PSA testing

Erectile disfunction, premature ejaculation, delayed orgasm, etc.
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OldMarriedLady
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PSA testing

Postby OldMarriedLady » Wed Sep 27, 2017 1:53 pm

Can I just vent here about this whole PSA testing business? DH has been injecting testosterone since 2010, and here is a review of his PSA scores from then until now:

2/9/10 - 2.18
9/17/2010 - 1.6
2/18/2011 - 2.1
6/29/11 - 2.3
10/28/11 - 2.82
11/15/2011 - 2.5
3/2/12 - 2.4
2/1/2013 - 3.9
4/26/13 - 8.16 (this sent his doctor and us into a panic, had to stop the testosterone for awhile and have a needle biopsy done, which came back negative.)
8/30/13 - 2.9 (back on the testosterone right after that negative biopsy)
11/14/13 - 5.13
2/14/14 - 2.8 (having been back on testosterone for 9 months)
5/13/14 - 4.43
8/8/14 - 3.5
2/13/15 - 3.4
8/14/15 - 3.3
2/4/16 - 5.7
5/23/16 - 4.67
8/12/2016 - 5.8
12/16/16 - 6.4
8/7/17 - 9.9 (another panic, stopped testosterone)
9/22/17 - 6.48 (after being off the testosterone for a month and taking 2 weeks of antibiotics)

(Interesting that nobody ever tested his PSA prior to 2010 – I have access to his records going all the way back to 2000 and there are no PSA tests.)

I have a hard time believing it's the testosterone causing the high PSA, because if that were the case, he would have been consistently high since 2010. His scores are all over the place. There has been much discussion in recent years about how inaccurate and irrelevant the PSA test is, and when DH saw his urologist last month (at the recommendation of his bHRT doctor), the urologist calculated DH's cancer risk at between 2-8% given all the various life factors and scores. A DRE found that his prostate is indeed enlarged but no lumps were found.

According to articles on the National Cancer Institute, American Cancer Society, and Mayo Clinic websites, PSA scores go up as a man ages, so I think most of this is just attributable to DH aging and his prostate enlarging for non-cancerous reasons. I just get so frustrated that so much credence is given to a test that has been shown to be almost useless in detecting anything.

DH will see his urologist again this Friday and we will see what he says about going back on the testosterone or not. I hate to see DH so miserable, and they let him go back on it the last time his score spiked, so I’m hoping they give him the green light.
"When you love them, they drive you crazy - because they know they can."
(From the 1987 movie "Moonstruck", written by John Patrick Shanley)

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PSA testing

Postby hotrod » Wed Sep 27, 2017 2:20 pm

I'm almost 58 and had two needle biopsies done when my PSA went high about 6 years ago and 2 years ago. Neither test came back cancer. I have an infected prostate and anti-biotics help, but as soon as I stop the medicine the infection comes back and my PSA goes back up. Let's face it my prostate is infected and enlarged.

I had a TURP surgery in May and we are waiting until April to test my PSA again to get another baseline. Urinating is much better now. The one side effect is no semen ejaculated. Weird, but my wife likes it. Less messy! I hope they figure things out for your husband!


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Re: PSA testing

Postby Hoosier52 » Wed Sep 27, 2017 2:41 pm

The doctor who created the PSA test now says that it's pretty much bunk and worthless. Leads to too many false positives and unneeded biopsies. Google it. At best, it provides a baseline. I am 65 and mine has been right at 4 ever since I started TRT injections over a year ago. Two recent DRE's found the prostate to be un-enlarged and no nodules.

I take 5mg of generic Cialis everyday which helps with any BPH. I also take Pygeum, Stinging Nettle (which supposedly lowers PSA per Dr. Saya with Defy). Pygeum is much used in Europe for prostate health. It also produces lots of pre-ejaculate - LOTS! I also take L-Citrulline for nitric oxide for erection quality. It also helps with my HBP.

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Re: PSA testing

Postby OldBear » Wed Sep 27, 2017 4:04 pm

One reason why PSA test results can vary wildly is due to the timing of the digital exam. NEVER have the blood drawn after the digital exam (can irritate the prostate). Also, bicyclists need to be careful when they have their PSA blood test drawn. A bike seat can irritate the prostate. Lastly, any prostate massage :D before the PSA blood test draw will skew the results.

