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Thread: Brachytherapy

  1. #51
    Regular User
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    Jun 2019
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    Quick update:

    Nothing much new. I stopped taking Tamsulosin, but at around the 36 hour mark after the last dose, my flow was down quite a bit and lots of stop/start when urinating. Went back on it yesterday. I'm just starting to change the time of day that I take it from bed time to morning hoping to improve the nasal congestion at night so I can sleep better. I took it around 6:00pm today, will move it to AM tomorrow. I just re-read what the potential side-effects are. Looks like I have an explanation for several things I've been experiencing lately-



    dizziness, drowsiness, weakness; (Dizzy spells and feeling weak, especially in the gym lately.)
    nausea, diarrhea; (Guess I know what caused my recent diarrhea)
    blurred vision; (Check)
    runny or stuffy nose, sinus pain, sore throat, cough; (Stuffy nose, I wake up with dry mouth because I can't breathe through my nose)
    painful or prolonged erection of the penis (Maybe this explains the painful attempt at sex last week.)
    PSA history: (raw-->corrected*)
    ------------------------------------
    6/16: 2.5 --> 5.0
    7/17: 3.1 --> 6.2
    3/18: 3.1 --> 6.2
    1/19: 4.1 --> 8.2
    * 8 years finasteride use. Initially 1.25mg/day, then 2.5mg/day for last year prior to diagnosis.

    Age 59, 12 core biopsy 3/5/2019
    --------------------------------------------
    Left lateral mid: Gleason 3+3, 10% affected
    Left lateral apex: Gleason 3+4(10%), 30% affected
    Left medial mid: Gleason 3+4(10%), 5% affected
    Left medial apex: Gleason 3+4(10%), 80% affected

    ---------------------
    DRE negative
    MRI negative
    Prostate volume: 27cc
    Testosterone: 251. Nine years on TRT. Discontinued when I suspected I might have prostate cancer.

    Two session (mono) HDR brachytherapy May/June 2019

  2. #52
    Hi TRTguy. Did you have a history of urinary problems, BPH? Why was the finasteride prescribed?

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3 -
    2013 TURP (90→30 g) path neg. then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015

  3. #53
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    Jun 2019
    Posts
    11
    Six week update:

    I was taking finasteride to prevent hair loss while on testosterone replacement therapy. No history of BPH and urine flow was decent before (not like when I was twenty of course).

    I'm trying to get off of Tamsulosin again. This time it's been two days since my last dose. The dizziness and fatigue have gone. Worked eight hours today on my backyard project without feeling tired. Nasal congestion is improved. No more diarrhea. Urine flow is considerably reduced, but unless it gets worse, I think I prefer this to the Tamsulosin side-effects I've been experiencing. Have not tried sex again yet. Last time was way too painful to continue with a barely usable erection after taking 20mg Cialis. Once again, I think my sexual function problems are more due to low testosterone than the Brachytherapy. I've ordered a hormone profile from privatemdlabs.com and will get my testosterone and some other hormone levels soon.

    To reiterate, the two HDR Brachytherapy sessions were a piece of cake. Side-effects at this point are low flow, start/stop urination. I can relieve that with 0.4mg Tamsulosin daily, but I suffer several side-effects from it, so I'm going to try staying off of it. I don't include impotence as a side-effect because I think it's more due to low testosterone. Two and a half months to go for my first post-treatment PSA test.
    PSA history: (raw-->corrected*)
    ------------------------------------
    6/16: 2.5 --> 5.0
    7/17: 3.1 --> 6.2
    3/18: 3.1 --> 6.2
    1/19: 4.1 --> 8.2
    * 8 years finasteride use. Initially 1.25mg/day, then 2.5mg/day for last year prior to diagnosis.

    Age 59, 12 core biopsy 3/5/2019
    --------------------------------------------
    Left lateral mid: Gleason 3+3, 10% affected
    Left lateral apex: Gleason 3+4(10%), 30% affected
    Left medial mid: Gleason 3+4(10%), 5% affected
    Left medial apex: Gleason 3+4(10%), 80% affected

    ---------------------
    DRE negative
    MRI negative
    Prostate volume: 27cc
    Testosterone: 251. Nine years on TRT. Discontinued when I suspected I might have prostate cancer.

