PSA reading 5.57; At 70+ should I worry?

Thank you for your encouraging words Sandip. Really appreciated. It's interesting that your PSA level came down to 1.37 just before your surgery! Were you not tempted to cancel the op? Anyway, it's done now, I wish you speedy recovery. Jeremy

I had no real problem while I was on meds for the last 10 years. Never had to wake up at night though my retention was big 120cc and the prostate 62cc. I took very little water in the night and that helped.

In the last 2 years my stream had come down to a trickle and my gut told me it was a matter of months before it would stop and that could be an emergency. It was ordained.  I regret my choice of surgeon/TURP though. My research about HoLEP was right, but a doc friend advised to engage that surgeon.

Thanks for your wishes and I'm sure just remaining alert will do the job for you.

Sandip, what meds were you in? I've taken one 400 mg tamsulosin per day over the past five years and one prostassan (herbal) over the past 10 years. Best, Jeremy

Jeremy the last 6 years or so I have been on the combo drug ALFUZOSIN HCL.,DUTASTERIDE and about 3-4 years before that on tamsulosin. But I had plenty of best quality food supplements as well containing Lycopene and Omega 3, among others for prevention of PCa. Vit D3 is also said to help prevent PCa. Hope this answers!

More useful information for my summary document! Thank you Sandip

Jeremy my Tamsulosin is .4 MG once per day.

Mine too, John. I've been taking it for five years.

Hi Sandip.

Did you have Holep or Standard Turp?

Jeremy

I've been taking it for about 9 months Jeremy and I'm considering stopping it just to see if it actually makes a difference or not. I haven't noticed any benefits in taking it.

John, I suppose the only 'benefit' I could claim is that my PSA level hasn't gone up dramatically since I started taking them, although there may be other reasons for it (I don't know). Plus I have not had any side effects. So I continue to take them. Not a convincing reply I know but in the absence of anything else (for me) I suppose I'll continue with it. Jeremy

Another item for my notes, Rich, thanks. Amazon will get even wealthier on Saturday! Jeremy

NB my first step was an MRI, but the darned thing said chance of clinically significant cancer.  And a "% free PSA test", came back 5%.  And a repeat PSA test 5 days later, now 9.7 and 4% free PSA (the negatie PSA velocity, at least, was good).  Biopsy and HOLEP samples all clear, just saying in ALL cases (all cores), "chronically inflamed prostate tissue".  Post HOLEP, it came back at 0.7 for my 10cc of remaining prostate tissue.  Is yours assessed as big ?  If so you need to "normalise" your reading down to a standard 30 cc prostae; e.g. if yours is 60 cc (or 60 g - specifc gravity is 1), halve the 5.57 to get 2.76 and that's very good for your age.  Mine, I should treble to get 2.1, not so hot for a 50 year old as I now am, but we know I have a history of inflamed prostate tissue, so as long as it doesn't go up, I have an explanation, and am content. 

Meantime prudently I suggest  you avoid eggs (a known Prostate Cancer, or PCa, accelerant), and eat PCa ameliorants such as red, orange, or yellow peppers, raw garlic, milled flax seed, onions (cooked is OK), fish oil, fish, but avoid burnt chicken.  See THE TIMES newspaper article about 19th April 2016.  Tomato = good for most cancers but can greatly exacerbate prostate inflammation, and tomato less good for PCa than other cancers. 

Hi Paul, I am glad that after going through all that you have an explanation and are content. I believe that's very important as not to have constant worries and anxieties must surely enhance quality if life.

As I said earlier I don't know the size of my prostate; I'll find out at the earliest opportunity. I hope 'real' size of it will be normalised downward.

To have a list of what to consume and what not to is very useful, thank you. More items for my mini document which I intend to produce based on all the info provided in this forum. I will also check out the Times article.

Re tomatoes: whilst I don't eat fresh tomato, for the past ten years I have been taking 'the miracle supplement' (according to the papers) of Ateronon. This is a highly concentrated tomato supplement, taken one per day. I wonder if I should stop taking it? Jeremy

As you do NOT have symptoms of inflammation e.g.poor flow rate or frequency issues, which I did before the HOLEP, stick with the tomato supplement as it may prevent stomach and bowel cancer and have small benefit re PCa, would be my wholly inexpert instinct...

Nb boringly you are encouraged to also avoid red meat and cured meat, but whereas cooked chicken is much better than these re: all other cancers, not so for PCa. You might hit a subscriber paywall re the times newspaper of britain / London, if so I am a subscriber and could cut and paste the odd excerpt. But not the whole article. Maybe just the bit about chicken... even if not visibly burnt it can still be a PCa accelerant, which is most annoying!! Not to say, surprising. Was summary of very genuine medical studies.