I had an extreme score a few years back at my annual physical. My doc (an excellent one) did the digital exam first. He referred me to an excellent urologist for a biopsy. The urologist repeated the blood test (before his digital exam) and I was back to normal. He suspected, and I confirmed, that my annual physical exam had been done with the digital before the blood draw. Thankfully, the scheduled needle biopsy was cancelled!!

OML, it would be good research to find out if your DH's high test results were due to his prostate being stimulated 2 - 3 days before the PSA blood draw.

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Re: PSA testing

Postby OldMarriedLady » Wed Sep 27, 2017 4:26 pm

Since I'm one of those weirdos who keeps a "sex diary", I'll check that out! :D
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Re: PSA testing

Postby beekeeper » Wed Sep 27, 2017 6:07 pm

While it is true that the medical community is today saying that PSA tests have too many 'false' posetives. I had a PSA test done and it saved my life. My PCP did not want to include the PSA in my annual physical, but I insisted that it be included. That test came back high, which led to getting a biopsy, etc. I had stage 2/3 prostate cancer. My surgery went very well, my prostate was removed. The cancer was caught just in the process of leaving the organ. If I had waited any longer, the likelihood is high that I would be dying of bone cancer today.

A high PSA simply means that you go to see a urologist. There is no 'harm' to a high PSA score, if it turns out to be 'false'.

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Re: PSA testing

Postby OldMarriedLady » Wed Sep 27, 2017 6:21 pm

beekeeper wrote:There is no 'harm' to a high PSA score, if it turns out to be 'false'.

Other than his doctors not letting him take his testosterone anymore, which would be quite detrimental to his physical and mental health. They have no way of knowing if the high score is false.

OldBear wrote:find out if your DH's high test results were due to his prostate being stimulated 2 - 3 days before the PSA blood draw.

Well, his blood was drawn on the morning of the 7th, and we last had sex the night of the 3rd. His prostate would not have received any stimulation beyond what it gets from regular sexual activity and intercourse/ejaculating (he's not interested in anything anal on himself). I suppose it's possible.
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Re: PSA testing

Postby OldBear » Thu Sep 28, 2017 4:22 am

OML, has he shared with you the order of the digital exam and the blood test in the doctor's office?

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Re: PSA testing

Postby OldMarriedLady » Thu Sep 28, 2017 8:07 am

I always go to the doctor with him and he got the DRE on 8/31. The blood had been drawn on 8/7 in preparation for an 8/29 appointment with his bHRT doctor, but that doctor called DH and told him not to bother coming in and to go see his urologist instead ASAP.
"When you love them, they drive you crazy - because they know they can."
(From the 1987 movie "Moonstruck", written by John Patrick Shanley)

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Re: PSA testing

Postby Dale » Thu Sep 28, 2017 11:24 am

I've been on Androgel now for about 10 years, and my PSAs always vary widely. Before I moved a few months ago, my old doctor did a PSA and it came back at 5 and the aide that called me was all freaked out, saying the doc wanted me to stop the Androgel and have my PSA retested, which there was no way I was going to do. Fast forward to less than 3 months later and I went to see my new PCP. He did a PSA and it came back in the normal range at 2.8.

I also had the experience years ago (before starting on Androgel) of having my PSA go up to 11, which really freaked the docs (and me) out and I went for a biopsy, which came back completely clear. And actually, at the time, I thought that having an ejaculation the night before would tend to make it come back lower, but that is not the case, and it probably worked against me then!

So yeah, I'm of the camp that it probably does do some good in some guys, but far too much stock is put into it by some in the medical community.

