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PSA with Dutasteride

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Posted 7/27/2018 8:08 PM (GMT 0)
Hello everyone,

I was diagnosed last year, at age 52, with a minute G6 in 1 of 12 cores. At the time my PSA was 4.4 and my prostate volume was 67cc. I started taking Dutasteride to help relieve the symptoms of the PBH and expected my PSA to drop by about half. In March my PSA was down to 2.01 and at the end of June it was down to 1.40. This is a more significant drop than I expected. Has anyone else seen this much of an impact on PSA as a result of Dutasteride or other similar drug?

Obviously this huge drop gives me hope that I will be able to stay on AS for many years to come. Maybe that is just wishful thinking but there is hope. I will continue to monitor my PSA and the wonderful DRE's and follow up Biopsy that is part of the AS. I know I can't let the PSA number be the only thing I look at since I know there is at least some small amount of G6 in there someplace.

I hope you all are well and wish you all the best on your journey!

Gemson
Posted 7/27/2018 9:33 PM (GMT 0)
Great news on the PSA!!!

Stay on that AS for as long as you can.
Posted 7/27/2018 9:40 PM (GMT 0)

Gemson said...
Hello everyone,

I was diagnosed last year, at age 52, with a minute G6 in 1 of 12 cores. At the time my PSA was 4.4 and my prostate volume was 67cc. I started taking Dutasteride to help relieve the symptoms of the PBH and expected my PSA to drop by about half. In March my PSA was down to 2.01 and at the end of June it was down to 1.40. This is a more significant drop than I expected. Has anyone else seen this much of an impact on PSA as a result of Dutasteride or other similar drug?

Obviously this huge drop gives me hope that I will be able to stay on AS for many years to come. Maybe that is just wishful thinking but there is hope. I will continue to monitor my PSA and the wonderful DRE's and follow up Biopsy that is part of the AS. I know I can't let the PSA number be the only thing I look at since I know there is at least some small amount of G6 in there someplace.

I hope you all are well and wish you all the best on your journey!

Great DX for you.. I had a PSA of 21+ in 2014 and went on Finasteride which dropped my PSA to 2.61 in just a few months.. AS panned out for me for 5 years but that ended this year.. I will be Starting treatment soon.. Ed

Gemson

Posted 7/27/2018 9:43 PM (GMT 0)
Gemson-

A drop by half is just an average. A lot of guys drop by more than that, a lot by less. The question is: how should the new PSA be incorporated into the AS protocol? I don't know the answer but I'll provide a few comments:

• In about half of dutasteride-treated men on AS, no cancer is found on a f/u biopsy. This, in spite of the fact that cancer should be easier to find in the smaller prostate.

• Dutasteride and finasteride (5ARis) are the only medicines known to prevent GS 6 prostate cancer (but not higher grade PC). So it might prevent multifocal bits of cancer from cropping up.

• Risk groups are, in part, based on PSA. When D'Amico first set the PSAs that define risk groups (0-10, 10-20, 20+) men were not taking 5ARis. Therefore, if a man saw his PSA drop from,say, 15 to 7.5 while taking a 5ARi, he should double it to see which risk group he falls into.

• But a slavish attachment to risk group as a criterion for AS is unwarranted. There's room for judgment. If doubling puts a man into intermediate risk, but a biopsy shows only a small amount of GS 6, the biopsy is determinative.

• On the other hand, if PSA shows a clear rising trend while taking a 5ARi, it is a better signal that a biopsy is warranted than if the PSA rose without a 5ARi. The 5ARi makes PSA a better indicator of progression.

• I would guess that PHI is a better indicator than PSA when taking a 5ARi while on AS. Since you get PSA too when you get PHI, you aren't losing anything. They haven't researched this adequately.
Posted 7/27/2018 10:28 PM (GMT 0)
My prostate at first biopsy was 137 cc. I have been taking finasteride for years. At last biopsy and after a TURP my prostate was 40. My PSA has gone from 4.7 to .7 during that time. Been on AS the whole time.
Posted 7/28/2018 6:06 AM (GMT 0)
Shinytop,

Thanks for sharing. It's nice to see another story with similar results.

Allen,

Once again you demonstrate why you are an ELITE Member. your wealth of knowledge is amazing. thanks for sharing it with us. I will ask my Uro about the PHI at my next visit. It is interesting that you say, "Dutasteride and finasteride (5ARis) are the only medicines known to prevent GS 6 prostate cancer (but not higher grade PC). So it might prevent multifocal bits of cancer from cropping up." since the Avodart page list this as one of the things you should know about Avodart, "Using dutasteride may increase your risk of developing prostate cancer." I guess it helps stop G6 but if you have the more aggressive type it could make things worse?

Thanks again for the information,

Gemson
Posted 7/28/2018 5:31 PM (GMT 0)
Gemson-

The FDA requires them to say that, but most urologists do not believe that. For 2 reasons:

(1) Ascertainment bias: The study design of the PCPT trial was flawed. In the placebo group, on an annual basis, all men in the placebo group of the study with a PSA level >4.0 ng/ml were advised to consider a prostate biopsy. But during the first 2 years of the trial, there were 141 more tumors with a Gleason score of 5 to 7 in the placebo group than in the dutasteride group. They were out of the study as soon as cancer was detected. During years 3 and 4, however, only 1 tumor with a Gleason score of 8 to 10 was detected among the 2343 men in the placebo group, whereas 12 such cancers were found among the 2447 men in the dutasteride group. if the men in the placebo group who had the 141 excess tumors with a Gleason score of 5 to 7 detected during years 1 and 2 had remained in the study, a proportion of the cancers might have been upgraded on biopsy during years 3 and 4 to higher-grade tumors, thus narrowing the difference between the two groups in the number of tumors with a Gleason score of 8 to 10 in years 3 and 4. about 8% of men with GS≤7 who are on AS get upgraded to GS 8-10 on repeat biopsy within 2 years. This would fully account for the apparent increase in detected GS 8-10 in the PCPT trial.

(2) Detection bias: Because 5ARis prevent GS 6 but not higher grade PC, the detection of higher grade PC in the shrunken prostates increased.

More recent studies showed that 5ARis do not increase higher grade PC:


/academic.oup.com/jnci/advance-article-abstract/doi/10.1093/jnci/djy036/4935092
/www.mayoclinicproceedings.org/article/S0025-6196(16)30456-6/fulltext
/jamanetwork.com/journals/jamaoncology/fullarticle/2212207
/www.nejm.org/doi/10.1056/NEJMoa0908127
/www.jurology.com/article/S0022-5347(12)04995-6/fulltext
/www.ncbi.nlm.nih.gov/pmc/articles/PMC2844801/
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