PSA Elevated; Age, HRT or Bad Luck?

Training Over 35 Lifter
1

Just checked in with my original HRT doc, lousy though she is, she’s cheap. My labs and levels are all good except the worst one possible…elevated PSA of 6.9 (above 4 is abnormal).

This test is a marker for possible prostate cancer. My PSA pre-HRT was 0.67. This sucks. I have to stop HRT cold turkey, and get a prostate biopsy.

 I am not convinced I have cancer...I think I have BPH like half of us past 50, even though the jerk urologist who examined me six months ago said my prostate felt normal. I also may have prostatitis, I had this once ten years ago and it elevated my PSA then.

But urination burned then, not now. I just have frequency, trouble starting and stopping, and the episodic ED which may or may not be related.

I have been taking saw palmetto and other prostate herbs due to symptoms for the past eight months and I thought my BPH type symptoms had improved. 

The question I raise here for all of you...how much can T replacement raise your PSA? And have any of you been through prostate cancer, despite being a doc, I don't have much experience on this one.                         Doc
2

Doc, I had to stop TRT 6 months ago due to high hematocrit and hemoglobin. My total and free t were about 2.5 times the high end of the normal range at that time. However, my PSA was only slightly elevated. I’d suspect elevated e2 (most likely) or perhaps DHT more so than t. Did you have those hormones measured as well? BB

3

[quote]Beach Billy wrote:
Doc, I had to stop TRT 6 months ago due to high hematocrit and hemoglobin. My total and free t were about 2.5 times the high end of the normal range at that time.

However, my PSA was only slightly elevated. I’d suspect elevated e2 (most likely) or perhaps DHT more so than t. Did you have those hormones measured as well? BB[/quote]

 Since I started HRT about a year ago, I've had several T and E2 levels. I learned the hard way all about high estrogen (I hit 155), and eventually I got into a regimen these past 4 months that gave me consistent levels of T around 600 and E about 30.

Havent checked DHT, and unfortunately never checked PSA again until 2 days ago. I’ve had doc problems, like many on this site, and have done most of this on my own. I had a digital prostate exam by a urologist who was an HRT hater, he “assured” me my prostate was fine (this about 4 months ago).

I started myself on some antibiotics today in case I have prostatitis, and I think I’ll recheck my PSA in two weeks before I see a specialist for biopsy (I have to FIND a specialist first!)

                      Doc
4

I’m hoping for the best for you. Keep us apprised Doc.

~katz

5

Hey Doc,
Two close friends of mine started on finesteride and adex for their BPH. Both have had significant reduction of symptoms (frequent and short urination) and both have drastic reduction in their PSA numbers. You might be one of the men that DHT exacerbates BPH symptoms. Just a thought…

Good luck, and I’m glad to see you’re back.

KNB

6

Urologist for pro football team here in FLA advised me that when your test. level’s are low for any extended period of time and then you wallop your system with a large dose of testosterone, it’s quite possible to get an elevated PSA due to rapid DHT increase.
Androgel can be a big offender here as it’s absorbed super rapidly and can cause the rise of DHT.
At least that’s what the team doc told me?

7

I would like to see your E2 closer to 20. My urine flow is better than pre-TRT. That improvement came when I added anastrozole 6 months after. I was taking and still take LEF’s prostate capsules. I now seem to take those regularily and unine flow is not changing. My PSA numbers are very good.

For all readers: Never have a lab done for PSA or prolactin soon after ejaculation. That bumps both. Never get a DRE followed by a blood draw as you leave the office as that releases PSA.

TRT will always increase PSA a bit as the prostate responds to the T and the DHT. The organ gets a bit bigger and a bigger organ produces a bigger PSA number.

“”"
Prostate specific antigen (PSA), also known as kallikrein III, seminin, semenogelase, γ-seminoprotein and P-30 antigen) is a 34 kD glycoprotein manufactured almost exclusively by the prostate gland; PSA is produced for the ejaculate where it liquifies the semen and allows sperm to swim freely.[1] It is also believed to be instrumental in dissolving the cervical mucous cap, allowing the entry of sperm.[2]
“”"

“”"
PSA levels can be also increased by prostate infection, irritation, benign prostatic hypertrophy (enlargement) or hyperplasia (BPH), and recent ejaculation,[9][10] producing a false positive result.