Dale

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Re: PSA testing

Postby OldMarriedLady » Thu Sep 28, 2017 10:02 pm

Day 12 of no sex. ::bh We see DH's urologist tomorrow afternoon, so I'll be interested to see what he has to say about all this. (I accompany DH to all his appointments because he has a really bad memory, so I'm the "designated remember-er" in our marriage. :lol: ) I'll email DH's bHRT doctor about what the urologist recommends, so that they can coordinate their care. We are so fortunate to have really good insurance, and really great doctors to take care of DH.
"When you love them, they drive you crazy - because they know they can."
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Re: PSA testing

Postby Graypoet » Fri Sep 29, 2017 3:57 am

PSA numbers can be a source of confusion and terror in some cases. 15 years ago ( I was 50 years old) my PSA number was ~ 1.78. It had more than doubled from the previous year. This detail along with the results from the DRE resulted in a visit to a urologist, which resulted in a needle biopsy. 3 of the 8 samples contained cancer cells. The prostate was removed a few months later. I have been cancer free since, PTL! I discussed recently with my family doctor the use of testosterone therapy. This is off the table being a prostate cancer survivor.

Over the years several friends and family have questioned me on PSA numbers and my cancer experiences. One friend is currently dealing with PSA number spikes similar the Old Married Lady's husband. My friend is still dealing with this issue.

I know that some in the medical world discount the use of PSA tests. My case, as in Beekeepers, the PSA test, and early detection saved me from cancer spreading.

One Thot for OML, would a second opinion from another doctor'be something to consider? My Thots are prayers are with you.
Proverbs 5:18-19 Let thy fountain be blessed: and rejoice with the wife of thy youth. Let her be as the loving hind and pleasant roe; let her breasts satisfy thee at all times; and be thou ravished always with her love.

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Re: PSA testing

Postby OldBear » Fri Sep 29, 2017 5:54 am

Keep us posted, OML. We're rooting for you and OldMarriedMan!

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Re: PSA testing

Postby pop fish » Fri Sep 29, 2017 12:00 pm

IMHO, a single high PSA result has no meaning. If repeated in 6 to 8 weeks and remains high, I would suggest a 3rd test in another 6 weeks. As has been indicated, there are many things that can cause a high PSA including sexually activity.

I had prostate cancer diagnosed in 2009. Had some cancerous biopsy cores tested in 2014 using Prolaris testing. This tests the DNA of the cancer and predicts fast or slow growing cancer. Here are my results:

"A biopsy Gleason score of 3+ 4 equals 7 and a clinical T stage of T1c. The patient had 1/11 cores positive. Given this information, the analysis
was done and his Prolaris score came back at 0, which is on the borderline of being consistent with his average 10-
year AUA cancer specific mortality and the more aggressive group, which would have a slightly higher 10-year prostate
cancer specific mortality. Plugging his data into the disease specific mortality curves, his risk for mortality at 10 years
was 3% with 95% confidence intervals of 2-5%, thus this means that the patient was managed conservatively would
have a very low risk of dying of disease at 10 years."

As a result of the Prolaris testing, I elected not to do anything other than yearly checks of PSA with repeat tests if any high values are found.

The bottom line for me is if repeat high values are found, a biopsy is indicated followed by Prolaris testing of any positive cores before any surgical or radiation options are considered.

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Re: PSA testing

Postby OldMarriedLady » Fri Sep 29, 2017 5:27 pm

Well, DH saw the urologist today, and it was interesting. He is very confident that the probability of DH having cancer is extremely low. He said DH should just monitor his PSA regularly, and if it spikes again he will send DH for an MRI of his prostate. When DH asked if he could go back on his testosterone, the urologist said something along the lines of "if I was advising my own father, I'd tell him to give up trying to restore sexual function at his age and just find other ways to be intimate". :shock: He said almost every couple in their 50's and older that he sees in his practice have stopped having sex except maybe as a birthday/anniversary thing. He also said it's usually the wife's idea because she's post-menopausal and either having problems with sex or just plain uninterested. I told him I found that very sad, and that DH and I are certainly not old enough to be "done" with sex.

He did concede that it's a personal choice DH has to make, and that if the testosterone improves his quality of life so much that he's willing to take the risk, then he should go ahead. I will email DH's bHRT doctor tonight and ask about getting a refill on his prescription. Meanwhile, DH just gave himself a shot. :D Here's hoping we can end this sexless streak we're on soon.
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Re: PSA testing

Postby Hoosier52 » Fri Sep 29, 2017 5:46 pm

OldMarriedLady wrote:When DH asked if he could go back on his testosterone, the urologist said something along the lines of "if I was advising my own father, I'd tell him to give up trying to restore sexual function at his age and just find other ways to be intimate".

