My first post here and apologizes as I expect something related must have been discussed several times already.
My PSA has recently risen to 3.41 ng/mL (from 2.2) in about 8 months. Free-PSA is 0.72 and the ratio free-PSA/PSA is 0.21.
PSA velocity (PSAV) over 3 years, when including the spike, is 0.72 ng/mL/y. PSA baseline (done 8 years ago) was 1.28 and, prior to the last point, PSAV was 0.26 ng/mL/y.
Over one year, I noticed a simultaneous strong rise in IGF-1 (went slightly off the ref. range), DHT as well as free-T (total-T decreased). IGF-1 and DHT together with PSA worry me the most.
I am very concerned. I am due to visit my urologist soon but wonder if you can provide any advise.
I am followed regularly for symptoms of BPH (mild, no nocturia) mainly due to high post void residual (PVR, has been ranging 250 to 600 mL (!) recently). Obstruction is a possibility also hinted, afaik, by a large urea/creatinine ratio in the urine. I am taking tamsulosin 0.4 mg/d and testing with my doctor 0.8 mg/d to check PVR. I have had regularly and also recently DREs which were all normal.
I am 56, otherwise healthy, moderately active, fit and eating a well balanced diet with relatively high protein intake (Zone). I am also supplementing since several years with the usual set of herbal remedies for an healthy prostate (saw palmetto, stinging nettle, pigeum, ….), antioxidants and found benefits in my IPSS score. I have a full record of blood and urine works since about 10 years and regularly consulting, hence my surprise.
Beside mild BPH, I think I have no particular risk of PC (race, family history …) but a genetic test (23andme) shows a 1.5x increased risk vs average.
Prior to last test I supplemented for 4 months with 25 mg/d of DHEA (due to constant deficiency), I3C and Crysin (considered as mild aromatase inhibitors) which is the only explication I can give to the hormonal changes and maybe the PSA increase, barring other potentially changing factors as prostatitis, ejaculation <48 hrs and DRE prior to test, cycling and of course a sudden aggravation, despite non symptomatic, of BPH.
I wonder if DHEA and others supplements triggered something bad!
You seem worried about something, but I can't tell what. % free PSA is good. In Europe, you can get the new PHI test (It's been approved in the US, but isn't yet available here) and the PCA3 test. Your rise in PSA may be attributable to your BPH, and your DHT rise may be due to the DHEA fuel you gave it. Sometimes blockage of urinary flow may also raise PSA. Finasteride/dutasteride will block DHT and help with your BPH and urinary symptoms, and will probably bring down your PSA after a few months. If it doesn't, you might want to have a biopsy.
The Following User Says Thank You to Tall Allen For This Useful Post: albedo1 (08-03-2012)
Very much appreciated the info on PHI and PCA3 tests I did not know about and to consider in a possible biopsy decision.
My concern is: the simultaneous rise in the PSA and in IGF-1 and DHT might be telling me I mess up something with DHEA/Chrysin/I3C fueling a latent PC (the positive (!) side could be an early diagnostic). Hence I stopped.
I understand this is just speculation and I am balancing it with what speculation is not, i.e. the large PVR and BPH. IGF-1 can also be risen by too much protein in the diet which is also a possibility hinted by the urea/creatinine ratio (I tend to lower carbs). Another possibility is a small infection (my WCB count and hCRP have increased) again due to the BPH. I will check with my uro what he thinks if a culture first and a course of antibiotics later would be appropriate. I would like to check that for sure.
Wrt finasteride my uro, so far, has not considered it for side effects and small prostate and put me on tamsulosin.
Last edited by hb-mod; 08-02-2012 at 05:34 AM.
Reason: Please don't post unapproved website links, or recommend Internet searches, per Posting Policy. Thanks.
Yes, a lot of IGF-1 is not favorable for prostate cancer. This is well established.
You can research some of this for yourself using a tool we can mention on this board because it is government sponsored: PubMed at www.pubmed.gov.
For instance, try this search (omitting the quotation marks): " IGF-1 AND prostate cancer ". I just did that and got 694 hits. (You can use filters and limiting words to focus on research that is most meaningful to you.) Most papers have abstracts, and you can view them free if you click on the blue hypertext titles. If you need help, we can help you interpret language in the abstracts that is puzzling.
Here's another example; search for " IGF-1 AND "high protein diet" ". I just did that and got 42 hits.
The Following User Says Thank You to IADT3since2000 For This Useful Post: albedo1 (08-06-2012)
After consultation with my well respected urologist (as well as my GP) decision is:
- prescribed new PSA and freePSA in two months (I will include few hormones as well). They both were skeptic on PSA in general and against biopsy at this stage.