Digital rectal examination (DRE) has been shown in several studies[11] to produce an increase in PSA. However, the effect is clinically insignificant, since DRE causes the most substantial increases in patients with PSA levels already elevated over 4.0 ng/mL.
“”"

“”"
Most PSA in the blood is bound to serum proteins. A small amount is not protein bound and is called free PSA. In men with prostate cancer the ratio of free (unbound) PSA to total PSA is decreased. The risk of cancer increases if the free to total ratio is less than 25%. (See graph at right.) The lower the ratio the greater the probability of prostate cancer. Measuring the ratio of free to total PSA appears to be particularly promising for eliminating unnecessary biopsies in men with PSA levels between 4 and 10 ng/mL.[15]

However, both total and free PSA increase immediately after ejaculation, returning slowly to baseline levels within 24 hours.[9]
“”"

5alpha-reductase inhibitors reduce DHT and the sex organs [and libido] get smaller. With very low DHT the prostate gets shutdown and slows down and atrophy’s to some extent. A smaller slower prostate releases less PSA, but does that mean that the root problem is improved?

8

More: Not related to the OP’s post, thinking out loud.

Fluid PSA (ng/mL)
semen 200,000 to 5.5 million

There is a very large amount of PSA in semen. For older men who are sexually inactive, the semen is retained, goes rancid and that creates inflammation in the seminal vessels. The inflammation spreads to the prostate and that is believed to be part of the progress to BPH and cancer.

When the prostate is inflamed as above, there is increased blood circulation as well. The inflammation and increased circulation may be responsible for part of PSA increase.

It is well known that inflammation of the prostate from an infection increases serum PSA. Inflammation from not been sexually active would appear to do the same. Thus being a cause of increased PSA that can have nothing to do with Cancer.

When it is stated that PSA is almost all manufactured in the prostate; not the seminal vessels. If one is not sexually active, where does the PSA go. Some might be getting into serum that otherwise would not be if the amount of stored PSA increases.

For those who are sexually active who have retrograde ejaculation, a lot of PSA would be dumped into the bladder. I have to wonder if any serum PSA can be created by that route.

9

Thanks, KSman, for all the info. I didnt have an ejaculation soon before the test. My DRE recently was normal size, normal shape. Prostatitis is my best hope to explain this test, and I’m now two weeks into a course of Cipro. I will get a free PSA/total PSA on my own this week as I cannot stand waiting anymore not knowing where I stand. My new position’s health insurance starts Tuesday so I have issues there in dealing with coverage, “preexisting” illness and that kind of thing.

It has been tough dealing with the ominous implicatons of this test while simultaneously stopping HRT cold. But I'm dealing with it the best I can. It should be pretty clear cut...if the next test is elevated I get the multi-site prostate biopsy, if its normal, I'm home free and I will cautiously restart TRT.          Doc
10

Great info KSman! It’s nice to see some new research relating to prostate issues. A lot of the data out there is outdated.

11

Good News. Repeated my tests, my PSA went down to 2.5!!! Some labs consider 0-2.5 normal, some 0-4.0. Either way, I am thrilled.
I did a free PSA, this was 3.0 or 12%. I have learned alot about PSA’s in the last few weeks, stressing about all of this. I am not totally out of the woods. Some strict prostate specialists suggest with a free PSA lower than 15% and PSA greater than or equal to 2.5 there is still risk. Risk rises with PSA going up and free PSA going down. Highest risk is with free PSA at 7% and total PSA above 10.
Interestingly, I had my T and E2 checked also, my T was 389 and my E2 was 40. I expected the T to be lower, as I have been off HRT for nearly a month and it was only 500 at the same time my high PSA was found.
My current relief of greatly decreased prostate risk temporarily offsets the increasing symptoms of declining T and rising E that I am feeling. I am still in a quandary about what to do. I have read dozens of articles online about the potential risk/association of testosterone and prostate cancer. Many articles suggest HRT does NOT increase prostate cancer risk, but some do, and other link higher testosterone in older men with prostate Ca who do not take HRT. Shit.
For now, I am taking the safe route, and I am going to do herbals to reduce E and raise T. I KNOW these things don’t work well, but I can’t risk HRT right now after this scare. I am considering just using adex maybe.
I’m playing it safe in part because in case you guys havent noticed, I’m not the luckiest guy in the world…but I count myself lucky right now. Doc

12

…that’s good news Doc, glad to hear things have improved…hebs

13

How the heck did I miss this thread? That said, I’m glad things are fine.