Keep doing the TRT. What an ignorant thing for the urologist to say. I'd rather die having sex than to let my sex life die.

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Re: PSA testing

Postby be64 » Fri Sep 29, 2017 11:39 pm

Very interesting thread. I'll post some hopefully helpful information as soon as I have time.

I'm almost 53, I've been on testosterone since 2011. My recent PSA 0.74 I am happy with that. Basically no significant rise in the past ten years despite having frequent prostatitis, an enlarged prostate and using testosterone.
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Re: PSA testing

Postby ledgemoor » Sat Sep 30, 2017 7:03 am

Hi OML:

He did the right thing. The thing is, I don't believe that there is any demonstrated risk of maintaining normal old-man testosterone levels in old men.

We went thru this whole cancer-scare discussion with two of her oncologists after her hysterectomy/oophrectomy. I was trying to nail them down on the actual risks of her having normal post-menopausal hormone levels, and couldn't get a straight answer. I finally asked that if you were to take 1000 healthy post-menopausal women and remove their ovaries, would their cancer rate go down? The doctor pretended to be horrified that I would even suggest such a thing. I explained that it was merely a thought experiment, and please answer my question. She admitted that they didn't know if their cancer rates would go down or not. And, there are no studies that I am aware of that show that women without ovaries have any lower cancer risks.

As providence would have it, I met a pharmacist on the bike trail. She is not a compounding pharmacist, but is interested in that. We discussed my wife, me, and your husband at length, as well as some of her issues. Anyway, she believes that PSA testing is pretty much useless.

As some men here have stated, PSA testing led them to get a biopsy that led to a life-saving prostatectomy. But, that still doesn't prove that there is any actual benefit to PSA testing. If we believed that throwing dice and getting doubles correlates with cancer, and get a biopsy that finds cancer as a result of our throw, you could credit the dice with saving our lives.

One thing we do know, there ARE health problems with low testosterone. No playing the odds about it.

Mr. OML's Urologist wrote:if I was advising my own father, I'd tell him to give up trying to restore sexual function at his age and just find other ways to be intimate

He ought to lose his license. We are having the best sex of our lives in our late 50's. Menopause was good for DW. The testosterone to estrogen ratios improve.

The medical profession is so concerned about the length of life, with no consideration of quality. I was having a discussion with my wife and relatives if ever medical decisions need to be made for me. I told them that if I could no longer have sex or ride my bicycle, just let me go. I said the sex didn't even have to be good sex. Someone asked if the biking had to be good. I said bad biking is like bad sex. It's still pretty good.
Everything you ever wanted in life is just outside your comfort zone (Jamie Lee Curtis)

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Re: PSA testing

Postby Hoosier52 » Sat Sep 30, 2017 7:58 am

Since I started TRT my PSA hovers around 4. I'm 65 and that is within the "normal range." I've had 2 DRE's in the last 2 months and nothing suspicious. Some men just have higher PSA's than other men.

I have read nothing that suggests that TRT increases cancer risk UNLESS you have pre-existing cancer. If anything, I would think that it LOWERS cancer risk. It's typically older guys with lower T levels who get PC. It's not the younger guys with high T levels. I told that to my old Doctor and he stopped to think about and gave me that "You could be right" look.

ExcelMale.com has some good studies on TRT and cancer risk. Frankly, most doctors just don't have sufficient training in TRT. That's evidence by the one shot of T a month routine that I went through for awhile. It was a totally worthless, but typical protocol.

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Re: PSA testing

Postby be64 » Sat Sep 30, 2017 5:33 pm

It's too much to detail here so I will suggest you google Abraham Morgentaler and his book on testosterone and cancer. His book reports his findings in prostate cancer that indicate that high testosterone levels protect one from prostate cancer rather than the other way around. Another thing to google is a report on experimentation with using high doses of testosterone to kill prostate cancer cells.

Estrogen is also highly linked to prostate cancer. Estradiol level should be monitored and suppressed if it is high.
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