    Two session (mono) HDR brachytherapy May/June 2019

  4. #54
    Just pointing out for anyone with a prostate taking low-dose finasteride for hair loss: the PSA-lowering effect was shown to be of the same magnitude as the full 5 mg dose taken for BPH/urinary problems (roughly halves the PSA after several months on the medication). This, of course, is an "artificial" lowering, so your doc will roughly double your PSA results to get your "real" number.

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3 -
    2013 TURP (90→30 g) path neg. then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015

  5. #55
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    Aug 2016
    Posts
    1,653
    My understanding is the halving formula is arbitrary. Are there any studies to suppport it?

  6. #56
    Quote Originally Posted by Another View Post
    My understanding is the halving formula is arbitrary. Are there any studies to suppport it?
    Several studies going back away. This falls within the bread and butter of urologists -- they need to know. Here's just one from 2004:

    Effects of Finasteride on Prostate Volume and Prostate-specific Antigen [2004, Full Text]

    Background. Finasteride was introduced to treat patients with benign prostatic hyperplasia (BPH) recently, and it has shown its effects in reduction of prostate volume and decrease of prostate-specific antigen (PSA). We want to know how and how much does finasteride affect prostate volume as well as PSA and prostate-specific antigen density (PSAD), since PSA and PSAD are widely used as screening tools for early detection of prostate cancers.
    Methods. Among 166 men with the diagnosis of BPH who received finasteride (5 mg/day) for 6 months, the serum PSA levels were measured. The prostate volumesbefore and after medication for a subgroup of 86 patients were measured by transrectal ultrasonography (TRUS). Paired t-test was used for the statistical analysis. The median percentage change in PSA of total 166 men and the median percentage changes in prostate volumes and PSAD of 86 men were also calculated.
    Results. Among 166 men, the average serum PSA level was 2.48 2.02 ng/mL at baseline and 1.57 1.47 ng/mL at 6 months later. The median percentage change of serum PSA level was -44.26%. For 86 patients who underwent TRUS evaluation the average prostate volume changed from 39.83 21.10 mL to 33.62 20.52 mL. The median percentage change of prostatic volume was -17.80%. Also, the median percentage change in PSAD for these 86 patients after medication was -38.67%.
    Conclusions. Finasteride does decrease the serum PSA level and PSAD as well as prostate volume in men with BPH treated with it for 6 months. Physicians prescribing finasteride for patients with symptomatic BPH should always keep in mind its effect on PSA and PSAD levels in order not to miss potential prostate cancers
    [Emphasis mine]

    I think that the doc can see the patient's largest % decrease after a few months, whatever it is, and either use the corresponding multiplication factor going forward on a customized, patient-by-patient basis or, what I suspect most uros do, just double the PSA -- what counts is really not the size of the PSA drop itself, but, after the drop, any rise going forward. Smaller increases have more meaning on finasteride. But no, the x2 factor wasn't pulled from a hat (Perhaps you mean approximate.) The original purpose of finasteride, of course, was to decrease volume and especially inward pressure on the urethra. Years later it was found that it probably decreases the chances of developing low-grade PCa.

    Note: when sending GenomeDX my clinical history in the request for my Decipher test (they ask the Gleason score and which adverse findings were noted in the path report), my uro gave my pre-RP PSA as 4.3 and not 8.6 (I was on finasteride then). This, IMO, is correct, because 4.3 is what my PSA actually measured. Rather, the company doesn't have a checkbox on the test-results to indicate whether the patient was on a 5-alpha-reductase like finasteride). Curious--I would think they would want to know. (Perhaps there are instructions about this on the test-request form, which I've never seen). If I remember, I'll ask my uro about this next visit. The reason I know this is that the Decipher results report has a clinical recap of my info at the top of the page, and my PSA is listed as 4.3.
    Last edited by DjinTonic; 07-15-2019 at 01:11 PM.

  7. #57
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    Thank you. Are there studies of men with intermediate cancer? The impact on cancer cells and PSA may be different than a benign condition such as BPH.
    Last edited by Another; 07-16-2019 at 01:47 PM.

  8. #58
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    Join Date
    Jun 2019
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    Neither my primary care physician (internal medicine) nor my hormone provider (D.O.) were aware of the effect finasteride has on PSA. Both knew I was taking it. I was only diagnosed when I passed 4.0 (limit for someone NOT on finasteride) and that was ignoring my primary care doctor's advise when I made the appointment with a urologist. I actually pointed out to the primary care doctor that finasteride lowers your measured PSA levels by about 1/2 during my follow up appointment when I had the PSA re-checked. Despite my having a print-out of the study showing it's effect, and a new PSA reading of 4.4, he still seemed quite surprised that I had already made an appointment with the urologist.

    Bottom line is do not blindly trust your doctors. I think any urologist you see would be aware of the finasteride effect on PSA, but it doesn't seem to be common knowledge among other doctors. I probably would have had a biopsy two years ago if I had known. I think I still caught this in time, but only because I just happened to visit a urologist on another matter and he asked me about my PSA results. I was at 3.4 at the time. He said I should get a biopsy if it didn't drop below 3. Then it went to 4.1, then 4.4 on follow up.

    There was a study looking at possible cancer protection from finasteride. Initial results showed it lowered risk of low-risk decease, but increased risk of more aggressive cancer. My R.O. said this was now considered a invalid result, but I haven't seen any study published debunking those results personally.

    Edit: I'm now eight days without tamsulosin. Doing ok, and unless urination gets worse, I'm done with it at this point.
    PSA history: (raw-->corrected*)
    ------------------------------------
    6/16: 2.5 --> 5.0
    7/17: 3.1 --> 6.2
    3/18: 3.1 --> 6.2
    1/19: 4.1 --> 8.2
    * 8 years finasteride use. Initially 1.25mg/day, then 2.5mg/day for last year prior to diagnosis.

    Age 59, 12 core biopsy 3/5/2019
    --------------------------------------------
    Left lateral mid: Gleason 3+3, 10% affected
    Left lateral apex: Gleason 3+4(10%), 30% affected
    Left medial mid: Gleason 3+4(10%), 5% affected
    Left medial apex: Gleason 3+4(10%), 80% affected

    ---------------------
    DRE negative
    MRI negative
    Prostate volume: 27cc
    Testosterone: 251. Nine years on TRT. Discontinued when I suspected I might have prostate cancer.

    Two session (mono) HDR brachytherapy May/June 2019

  9. #59
    Finasteride Concentrations and Prostate Cancer Risk: Results from the Prostate Cancer Prevention Trial [2015, Full Text]

    Results and Conclusions
    Among men with detectable finasteride concentrations, there was no association between finasteride concentrations and prostate cancer risk, low-grade or high-grade, when finasteride concentration was analyzed as a continuous variable or categorized by cutoff points. Since there was no concentration-dependent effect on prostate cancer, any exposure to finasteride intake may reduce prostate cancer risk. Of the twenty-seven SNPs assessed in the enzyme target and metabolism pathway, five SNPs in two genes, CYP3A4 (rs2242480; rs4646437; rs4986910), and CYP3A5 (rs15524; rs776746) were significantly associated with modifying finasteride concentrations. These results suggest that finasteride exposure may reduce prostate cancer risk and finasteride concentrations are affected by genetic variations in genes responsible for altering its metabolism pathway.

    The continuing debate of 5-alpha reductase inhibitors and prostate cancer risk [2018, Full Text]

    Despite conflicting data regarding the incidence of high-grade PCa, the question remains whether or not these differences translate to impact long-term oncologic and survival outcomes. Longer-term data from the PCPT showed that 15-year overall survival rates were not significantly different between the finasteride group (78.0%) and the placebo group (78.2%) (17). Furthermore, Pinsky and colleagues demonstrated that the projected PCa mortality rates from the treatment arms of both PCPT and REDUCE trials were not greater than the placebo arms (18 ). The Finnish Prostate Cancer Screening Trial (which did not show a difference in incidence of high-grade tumors with finasteride use) similarly found that 5-ARI use was not associated with an increased risk of PCa-specific mortality (19). While reassuring, these analyses do not provide the definitive evidence desired when considering intervention in otherwise healthy patients.

    Finasteride Effective in Preventing Prostate Cancer [2019, Article]

  10. #60
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    "This medicine will not prevent prostate cancer but may increase your risk of developing high-grade prostate cancer. Tell your doctor if you have concerns about this risk."

    Off of Mayo Clinic's Finasteride drugs and supplements info. Updated April 2019.

 

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