Doubling the psa result whilst taking Finasteride 5mg

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After many years of psa testing 2 biopsies showing only inflammation and 2 MRI scans.  My husband was put on finasteride 1 year ago.  At the time we lived in London and were told by the urologist that he only needed to be referred back to the hospital if his psa rose 20% above the reading when the MRI scan was performed this was 38 which 2 weeks later went down to 30.  We moved up to North West England 1 year ago since then both psa test results were 23 and 26.  Today after being referred back to urology for another reason the consultant said that when taking finasteride you should double the psa result to get the correct reading which would make the latest result 26x2 == 52.  We were never told that and we have a letter from the hospital to gp stating measure psa 6months then annually and only refer back if the psa goes 20/% above the presenting level of 38.  Naturally we are now worried.  He is waiting now for a bone and MRI scan and possible biopsy.  We go back in 4 weeks to get results and to let the consultant see all the letters and MRI results we have so he can see the whole picture.  Has any one else been told to double the psa result when taking finasteride.  He is 71 with type2 diabetes,asthma/copd and arthritis but he is overweight.  The consultant said sometimes an enlarged prostate can cause these high readings but they would be looking for cancer with this result.  

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  • Posted

    >>Has any one else been told to double the psa result when taking finasteride.<<

    Yes.

    From Harvard Prostate Knowledge web page:

    Finasteride’s effect on PSA

    In patients with BPH, finasteride decreases PSA levels by about half. This phenomenon occurs even if a man taking the drug for BPH has prostate cancer. As a result, actual PSA levels for men in the finasteride arm of the PCPT study were doubled to approximate their true PSA.

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  • Posted

    I was told fernasteride will cut your PSA score in half. Seems to me a score 30 is pretty high unless it's measured different where you're from. My PSA is .8 on fernasteride. I'm 59 years old. If your husband is headed for a biopsy looking in to getting an MRI guided biopsy. That way an area of concern can be targeted instead of the blind biopsy that are usually done.

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    • Posted

      Just thought I would let you know that my husbands MP MRI result was pirads 4 score if you familiar this this new MRI.  This means high likely hood that cancer will be found.  They were also concerned about a pelvic lymph node.  The specialist nurse said the saturation biopsy will be to confirm what they already know.  Well  he had the biopsy 24 samples taken some targeted.  The results found no cancer just like the previous 2 biopsies.  This has all been going on since 2002.  Then there is the finasteride thing will reducing the psa by 50%.  This means that his last readings of 26 was really 52 and then 75? which would be 150.  The consultant said that they had at team discussion and have advised either the new perineal biopsy or regular psa testing.  My husband is adamant that he wants no more biopsies.  I can partly understand  this as he is 71 with other health problems.  I am still not convinced about the finasteride actually reducing psa by 50% but that is what the medics say.  Also he takes a inhaler called spiriva and I have read on other forums that men have had increased psa readings after using it.  Once  again  the doctor says no it is safe to use and it does not raise the levels.  There is a warning on the instruction leaflet saying care with those with enlarged prostate because of urine retention.  It is odd though because although the psa had been steadily rising the large rises only came after starting this drug.  He goes back to the hospital in 4 months for urine flow tests repeat psa and to discuss whether he wants the biopsy.  I am wondering whether there are other men out there with a similar history.  My husband has a very large prostate 200cc. I did ask what sort of psa reading would account for that but the consultant could not give an answer.  I would like to try and find out other reasons for high psa with negative biopsies.  He is overweight (large belly) and I am sure this does not help pressure on bladder and prostate maybe.  He had a vascetomy some 40 years ago which was fine but 6 months afterwards he has a bad infection which cleared up with antibiotics.  Once again I have asked the consultant but they say no not connected.  You hear of men with high psa and asymtomatic infection/inflammation.  On previous biopsies they have noted a lot of inflammation but no cancer.  What about diet is there anything there that would help.  I guess I am saying if he won't have the biopsy then perhaps he should try everything he can to get healthier both for prostate and in general.  He has osteoarthritis,asthma/copd (On a course for breathing and exercise at the moment) and type 2 Diabetes.  Anyone can add anything I would be grateful as I can't find anyone with  a similar history and it does sometimes seem as they want to keep doing biopsies as they are determined to find a cancer.

