Finasteride

Hank-  how are you doing?  Are you still doing CIC?

 

Keith, I am still CICing, but only once before bedtime, to have longer sleep and as a kidney insurance. During the day, I can empty naturally ok with decent PVR, with help from my daily dose of Doxazosin. Hank

I've been having high numbers on my blood tests for PSA numbers.  I've been having blood tests because of other health issues.  Not a lot; the last one was to test my psa.  This sounds like something I may have to do.  What is a DRE?

DRE = Digital Rectal Examination (doctor puts gloved, lubed finger up patient's anus to feel changes in size and texture of prostate).

If its Digital Rectal Exam whats that got to do with collecting DNA?  

You have to pee right after the DRE and that pee is sent for analysis to see if any DNA relevant to prostate cancer shows up. The doctor will do a rather vigorous massage of the prostate for a few seconds while he is also feeling for any lumps on the outside of the prostate. If any cancer cells are present on the prostate surface then a few of these will get flushed out in the urine right after the DRE. That sample of pee is then sent to the lab for DNA analysis (Select MDx).

That's new to me. Is this something commonly done?

Jim

Thanks Howard. Goodbye to blind biopsy. 😀 Hank

I googled ' SelectDX test ' ,as suggested, and the explanations are there.

Thankks for that.  I'll check it out and maybe ask my GP.  He seems to think that I had to either take a round of antibiotics, which I did, or do a biopsy... no other choice.  Great to hear there are other choices. The jury still seems to be out on how good of an indicator of PC the PSA score is anyway.  My doctor told me that when one has a score of 10 they start to get worried about it spreading to other organs.  Mine had gone from 5 to 9.  After the A/B it went down to 7.  I don't think it was the A/Bs though becausse I didn't have a noticeable infection.  Seems to me that my spike in PSA is because I have been regularly cathing for a little over a year and maybe I'm poking the prostate and irritating it.  

Yes - I CIC too and it raises my PSA quite a bit. Any irritation to the prostate will cause the PSA to rise. What is really relevant to those of us with BPH is the PSA density - not just the PSA since the enlarged prostate means we have more PSA activity just due to the prostate size and not due to cancer as might be the case for guys with normal size prostates. In my case my prostate is 240gm and my PSA is 24 which sounds bad but the PSA density is well below the value of 0.15 used for BPH patients to screen for cancer. Also, the trend over several years is important. Again in my case my PSA value wobbles between 12 and 33 over the past 2 years without any trend. The doctors look for a steadily increasing trend in the PSA over a few years as a sign of cancer.  The PSA test by itself is not a good indicator of cancer when you have BPH.

Yes - goodbye to blind biopsies! I've had 3 over the past 15 years because of a rising PSA and they all were negative but they caused me terrible pain and bleeding and infections. My uro a few years ago told me when it was negative that "there likely is cancer in there but he just missed it" !! I fired him after that.

A few years ago I had a 3TMRI which showed a small lesion near the outer capsule. My uro at that time ( a different one I also fired) said he would a saturation biopsy of 36 cores!! I said no way and went to Dr.K in Houston who did a targeted biopsy of the tiny lesion using an MRI. Turned out it was just inflammation thankfully.

Now I have a great uro in Detroit who is very pro CIC and against blind biopsies. He just did the SelectMDx test on me.

There is another genetic test just approved for insurance called MicroGenDX. It examines the prostatic fluid that comes out during a DRE for any bacteria and if there is any then it identifies the bacteria and designs an appropriate antibiotic to be injected into the prostate. This could help reduce inflammation and the size of the prostate gland. I just had that done too. I would give you the link but this forum wouldn't allow it so please google it if interested.

I think it's quite possible CIC raises the PSA score - also sexual activity - 6 months ago I had PSA of 9.9 - the Urologist told me it might be due to CIC. I stopped CIC for over a month, refrained from sex for a week, had the test again and it went down to 2.4

I wonder if they know - let's say PSA goes up due to CIC - does that increase the chance of PC on it's own?