- if PSA increase reproduces, test for inflammation (using a specific process including prostate massage and multiple urinations). The urologist was skeptic on infection and cautious on Cipro course (might be counterproductive prior to biopsy)
- DRE was again normal.
- PVR happily reduced -33%, still high (about 450mL) but back to values I had 1-2 years ago. Continue tamsulosin 0.8mg, well tolerated.
- Biopsy decision after these tests
I hope I am doing well ! All this looks to me reasonable even if I am concerned I did not "wanted" the biopsy and followed recommendation.
I am also doing some changes in my diet and supplementation increasing anti inflammatory foods, reintroducing soy, moderating protein intake, increase exercise, reducing calories.
PSA (2.3) back to *normal* values, i.e. previous to the spike. DHT and IGF-1 lowered and hrCRP dramatically lowered likely due to my aggressive anti-inflammatory diet. DHEA stopped and slightly lowered protein intake. Happy I did not go immediately to the biopsy.
Unfortunately post void (PVR) is very high to abut 500mL despite 0.8 mg/d of the alpha-blocker tamsulosin but good on flow. I am scared to death to be heading to a TURP for side effects but on the other side very concerned PVR is damaging my bladder due to BPH. Should an 5-alpha reductase be tried with tamsulosin prior to try the surgery? Experience please !! I keep supplementing with saw palmetto, betasitosterol, stinging nettle, pigeum, lycopene, etc ...
I finally decided to undertake a (bipolar) TURP. This is status today (19 days after surgery) and would like to share experience.
• TURP (bipolar) done 19 days ago
• Main reason: huge post void residual which increased over 6 years from 200ml to 800-900ml and no effect of large doses of tamsulosin (2x0.4mg). Prior to TURP I had a cystoscopy and pressure-flow study.
• Surgery went very well, prostate was small and surgeon very well experimented and cautious (2000+ interventions)
• So far one complication: had to be re catheterized the very same day they removed the 3 ways surgery cath as I could not urinate at all.
• 19 days after, I am drinking a lot (2-3l fluids), taking normal dose of tamsulosin in the evening (0.4) (will soon try to stop this under medical recommendation) and distigmine bromide (5mg) in the morning (not every day, 1 every 2 days)
• Can empty 350-450ml typically at night (going 3-4 times) but also during day, this looks good. Had peaks at 500ml and even 600ml.
• Regarding stream I am waiting to see the TURP effect after doc agreed to stop the tamsulosin but does not look bad.
REASON OF CONCERN: after every time I pass a stool (was constipated a couple of days after the first week from surgery) or I stay seated or walk in the house I have very reddish blood at the start of urination. This completely disappears when I urinate after I stayed in bed during the day and of course during the night.
IS IT NORMAL? How much time I need to wait for this to goes away? Please give your experience (in meantime I read many posts on this Board and it looks like this is going to take long, possibly 6-8 weeks, with full recovery after only 3-4 months!)
LESSONS LEARNED (so far):
• Research, look for experienced surgeon and ask opinions before deciding on the procedure.
• Try to relax if you are anxious (easier said than done, I was given an anxiolitic after removal of the surgery cath).
• Stay close to an ER for say the first week if you need by any chance a new cath. This helps also with anxiety.
• Have at hand a laxative if you got constipated. Plums worked great for me but had to take a glycerin suppository one day I was completely blocked.
• Of course drink a lot.
• Have a perfect diet and watch supplements in case you take them; avoid herbs and blood thinning substances for while.
• Keep constant talk with doctor.
Last edited by Administrator; 03-02-2013 at 12:54 AM.
Recovering well. Visible blood in the urine (at the start of stream) disappeared when entering the 4th week after surgery. I am now at the end of 5th week. Stream good without the tamsulosin. PVR measured at 250mL and more than halved from previous measurements, hence not perfect, hopefully I will improve a bit, maybe never completely, but at least I am protecting my bladder.
Histology has shown low grade PIN (LGPIN), some atypical adenomatous hyperplasia (AAH) and low inflammation.
All this looked OK to urologist as not high grade PIN (HGPIN). However, I wonder if/which actions could be considered as prevention. I am thinking mainly to a nutritional anti inflammatory approach (e.g. Zyflamend, Curcumin, ...) and chemio prevention (Selenium? others?). Low dose finasteride?
Anyone out there trying something?
However, while HGPIN would definitively require more testing, LGPIN seems not increasing PCa risk.
Last edited by Administrator; 03-02-2013 at 12:54 AM.