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  • Posted

    I wondered about that myself. No two ppl are the same and saying double the PSA seems to me to more be a guess than a exact science.
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  • Posted

    I think they do that to err on the side of caution. It is a guess. It may mot cut someone's PSA in half it may be more like 25% for some and none for others. I never liked that way of doing things. If woried get a 3T MRI done and it will show if there is an issue. If the last MRI showed nothing, then why would there be an issue in six months? Was his PSA 23 or 2.3? If 23 then that is high. Best thing to do is get a 3T MRI done first, then if needed a Biopsy that is targeted.

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  • Posted

    Thank you all for your quick replies.  Just to give you somebackground he has been having his psa checked since 2002.  It started off at 4.5 rose to 7.2 by 2005 ordinary biopsy was done at this time and showed only inflammation.  It rose to 17.5 then down to 14.4 between 2009/11 another biopsy in 2010 same result just inflammation this time he had an allergic response to the antibiotic given after the procedure.  When it rose to 21.00 in  2012 this time he had an MRI scan not being keen on another biospy once again no evidence of malignancy.  2015 down a bit to 19.6 was told only need to be referred back to hospital if it reaches 24.  Feb 2016 gone  up a lot to 38 another MRI scan once no malignancy had another psa down  to 30.9 started the finerastide for increasing size of prostate.  Oct 2016 23.9 psa and May 2017 26.7.  We were told nothing about doubling the result and I don't think our gp knew either.  I have read craig84609 like you that some men it only brings it down by 25% others it does not work so like a bit sceptical about this.  However the results are high but the consultant today said that whilst they would be looking to rule out cancer sometimes  results as high as this are just from enlarged prostate.  I do wonder about the inflammation as well.  I have wondered if vascetomy has anything to do with which he had done many years ago although they say no.  Actually it is a year since the last MRI scan.  The consultant said that after the MRI and bone scan if he decided to do a biopsy it will be not the normal one so I assume it will a guided one.  In a way it is like starting afresh with new hospital who have not seen him before where as when we were in London they had a long history to refer to.  The last MRI the consultant said he met with the cancer team and they were happy with the results.  I do appreciate your replies.  I will let you know what happens after tests he will return to the clinic end of June.

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    • Posted

      That is BIG and they have never suggested a procedure on his prostate ?.

      When my prostate was 135mg ny PSA was over 9.0. After laser surgery my prostate was 55grms and my PSA 0.74. Big prostate = high PSA.

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    • Posted

      Thanks for your reply.  No they have never suggested it probably because he has not pushed it  and does not find the urinary symptoms too much of a bother.  His brother had it done but had a problems for some time afterwards so that probably put him off as well.  Not sure if he would be a good candiate for surgery overweight/large tummy type 2 Diabetes and more importantly asthma/copd and takes 3 different inhalers and coughs a lot.  Have tried to get him to try and lose weight but it falls on deaf ears.  He hates hospitals as well.  To be fair both of use have had our fair share of medical stuff since Christmas we have both had colonscopies he has had a kidney scan and is on a few different medications.  I have also had heart scans which thankfully turned out to be negative. Fed up with it all now all this again went through all this with the prostate a year ago so hope this time it will be good news again.  We are either at a hospital visit or back and forth to gp would just like to get on and enjoy life all be with some limitations having moved house 1 year ago to be near daughter and family.
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    • Posted

      I had my two prosatate laser surgeries with T2 and some cardiac problems but not asthma/copd.

      My wife and I like you have too many doctor and hospital appointments sometimes two on the same day but we are 11 years older than he is. This is the first clear week we have had all year. 

      You could ask about the PAE prostate procedure that is not surgeryl but a radiology procedure that shrinks the prostate. 

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