Carlsbad

14

[quote]Carlsbad wrote:
How the heck did I miss this thread? That said, I’m glad things are fine.

Carlsbad[/quote]
Thanks. Actually, I noticed how this topic generated very few responses. I think it might have something to do with “that kind of thing happens to other people, not me.” I say this because thats what I thought, too.

I’m out of the woods for now, but I’m still at some risk from what I’ve read, even one study suggested I should get a biopsy anyway because my PSA was at the cutoff mark (2.5) and my free PSA was slightly low (higher is better here).

I think I had prostatits, only reasonable explanation. So I’ll sit tight and recheck in 6 months. Gonna see how I do without HRT, should be loads of fun. Doc

15

[quote]Dr.PowerClean wrote:

Thanks. Actually, I noticed how this topic generated very few responses. I think it might have something to do with "that kind of thing happens to other people, not me."

[/quote]

…this thread actually prompted me to finally get my a** into the doctor’s office and get my PSA test done. We didn’t do one pre-TRT, the original Uroligist didn’t feel that it was necessary being that I’m only 38! Four and a half months into my TRT protocol and it’s really been bothering me not knowing where I stand.

Anyways, I had the test done last week and I came back with a level of 0.37. So good news for me, but thanks for the extra ‘motivator’ just the same…hebs :slight_smile:

16

[quote]Dr.PowerClean wrote:
Carlsbad wrote:
How the heck did I miss this thread? That said, I’m glad things are fine.

Carlsbad
Thanks. Actually, I noticed how this topic generated very few responses. I think it might have something to do with “that kind of thing happens to other people, not me.” I say this because thats what I thought, too.

I’m out of the woods for now, but I’m still at some risk from what I’ve read, even one study suggested I should get a biopsy anyway because my PSA was at the cutoff mark (2.5) and my free PSA was slightly low (higher is better here).

I think I had prostatits, only reasonable explanation. So I’ll sit tight and recheck in 6 months. Gonna see how I do without HRT, should be loads of fun. Doc

[/quote]

Six years ago my Father died from prostate cancer at age 77. I am trying to avoid the same fate. I have a tablespoon of organic tomatoe paste every day, the lycopene and other phytochemicals are good for a healthy prostate. I also take a tablespoon of pomegranate concentrate every day. Also a clove of garlic and 6 hi DHA fish oil caps per day. You guys in the northern areas make sure you are getting enough vit D. New research shows a deficiency is related to prostate cancer. I just had my first PSA test last week and was 0.6 so I am quite happy. My HDL and LDL cholesterol, triglycerides and fasting blood sugar were also very good. I will be 49 years old in September…

18

Doc,

I fought prostate infections for over 2 years. Finally think they have cleared up.

Hope you have better luck.

19

[quote]GaryCDeWitt wrote:
Doc,

I fought prostate infections for over 2 years. Finally think they have cleared up.

Hope you have better luck.[/quote]

 Gary, I have some questions. I actually had a bout of prostatitis about five years ago, it was more clear cut (urine burned, etc) and my PSA went up then too, at the time I didnt think twice about possible cancer. This time my symptoms were minor and the HRT was possibly the culprit also. 

 Did you have symptoms...and the whole time? What helped you get rid of it finally? And did you get serial PSA's?                             
 My docs suck, don't give me answers, just ultimatums, like come back in a month and if your PSA is up you get biopsy period.                                    Doc
20

[quote]Dr.PowerClean wrote:
…
I have been taking saw palmetto and other prostate herbs due to symptoms for the past eight months and I thought my BPH type symptoms had improved.

The question I raise here for all of you...how much can T replacement raise your PSA? And have any of you been through prostate cancer, despite being a doc, I don't have much experience on this one.                         Doc[/quote]

This may be of interest, and it can not be accepted on face value:

Change in Prostate Specific Antigen Following Androgen Stimulation is an Independent Predictor of Prostate Cancer Diagnosis
The Journal of Urology, Volume 179, Issue 6, June 2008, Pages 2192-2196
Robert S. Svatek, Michael J. Shulman, Elie A. Benaim, Thomas E. Rogers, Vitaly Margulis
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B7XMT-4S9NGJ1-29&_origin=SDEMFRASCII&_version=1&md5=f9de8b45c182f0d81eb52ffbc81bec10

Prostatitis is common.
An ultrasound is inexpensive and reassuring.