Howard I'm curious what your new Uro says about CIC and PSA levels - my experience and someone else mentioned CIC apparently causes PSA levels to go higher. If it's true that PSA goes up as a result of CIC, presumably because it irritates the prostate, is that on its own something to worry about? My levels were 9.9 I'm 63, after I stopped CIC for over a month, and refrained from sex for a week it went down to 2.4. Other factors could be diet, I was getting a bit more sunshine and exercise so I'm not 100% sure it was just stopping CIC.

Regarding leaving links I was told by moderator that they allow links. If the link is advertising a product they probably will not allow so the genetic test would probably get flagged as advertising.

Hi Mike,

I've had my current uro for 2 years now and I really like him. He is the one who got me going on CIC and ordered my catheters. But his specialty is robotic simple prostatectomy for large prostates ( prostate cancer) and he always reminds me that if I ever get tired of CIC he has a table ready for me! He also does most of the other BPH procedures but at 240 gm I don't qualify.

Your question is very relevant for me. I stopped doing PSA tests a few years ago as they are very misleading for men with BPH and often lead to unnecessary biopsies. But at my last visit 2 weeks ago we thought it would be interesting to get a value for me and compute the PSA density. The value came back at 35 which seems very high but the PSA density was 0.15 which is  ok though a bit high. When I told him I had done CIC 3 hours prior he dismissed the PSA test results as the catheter causes the PSA proteins that reside on the outer surface of the prostate gland to enter the blood stream. It is just a mechanical thing and nothing to worry about.

Another good blood test though is Free PSA which is unaffected by prostate irritations like CIC and sex. That value should be above 15%. Mine in the same test was 35%.

Still my uro did a SelectMDx test on me and I will know the results when he gets back from vacation in Europe!

Thanks Howard,

Interesting info - why can't you do things like Turp or Green Light? My Uro did advise me to take Finasteride to reduce size to make any surgery needed and he said it works well on men with large prostates - it might have been working but nothing dramatic, and after about 3 months I was feeling a bit listless in general. I then read about sexual side effects which can be permanent, so I stopped.

Hi Mike,

My prostate is much too big for those procedures (240gm). So I do CIC and have integrated it into my lifestyle ok.

You are VERY smart to stop finasteride. I have permanent sexual side effects from it after 10 years and cannot get off of it as my prostate would explode in size. The benefits are gone after 5 years but the adverse side effects last a lifetime!

Thanks Howard I really appreciate that information.  My GP just seems to have a pretty limited knowledge of prostate issues.  This gives me something to research because I would like to avoid a biopsy which is what he threatened me with if I didn't do the doxycylin.  I know it seems odd to some here that A/Bs be used to lower PSA level but that was dr orders.

 

Hi,

Doxycycline is an antibiotic used to treat people who are allergic to penicillin.

You are welcomed. Actually using antibiotcs for BPH is common since many believe that BPH started with prostatitis and if the bacteria in the prostate can be destroyed then the BPH (inflammation) will go away. There is so support for that idea.

But the problem is identifying the bacteria which is very hard to do because they live very deep in the prostate unless you are experiencing acute prostatitis. By the time BPH shows up he prostatitis is in the chronic stage (if this idea is correct) .

That is where the genetic test comes I t I mentioned above where they identify the exact bacteria from the DRE fluid and then design a proper antibiotic to destroy by injection into the gland. Otherwise the a/b is just a guess.

Is that right?  I didn't realize that.  Wonder why he prescribed that.  I'm not allergic to penicillin.  He has given me Sulphameth or something like that and then Cipro for 2 weeks before when I had prostatitis.  As Howard described earlier (and I was glad to get an affirmation of that) some doctors believe that BPH is caused by an inflamed prostate from bacteria rather than a permanently overgrown one.  I know my doctor had told me at one point that this was his goal in having me take antibiotics for urine retention.