Re eggs, it also said 3 or 4 a week raises risk of PCa by +80% and is your biggest single potential risk factor.

Nuts !! I forgot the nuts.... almond nuts are a potent ameliorant of PCa, so to a lesser extent are hazel nuts. It is to do with the phylates, or some such, enabling your body to kill the mutant cells. Just a small handful a day is all you need, like 4 or 5 nuts. Walnuts aand maybe Brazil nuts better for other cancers and cardiovascular - wise, but for PCa walnuts, hazelnuts are best

Whoops I ended that last post wrong, meant for PCa almonds and hazelnuts are best !

Excellent stuff, Paul! A mine if information. No, I don't subscribe to The Times, so I would be grateful if you could copy and paste the article. Thanks, Jeremy

Article 19th April entitled "Going to work on an egg? Not if you want to beat prostate cancer" : ...According to Dr Michael Greger, diet can have a dramatic impact on the disease....About half of men over the age of 80 have prostate cancer...Men who consume two and a half or more eggs per week have an 81 per cent increased risk of dying from prostate cancer....The only thing potentially worse for prostate cancer than eggs is poultry: men with more aggressive cancer who regularly ate chicken and turkey had up to four times the risk of prostate cancer progression. The researchers suggest that this may be because of carcinogens in cooked meat known as heterocyclic amines (HCAs), which the National Cancer Institute describes as “chemicals formed when muscle meat — including beef, pork, fish, as well as poultry — is cooked using high-temperature methods” such as roasting, pan frying, grilling and baking (eating boiled meat is probably the safest). The longer meat is cooked, the more HCAs form. For unknown reasons, these carcinogens build up more in meat from chickens and turkeys than in meat from other animals....In 14 separate experiments, researchers dripped organic milk — to exclude any effect of added hormones which are commonly used in US dairy farming — on human prostate cancer cells in a petri dish. In each experiment the researchers found that it stimulated the growth of human prostate cancer cells, producing an average increase in cancer growth rate of more than 30 per cent. In contrast, almond milk suppressed the growth of the cancer cells by more than 30 per cent....studies have found that FRESH cranberries are effective in vitro against many cancers, including prostate cancer....An extraordinary study published in the journal Food Chemistry : orange peppers were able to suppress prostate cancer cell growth by more than 75 per cent. 

Of all the vegetables tested, those that had the most cancer-preventing potential were brussels sprouts, cabbage, curly cabbage, kale, garlic, spring onions and leek. They belong to one of only two superfood families: cruciferous vegetables and the allium veggie family, which includes garlic and onions. However, the researchers found that many common vegetables, including potato, carrot, lettuce and tomato “had little effect on the proliferation of the tumour cell lines”.

Less than a single serving a day of broccoli, brussels sprouts, cabbage, cauliflower or kale may cut the risk of cancer progression by more than half. The single most effective is garlic, which came in first against prostate cancer, breast cancer, brain cancer, lung cancer, pancreatic cancer and stomach cancer. 

Researchers put lignans to the test by asking men who were to have cancerous prostates removed to consume three tablespoons a day of flaxseed in the month leading to surgery. After surgery, their tumours were examined. Within those few weeks, the flaxseed consumption appeared to have lowered their cancer-cell proliferation rates, while increasing their rate of cancer-cell clearance.

Flaxseeds may also be able to prevent prostate cancer from advancing ...15 men with prostrate cancer were asked to eat three tablespoons of milled flaxseed a day for 6 months.  They later showed a significant drop in PSA levels and cell-proliferation rates — the PSA of two of the men dropped to normal.

Phytates are found in the seeds of plants — ie in all whole grains, beans, nuts and seeds.

Phytates target cancer cells through a combination of antioxidant, anti-inflammatory and immune-enhancing activities. Besides affecting the cancer cells directly, phytates have been found to boost the activity of the white blood cells that form the first line of defence against cancer cells.

Many plant compounds appear able to help slow down, and even stop, cancer cell growth but phytates can sometimes also cause cancer cells apparently to revert to their normal state — to stop behaving like cancer. This cancer cell “rehabilitation” has been demonstrated in vitro in prostate cancer cells.

(the information that hazelnuts and almonds are the best nuts, strongly embedded in my head from the days of my PCa "scare", was from another source, as it is not in the Times story - but I certainly didn't imagine it .... another source commended blueberries, frozen just as good as fresh and way cheaper, a good counter to many cancers including PCa). 

Oh yes, and turmeric is generally anti-cancer, not sure about PCa specifics, it is best taken as a powder with food, but not that nice so I take the capsules instead so you can't taste it, or spill it and stain everything in sight, yellow/orange. 

Thanks for reproducing the article Paul, plus your comments. Some significant content there! This is what I have decided to do: I will have my PSA levels measured again in six months. During the six month period I will follow the recommendations in the article on what to eat (and what not to eat) and see which direction the PSA reading will go. I will report the outcome to the forum.

Would others like to join the experiment? If this is feasible I think we'll probably need to formalise the process a little - the participants would eat the foods from an agreed menu. We would need to agree the start and end dates if the six month experimental period. Some participants may need to have their PSA measured before the experimental period starts so that they can measure progress in six months. I appreciate it may be challenging to co-ordinate the experiment over six months given the diverse geographical locations./ Maybe a Project Manager can be appointed to put a plan in place (not me, I am not very good as a PM!). Any volunteers out there assuming what I am suggesting is doable? Just an idea. Jeremy.

NB I failed to paste out the little bit where he says the flax seed should be MILLED, otherwise you may not digest it.  Don't need much.  He also says milk is slightly bad, but that soya protein is slightly good, sugar is an accelerant for cancers, this created a conundrum ... I first had the milled flax with water (SO DULL to eat), then looked for Almond and Soya milk that did NOT have added sugar (check label carefully).  Calcium is slightly bad for PCa, if you are perfectionist you can find those milks WITHOUT added calcium (check the label), but that is not that important.  And I had those fake milks with the very modest daily amount of milled flax (which is expensive, except intermittently in LIDL stores it can be very cheap).  Sainsbury's sells milled flax with nuts, covering many bases at once !  NB if you leave the milled flax, it absorbs the moisture and becomes stiffer, so eat it within 5 minutes. After 5 days on this diet my PSA had dropped from 16.92 to 9.7 with no other treatment, but that might well be just because some inflammation had gone down if I had acute bacterial prostatitis (albeit, repeated urine tests showed no bacterial infection and I had no temperature or other symptoms, except the peeing issues - high frequency and low flow rate).  It is possible to imagine that the diet (which I pursued with ruthless single-minded extremism - I ate NOTHING ELSE but the perfect anti-PCA diet, from the day of the first PSA result as my wife had found the Times article still kicking around from 11 days ago .... opened at the right page, just before we lit a fire with it, how fortuitous ?!) cured the cancer, but equally it could just be the bacterial inflammation had gone down (the principle of Occam's Razor may apply here ....), or it could be because a bunch of people from church were praying for me.  Look at it this way, if the perfect diet only accomplishes a 30% slowing down in the rate of development of the cancer, and it was a slow one so WOULD have got you in 20 to 30 years, if you are 70 .... that +30% on the years you have, could well mean that it never gets you.  NB although the TIMES article mentions only orange peppers - and it means big sweet salad peppers - I read elsewhere that the yellow and red are handy too, it is the green that is way less good (fortuitously, the green ones taste less sweet); I look in Tesco/Sainsbury for the value bag of 3 or 4 mixed, and find one with no green; you will never find one that is all orange !!  They are a bit dull so I allow myself some salad cream or mayo with them.  I no longer do this diet to extreme.  Other sources say although the Capsicum in little hot chilli peppers can cause stomach (and mouth) cancer if you have a LOT, it is an ameliorant for many other cancers including PCa and you only need a little; so I have a little hot pepper salad dressing sometimes.  And other hot sauce with chilli in it.  Even though my cancer scare is gone, having read that PCa kills more non-smoking British men than any other cancer, and that it can be an unpleasant end, I still eat a few coloured peppers and nuts and broccoli or cauli's a week.  I have stopped bothering avoiding cow's milk, that is not rated as very important anyway, and do eat a bit of chicken but only when it is the sandwich at business meetings; I never buy any to eat at home now.  And no eggs at all.  One little real piece (a bulb) of garlic every other day.  Red (or other) onions every now and then, sometimes raw, sometimes fried, spring onions whenever I see them reduced.  Every day I eat a mixed fruit skewer or bowl of mixed fruit, normally bought reduced.  Teaspoon of cod liver oil when I remember (also rated as slightly helpful for PCa). Bits of coconut when I see some reduced, and a jar of coconut fat for cooking (again, mildly good for most cancers).  There is a theory that a couple of vitamin C pills help the body fight off cancer too, so I steal a couple of my wife's whenever I remember.  The nice thing is, such a diet also greatly reduces the risk of heart disease, especially if you don't exercise much, and if you can avoid carbs/sugars (carbs just turn into sugars via enzymes in your body, and sugars feed all cancers if you have any), it keeps the weight down too.  Some people say not too many smoothies as mashing up fruit like that releases too much sugar too fast, especially since the main ingredient is always ripe bananas (ripe bananas have too high glycaemic index - convert to sugar too easily - the horrible green ones are best !! - also brown bread/rice much better than white for same reason....).  Bananas though are good for blood pressure due to potassium

