Sudden PSA Rise & Hormonal changes

[albedo1]

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!

[S. Kaul, MD]

Hi there!

Well, all values (PSA, free PSA and IGF-1) seem to be in the intermediary range and it would be difficult to give a precise comment on these values alone; though with this mild a change in the values, I would not suspect a cancer. At this stage there could be two ways of approaching the problem, either we can follow these values over time, with treatment of possible infections/ inflammations or go ahead with a biopsy. I would suggest consulting a urologist for a detailed discussion and suggestion of an appropriate management plan.
Hope this helps.

Take care!

[albedo1]

Thank you for your reply. Sure it helps and confirm my thoughts. I have a scheduled visit with my urologist next week to check for PVR (600ml was really too high) and the effect of tamsulosin. I would like to ask to check for a small infection (a urine culture first and, if prescribed, a cycle of antibiotics). I noticed a small increase of WCB count and hs-CRP signaling some inflammation. IGF-1 can also be due to a high protein intake which I need to look at. DHT is still in the ref range but has a 172% increase compared to one year ago. I will try to see what my doctor also thinks about finasteride. Maybe to consider prior to biopsy, I also learned about the Prostate Health Index (phi) and the PCA3 gene test. Not sure what he will think about a biopsy: I read it should be done, even with DRE normal, when PSA >= 4. Thank you again for your comments.

[albedo1]

I forgot to add that a high IGF-1 from high protein intake (both animal and soy, the latter considered as protective to some extend) can increase PC risk. There is a published study on this I can post if allowed.

[albedo1]

After consultation with my urologist decision is:

- new PSA and freePSA in two months (I will include few hormones as well). He is skeptic on PSA and against biopsy at this stage.
- if PSA increase reproduces, test for inflammation (a process including prostate massage). He is 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 recommendations. Of course critics/comments are welcome!

[albedo1]

PSA (2.3) back to *normal* values, i.e. previous to the spike. DTH 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 ...