PSA, Biopsy, TRT, Anastrozole

[novicejay]

Coach,

54 years old. I'm on trt. PSA=4 (gone up from 2.5).

I sit on my rear-end all day in front of a computer.

My primary care sent me to a urologist who wants to do a biopsy.

I read the transcript on this: Testosterone, PSA, and You with Keith Nichols and Scott Howell | Starting Strength Radio #94

If I am understanding the doctor correctly, the following is true:
1. PSA is not a good measurement for prostate cancer.
2. The biopsy sounds as if a bunch of bad shit can happen to me.
3. TRT does not cause prostate cancer.
4. The anastrozole pill may not be necessary to take if I increase the TRT dosage (as long as I am not a member of a very small population that has some genetic defects).

So, my questions:
1. Do the doctors suggest how to detect for prostate cancer other than doing a biopsy such as the 3t mri?
2. Is there a study out there that says what the optimal trt level is for someone so they don't have to take the anastrozole?

Thanks.

[Mark Rippetoe]

Look for my podcast with Dr. Joe Busch.

[neilc1]

Look for my podcast with Dr. Joe Busch.

is this out now,
or coming in the future,
search didn't click

[Mark Rippetoe]

#143 | PSA and Rethinking Prostate Health with Dr. Joseph Busch

[J. Keith Nichols MD]

Coach,

54 years old. I'm on trt. PSA=4 (gone up from 2.5).

I sit on my rear-end all day in front of a computer.

My primary care sent me to a urologist who wants to do a biopsy.

I read the transcript on this: Testosterone, PSA, and You with Keith Nichols and Scott Howell | Starting Strength Radio #94

If I am understanding the doctor correctly, the following is true:
1. PSA is not a good measurement for prostate cancer.
2. The biopsy sounds as if a bunch of bad shit can happen to me.
3. TRT does not cause prostate cancer.
4. The anastrozole pill may not be necessary to take if I increase the TRT dosage (as long as I am not a member of a very small population that has some genetic defects).

So, my questions:
1. Do the doctors suggest how to detect for prostate cancer other than doing a biopsy such as the 3t mri?
2. Is there a study out there that says what the optimal trt level is for someone so they don't have to take the anastrozole?

Thanks.

80% of men that have an elevated PSA don't have prostate cancer. It has been written that half of all urology practices would go out of business if prostate biopsies and radical prostatectomy's were discontinued. The least invasive and presently best method to detect prostate cancer would be a multi parametric MRI of the prostate. If a suspicious lesion is identified then that lesion can be biopsied with MRI guidance. Blind 12 core biopsies will miss a large percentage of cancers. The blind 12 core biopsy is also associated with significant potential side effects.

With regard to your question regarding anastrozole and TRT levels. Every study done to date showing beneficial effects utilizing testosterone in men did not use anastrozole.

[dalan]

80% of men that have an elevated PSA don't have prostate cancer. It has been written that half of all urology practices would go out of business if prostate biopsies and radical prostatectomy's were discontinued. The least invasive and presently best method to detect prostate cancer would be a multi parametric MRI of the prostate. If a suspicious lesion is identified then that lesion can be biopsied with MRI guidance. Blind 12 core biopsies will miss a large percentage of cancers. The blind 12 core biopsy is also associated with significant potential side effects.

With regard to your question regarding anastrozole and TRT levels. Every study done to date showing beneficial effects utilizing testosterone in men did not use anastrozole.

I'm not sure if this is in your wheelhouse or not but I'll give it a try. Do you think that lowering a prostate cancer patient's androgens, as is the current line of thinking (to my understanding) is something that is beneficial and necessary? I know someone in this position and frankly it seems horrible. No sex drive or even the ability, mood swings and even hot flashes, not to mention whatever else happens when your testosterone is almost nothing. I'm not arguing one way or the other because I have no idea. Do you have thoughts on this? Thanks!

[Mark Rippetoe]

Sounds like a very personal decision: alive (?) as a eunuch, or dead earlier as a man. Not everybody will agree.

[dalan]

Sounds like a very personal decision: alive (?) as a eunuch, or dead earlier as a man. Not everybody will agree.

Agreed. I ask because I recently read of a study where a small group of men with prostate cancer who were also on TRT did not have additional progression of the cancer even though they were on TRT. It did go on to clarify that this was a small study and not a large randomized study so it shouldn't be concluded that the results found were absolutely true for all patients and that additional studies need to be done.

Given the medical community's tendency to blame testosterone for everything and their lack of desire to learn more about it, even for healthy people, I'm not sure there will be many, if any, larger studies done in our lifetime but at least someone looked at it. Even if there were, I doubt most doctors would know about it since they aren't even up to date on basic TRT.

[Jovan Dragisic]

Sounds like a very personal decision: alive (?) as a eunuch, or dead earlier as a man. Not everybody will agree.

Based on data available in the past two years, far too many would choose the latter. I could never really understand this desire to live. What is so great about life?

[J. Keith Nichols MD]

I would recommend you watch the video I just did with Mark on the topic of prostate cancer. When a man undergoes androgen deprivation therapy for prostate cancer, the cancer will ultimately become androgen insensitive and it will spread anyway. During that time he is on androgen deprivation therapy he will feel like dying. So many men are choosing a quality of life over a little bit more quantity. It is a very personal decision, as Mark has stated. High levels of testosterone have the same affect as castrate levels of testosterone when it comes to prostate cancer: they both have a negative affect on prostate cancer growth. I personally will choose the higher levels. Men that have been treated for prostate cancer with radical prostatectomy or radiation therapy can utilize testosterone, but unfortunately many urologists are hesitant to do so, and instead will utilize androgen deprivation therapy and kill the men in other ways, such as with cardiovascular disease. But I think when I look back on your question you're asking me that if you decrease your testosterone would it be beneficial with regard to prevention of prostate cancer and the answer is absolutely not. It's actually the exact opposite as I discussed in the podcast. Men with low testosterone are at the exact same risk of developing prostate cancer as men with high risk factors for developing prostate cancer such as a high PSA and positive digital rectal exam. I am actually saying that keeping testosterone levels in an optimal range can be preventative.