A website to provide support for people who have or have had any type of cancer, for their caregivers and for their family members.
Results 1 to 6 of 6

Thread: PSA drop and finasteride

  1. #1
    Regular User
    Join Date
    Oct 2015
    Posts
    30

    PSA drop and finasteride

    Hello all
    I'm 51 years old and had my PSA taken last year and it read 3.10
    I started taking finasteride about 3 months later and had another PSA test and it dropped to 2.10
    My research has showwn that it can take up to 12 months for your new baseline PSA to normalize after being on finasteride. The common ratio for PSA measurement while on finsateride is 1:2, meaning that my PSA should show approximately half of the true value
    My questions is that I have heard that if your PSA drops while on finsasteride, it isn't indicative of prostate cancer. Can anyone comment on this. My PSA number have spiked up and down for about 8 years now.

    Thanks for any feedback

  2. #2
    Quote Originally Posted by KPINOTT View Post
    Hello all
    I'm 51 years old and had my PSA taken last year and it read 3.10
    I started taking finasteride about 3 months later and had another PSA test and it dropped to 2.10
    My research has showwn that it can take up to 12 months for your new baseline PSA to normalize after being on finasteride. The common ratio for PSA measurement while on finsateride is 1:2, meaning that my PSA should show approximately half of the true value
    My questions is that I have heard that if your PSA drops while on finsasteride, it isn't indicative of prostate cancer. Can anyone comment on this. My PSA number have spiked up and down for about 8 years now.

    Thanks for any feedback
    Hi KPINOTT ! Funny you should ask this question. I recently posted the abstract of a study in #56 in this thread.

    After your PSA has settled to its finasteride low, it's relatively simple for you and your doc to track future rises. Just keep in mind that a OSA rise that might not normally be significant (like objects in your side mirror) is really bigger than it seems if you have been taking finasteride (yes, roughly double).

    I think your question, rephrased, is: if your PSA would be rising from PCa, how would you know if you've begun finasteride and the medication is causing your PSA to drop? You many not. However, the drop might be a bit less than the doc expects and slower in rate if cancer is pushing it upward. Generally I would think the medication-inducted drop is much greater and would mask a PCa-caused rise for a time. But as you know PCa is usually slow moving. Once your prostate and PSA "acclimate" to the finasteride, if you have PCa, your PSA should then start to go up and, hopefully, reveal itself. (BTW, it's been demonstrated that finasteride probably decreases the chance of developing low-grade PCa; it has no effect on chances of high-grade PCa.) As my uro and the cited study say, the avg. 50% or so drop takes an average of 6 months, which I believe is the "rule of thumb", not 12. In my layman's opinion your 3-month drop seems on target to "land" at 6 months What does you doc say? Why was it prescribed? BPH? If so, are you noticing an improvement in symptoms?

    IMO, the amount of the actual PSA drop isn't that important (regarding PCa detection). What counts is what your PSA values do after the drop.

    Unfortunately, finasteride aside, some prostate cancers present with very slight PSA increases. PSA is. unfortunately, a fairly crude indicator of PCa, but it's very valuable nonetheless.

    Djin
    Last edited by DjinTonic; 07-16-2019 at 11:58 PM.
    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. #3
    Regular User
    Join Date
    Oct 2015
    Posts
    30
    Thanks DjinTonic. Thanks so much for your response.
    I was prescribed finasteride to slow down hair loss. It was my GP and haven't been to a urologist but that might be in order

  4. #4
    I didn't know you were taking a low dose for hair or I would have mentioned this: it was determined years ago that the lower dose of finasteride has the same magnitude effect on lowereing PSA as the full 5-mg dose taken for urinary symptoms caused by an enlarged prostate.

    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. #5
    Top User
    Join Date
    Aug 2016
    Posts
    1,653
    It is helpful if you complete your signature if you are looking for more support. By your description your bouncing PSA may be more indicative of BPH making it more difficult to distinguish it from cancer if and when it begins. Men often have to deal with both. The odds are good you will be dealing with cancer in one form or another eventually. 80% of all men will have developed a form of it by the time they are 80. However as a young man, your concern going forward now is how do I use my PSA to monitor for cancer while on Finasteride?

    Short answer imo, if your taking it for hair loss then stop. Tracking for cancer is more important and PSA is our frontline tool. If it matters, people in general don't care about hair. They care about style and style makes anything work, hair or no hair. What doesn't work is vanity or low self esteem. Better to deal with those, if they're your issue. Self confidence wins the day everytime. A head of hair on a man who worries about it will not.

    More about Finasteride, if your PSA was rising slowly and it lowered on Finasteride and then continued to rise it is considered stronger evidence of the likelyhood of the presence of a more aggressive cancer than your PSA rising alone. It is sometimes used this way as a diagnostic tool for PC. To answer your question, no. Lowering PSA on Finasteride is not evidence of being cancer free. There is no such regimen or diagnostic tool available. Best case scenario, it is a complication adulterating your best frontline tool (PSA) for the sake of vanity. Worse case scenario, it may flare/cause a more aggressive cancer. Some believe it may suppress low grade cancer (G3). I do not believe it to be a good therapy for this use unless you are on a rigidly monitored professionally managed Active Surveillance program, i.e. multible biopsies and 3T MRI scans. Attempting self managment of AS is a train wreck waiting to happen. We need objective observation or we will be seduced by our own bias.