Oh !!  Blood pressure : keep an eye on that.  Mine dropped from a perfect 120 over 80, to somethijng like 107 over 59 within 13 days of fanatically following this diet (and NOTHING else).  I semi-fainted onto the floor right after cystoscopy, though I must admit I am squeamish and it hurt going through the prostate; also I was v. tired that day and lacking resilience.  That was blamed on the low blood pressure due to suddenly and radically changing my diet; the solution is to add a controlled amount of salt - half a teaspoon of marmite a day does the job (blood pressure went back up to 120/80), and it has other goodies in it.  However do consult your doctor if you have extreme blood pressure issues.  Unlike high blood pressure (hypertension), low blood pressure is generally not so bad and tends to just make you faint.  Alpha blockers are used to treat hypertension and reduce blood pressure. The TARGETTED alpha blockers used for BPH etc, do not reduce blood pressure anything like as much as the broad-spectrum alpha blockers used to treat hypertension, but they do do so a bit, so be aware of that and keep an eye on it.  If you keep feeling faint when you stand up after sitting for a while, it might be going low due to cutting out sugar and carbs suddenly, or losing the salt that comes with red and especially processed meat, if you reduced that (not for PCa but for other health reasons e.g. bowel cancer risk).    The TARGETTED alpha blockers used for BPH etc (Flowmax is the main one, also known as Tamsulosin) only target the A1 receptor on the prostate (and unfortunately also on the iris - see interactive floppy iris syndrome....), and will reduce blood pressure to a lesser degree.  I have never taken Tamsulosin (or a 5-ARI), I went straight to HOLEP and avoided any drugs.  HOLEP removed 2/3 of my prostate so the PSA should have gone down to 2/3 of the previous readings of 16.92 or 9.7, instead it went to 0.7.  However that may just be the inflammation going down, and nothing to do with diet (or others' prayers), one can simply never know. 

NB I am not a doctor, actually I am a mere engineer so all of this could be nonsense, do not rely on a word I have written without discussing with your doctor or doing your own research. 

I will most definitely try your suggestions Paul. Also, I could do with reducing my blood pressure!

They use to recommend individuals who had BPH and high blood pressure to take Hytrin. This a blood pressure medicine that also helps some individuals pee better. I took it for several years but it drove down my blood pressure to low because I had normal pressure when I started taking it. Just some information. 

Hi Paul,

Where did you have HOLEP?

Ed I am no urologist but, instinctively, I wouldn't want to bring blood pressure medication into the mix - principally because, I know from friends' experiences, they havesude effects. This is just my view, I am sure others, through their own experiences, will have theirs. Jeremy

I was not recommending it ..just information if someone is on a blood pressure medicine they might consider changing to this one to get some added benefit. I had tried almost everything over the last 30 years to keep peeing. All have some side effects including supplements. 

I am never sure what the balance is of users of this site, as between USA and UK, so this information, and my previous posts mentioning sources of milled flax, might be useless to half the people here ...  I had my HOLEP done privately at the BMI Princess Margaret Hospital, Windsor, under the care of Marc Laniado.  I was only in one for one night, the total charge I recall as about £2700, of which £700 was Marc's fee.  I think there might have been £150 before that for the consultation.  I am ignoring the cost of the preceding cystoscopy, PSA test, flow rate test and other procedures, although cystoscopy is recommended before HOLEP, TURP etc to rule out bladder neck or bladder stone issues as an explanator of frequency or flow rate issues.   So maybe you should budget on £3450 all up.  If you need more than one night in, it's going to be more, as it's not fixed price; the hospital charges per night, I think. 

Marc told me in April that he had done 60 Holep's, with a stricture rate of 2% (which is average).  The other one I could find was Ben Challacombe, who works near Marylebone, central london - less convenient if you want someone to drive you home, and he openly warns that the cost with him (not clear if surgeon's fee, hospital fee, or both) exceeds some insurers' limits so you would be left with a surplus cost to self-fund.  Ben quotes a typical all up cost of £6000 to £7000, or at least he did back in April - but he may be assuming more than one night in; some men are in for 3 nights after Holep, even more.  I believe that Ben has done a rather larger number of HOLEP's than Marc.  I do not know Ben's stricture rate.  The BAUS website has audited complication rate data for various procedures such as a Da Vinci prostatectomy for a large number of British uro's, but doesn't have this data for Holep, greenlight, or TURP.

It was easy to find private HOLEP surgeons OUTSIDE of the South East : Cambridge, Bristol, Sheffield, Brum – all clearly, prominently advertising HOLEP, and in a few cases setting out its advantages, in case the searcher didn’t already know.  But inside the South East, very hard for a new patient to find any.  Most of the private hospitals only advertise “laser prostatectomy”; if you ring their reception, which I did in my research phase, they’ve no idea if it’s HOLEP or Greenlight – they take your details and offer an email back from say the business development lady or the uro department – this takes 3 days, by which time the searcher has probably already found someone (I had…).  One of Raj Nigam’s (a uro' near Reading) shared PA’s couldn’t even tell me when I phoned, if he did HOLEP or Greenlight, only that what he did entailed a laser (which I already knew).  I did find a hospital near Hastings, and one near Maidstone, plus Roding (Ilford) that did HOLEP – all too far for me.  A lot of Uro's need to chance their personal web pages to specify what sort of laser prostate de-coring or Turp they do, and where they do the laser prostate de-coring (and urolift etc - e.g. Marc Laniado does that, too) is done – most men will want to know that, and you want to see it on the web, not have to send an email or phone within restricted hours.  The receptionist in some private hospitals' urology department, can't tell you what sort of laser prostate de-coring they do (greenlight vs Holep/Thulep) - well, that was the case with one that I rung. 

Some people speak vaguely of Holep being available on NHS, but apart from Newcastle they never say where, which isn't available.  There really ought to be one website saying where you can get (a) holep (b) thulep (c) urolift done   (i) on NHS, (ii) privately.  With the exception of just a vew few like camurology (Cambridge) or Challacombe, the information is hard to concisely access.  In theory the NHS allows you to choose an NHS surgeon and hospital/exact procedure once assessed as needing it.  I bet it's usually almost impossible to choose in practice. 

I never did discover what are the advantages or disadvantages of THULEP versus HOLEP - they sound almost identical, the key difference being that nobody actually offers THULEP in Britain !  I spent four days peeing a pathetic dribble every few minutes, ridiculously (prostate pressing up on bladder), researching the matter thoroughly (it really does take a long while as the information is all so dispersed), before concluding that Holep was the best option assuming it was just a prostatically-constrained urethra, with pressure up onto the bladder messing up its empty/full transducer; having failed to identify a choice (central London no good really) of places I could get to, I chose Marc Laniado (knowing he also offers Greenlight, turp and urolift) and emailed him at 11pm, the repy came at 11:10 pm offering an appointment at 08:00 the next morning, which gave confidence compared to the sleepy uro's that hide behind a PA who doesn't even know what sort of op that uro does.  The op has been a success, I often sleep through (not always, it depends how much I drink in the evening), flow rate now 36 ml/second, all sexual function normal at 3 months after transient effect described in earliet posts, and I can set off to a distant business meeting at 06:30 (last pee before departure), arrive 10:00, and not need a pee unti 14:00.  I also no longer need a pee when having a meal out, at all.  Most of that is trivial, it's not getting up multiple times a night, and not peeing super-slow, that is important. 

NB I couldn't pee AT ALL the first 2 hours after holep, which was very alarming, but the nurse was totally non-plussed; it sounded like the urethra can swell up after the big 22 gauge three way catheter is pulled through the cut part (the operation site), and take a little while to un-swell.  One is inclined to advise men to not drink TOO much so as to give it time to un-swell, as if you can't pee they eventually will need to re-catheterise you, and I bet that would hurt.  And yet, if you let the pee get too concentrated, it hurts more after Holep; I found that out part way through the first night at home.  After that, each time I pee'd at night, for the first 2 weeks, I drank some more water, to keep it dilute.  After 2 weeks the pee-pain (dysuria) stopped abruptly and this issue was no longer relevant.

What a fantasticly detailed and informative post Paul!

So much useful info there, especially if you are in UK which i am.

You say sexual function normal after 3 months. Does this mean you avoided Retrograde Ejaculation? Thanks

Jeremy

>>You say sexual function normal after 3 months. Does this mean you avoided Retrograde Ejaculation ?

 - ah, no, avoiding RE would not be normal ... I do have RE.  Merely that everything works and feels as it should.  I have posted on this here before, during a period from 7 to about 14 weeks after the op when there was some loss of sensation, which linearly, progressively self-resolved, and I reported also the final outcome. 

Ah ok I had'nt seen those posts.

Thanks. I have seen posted that some people have managed to get the surgeon to carefully avoid those areas that would cause RE.

But as you say its normal to get RE with Holep as with Turp and GL.