Dr. Catalona in Chicago. I am not sure if this is due to remaining concerns about the high-grade cancer that appeared in the PCPT study. I doubt that, though, since high grade cancer apparently did not appear in the REDUCE study results, and it seems current thinking is that finasteride/dutasteride do not cause high grade cancer but instead, by shrinking the prostate, make it easier to detect. Maybe the reluctance is because of the unknown impact of taking these drugs for many years. In any event, I am really uncertain whether to start this or not. By the way, I also asked the second urologist whether I should have a biopsy, given my higher-than-usual-for-my-age psa scores. He did not recommend that, unless I need it for peace of mind. He said psa velocity is, in his view, more important than absolute scores, and while my psa is high for my age, the trend is not bad. (I turned down the "peace of mind" biopsy -- it does not sound like a lot of fun, and while I would readily do it if there were a reason or a credible doctor recommended it, I don't want to do it for recreational or "psychiatric" reasons). Any thoughts appreciated.