    We do know prostate cancer can adjust to hormone treatment and become resistant to its deprivation. We also know our body will stop producing and regulating its own testosterone when we supplement it. Using it now to grow hair, maintain body mass, or libido, or diagnose for cancer may have an unknown impact now on aggressive cancers or latter when we may need it to fight the cancer.

    Any form of hormone supplement use is questionable in older men. We are uncertain of its impact on prostate cancer. We do know depriving the cancer of testosterone can put it into remission for a time. The implication is adding it may stimulate it. Regardless, the use of hormones to counter the effects of aging is not recommended (John Hopkins for one). Frivolous overuse of hormones, like antibiotics, may be a tickling time bomb squandering a previous resource.

    Back to your spiking PSA. A steady and reliable PSA is your best friend. A spiking PSA can complicate its use in watching for cancer. However, if it is not returning to a base line and a curve of the values is showing a rising trend, albeit irratic, you want to pay attention to it.

    The standard trigger point for biopsy had been 4.0, and without question at your young age. Studies and some protocols now suggest 3.0 as the threshold for biopsy. Ethnicity is a factor. You are too young for a persistent 4.0 and a 3.0 would catch my attention.

    I recommend you establish a relationship with a urologist competent in monitoring for PC (not all are and you will find sad stories here of uros buying into the myths of PC) and include annual DREs, record your family history with PC, and track urinary symptoms.

    Prostate cancer is most often a slow growing and treatable cancer and is best managed with early detection and treatment if required. Denial and delay are cancer's two demons. Back to your original question, a biopsy is the only way to diagnosis prostate cancer.

    Good to hear you're paying attention and educating yourself. This is the best forum around, imo. Hang out here and you will learn a lot. A caution, it can be a risk as well. You can't out think this disease. This circles back to the signature. Keep the simple facts of what you know about your profile always front, center, and updated. Return to it constantly. It will ground you and keep you from going into the weeds alone and getting lost in your own head.
    Last edited by Another; 07-18-2019 at 08:29 AM.

  6. #6
    An important side-note to your Finasteride post is that Finasteride is known to cause sexual side-effects including erectile dysfunction and Peyronies Disease. Petronius Disease is a condition that causes the elastin in the shaft of the penis to be replaced by scar tissue that does not stretch. The result is like putting tape on a balloon and then blowing it up. You get a bent, or curved penis and lose size. The incidence of this may be low but it is very real. In fact it is real enough that on the largest Peyronies Disease and ED forum on the internet there are scores of devastating stories of even young men who wanted to fix a relatively minor issue and their most noticeable result was a condition that rendered them incapable of intercourse. The devastating part is that the symptoms did not reverse by stopping the drug, in fact they often continue to worsen.

    The odds are in your favor but I personally would never roll those dice.
    History: age 53 It took 3 biopsies (34 cores) to find 2 cores 4+4 Gleason 8
    Lap RP at MSKCC Apr 2004, age 54 All neg margins, nodes & structures. (T2a).
    Post RP PSA: <.1 until Feb, 08 (46 mos) PSA 0.1 - I then got sensitive tests -> 2008: Feb 0.06,
    May-08 0.09 - Jun-08 0.10, - Aug-08 0.10, - Nov-08 0.15
    SRT Dec-2008 ---Post SRT PSA 2009, Feb-09 0.10, May-09 0.09, Aug-09 0.06, Dec-09 .04, - 2010 Mar-09 0.04, 2011 .02, 2012 .02,
    STARTED UP Feb 2014-0.06, Jul-2015 0.10, Oct-2015 0.10, Feb-2016 0.15, Jun-2016 0.17, Dec-2016 0.25, Jan-2019 0.74, Jun -2019 0.72
    Aug 2018 Auximin scan - nothing
    Had an inflatable penile implant 2018 for ED. Best decision ever https://www.peyroniesforum.net/index...oard,56.0.html

 

Similar Threads

  1. How Long Until Finasteride No Longer Affects PSA?
    By joekcmo in forum Prostate Cancer Forum
    Replies: 14
    Last Post: 11-24-2017, 04:32 PM
  2. Finasteride prescribed for early PSA rise following prostatectomy
    By Prowler in forum Prostate Cancer Forum
    Replies: 6
    Last Post: 04-02-2017, 11:30 PM
  3. Husband has PSA 14. Please need advice about using Finasteride.
    By byhisgrace in forum Prostate Cancer Forum
    Replies: 9
    Last Post: 03-29-2017, 04:52 PM
  4. Replies: 19
    Last Post: 11-16-2012, 05:57 PM
  5. Proscar, Finasteride 5mg; Propecia, Finasteride 1mg
    By DDough in forum Prostate Cancer Forum
    Replies: 5
    Last Post: 08-06-2009, 03:11 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •