Masturbation (ejaculation) dilemma

Posted by steveapplebaugh @steveapplebaugh, 3 days ago

I am new to the group and a new patient with PSA/PCa findings. During my annual physical, we discovered elevated PSA - doubling from the previous labs done 16 months earlier (from 2.0 to 4.3). Saw a very well-respected Tucson urologist two months later, and he said his DRE was "typical." Repeated the PSA, which was actually lower (3.2) with a higher free PSA % of 52%. On the other hand, my MRI report impression included "0.9 cm T2 hypointense circumscribed focus with mild restricted diffusion.... difficult to discern whether this reflects a PI RADS 3 extruded BPH nodule or a focal PI RADS 4." "No additional prostate lesion noted; the capsule of the prostate is intact." So. Here I am. I see my urologist again next week to go over the labs and MRI. Meanwhile, I have to confess that I lost all interest in sexual activities from the time I saw my elevated PSA over three months ago. I have been afraid to have any activity involving my prostate and the rest of my sexual organs. Weird, right? I used to be extremely sexually active - probably too much so. My testosterone level was that of a 20 year-old five years ago -- there's part of the problem. I will ask the doc about sex, more specifically ejaculation. Doesn't that generate more testosterone, elevate the PSA and feed the cancer? Should I or shouldn't I? I have been comfortably ejaculation-free for over three months. Maybe that's healthier. Thoughts?

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jeff Marchi | @jeffmarc | 2 days ago

PIRADS 4 can mean a problem. At this point, you don’t have enough information to really move forward. Your doctor may want to do a biopsy. You could get a PSE Test which shows whether or not you have prostate cancer in your system and need a biopsy or it can show that a biopsy isn’t necessary.

Your testosterone is already high, Having it a little bit higher from having sex is not gonna make any difference. Prostate cancer would have more than enough testosterone to feed on without doing that.

topf | @topf | 2 days ago

Did you abstain from ejaculation for 48-72 hours before your PSA tests?

steveapplebaugh | @steveapplebaugh | 2 days ago

In reply to @topf "Did you abstain from ejaculation for 48-72 hours before your PSA tests?" + (show)

Not on the first one -- at the physical back in May, but by the time I repeated the lab/PSA in July, indeed, I abstained for two months! Still abstaining. I am admittedly "freaked out" a bit. The truth is, I have "known" that I have some form of prostate cancer all along.

retireditguy | @retireditguy | 2 days ago

In reply to @steveapplebaugh "Not on the first one -- at the physical back in May, but by the time..." + (show)

If you think you have prostate cancer to the point you're changing your lifestyle (regarding sex), then I think if it was me I'd push for an MRI fusion biopsy so you can know they actually biopsy those 3 lesions. Then you'll have a much better idea what you're dealing with. Plus you'll have more treatment options catching it early rather than later. But I'm not a medical professional and this is just my layman's opinion. I do believe there's a NCI recognized CCOE in Tucson and another in Phoenix. Best wishes.

steveapplebaugh | @steveapplebaugh | 2 days ago

In reply to @retireditguy "If you think you have prostate cancer to the point you're changing your lifestyle (regarding sex),..." + (show)

Thanks for the insightful comment, even though I regret posting about my dilemma or my situation. I am investigating how to delete it. I feel foolish, or at least silly.

retireditguy | @retireditguy | 2 days ago

In reply to @steveapplebaugh "Thanks for the insightful comment, even though I regret posting about my dilemma or my situation...." + (show)

No reason to feel foolish; we've all been there and done that at some point. In my case I was exactly the opposite; I was sure I didn't have prostate cancer. But when my psa started going up my PA ordered an MRI. It showed a lesion, and even though I didn't think I had cancer I drove 300 miles to where I could get an MRI fusion biopsy so I knew they'd be able to biopsy the lesion. I fully expected it to not be cancer. Lo and behold, I had 3+4=7. Then I felt foolish when I reflected how sure I was I didn't have cancer. The important thing is to make the effort to find out early since prostate cancer is so much better to find early as compared to later. Best wishes.

steveapplebaugh | @steveapplebaugh | 2 days ago

In reply to @retireditguy "No reason to feel foolish; we've all been there and done that at some point. In..." + (show)

I started to process of getting seen at The Mayo Clinic Arizona -- "applied" and sent all related records. I know they have state-of-the-art technology for diagnoses and treatment. Still, I genuinely like my local urologist and will see him in a week. I definitely want an MRI guided biopsy. Then go from there. My father from prostate cancer at age 65 in 2000. I know that so many things have changed -- evolved for the better -- since then. Thanks again for your sharing. I appreciate it. Be well.

retireditguy | @retireditguy | 2 days ago

In reply to @steveapplebaugh "I started to process of getting seen at The Mayo Clinic Arizona -- "applied" and sent..." + (show)

Mayo Phoenix is where I also had my mri fusion biopsy. I also had my primary treatment there. I'm completely happy with the care I received at Mayo Phoenix. Best wishes.

bens1 | @bens1 | 2 days ago

@steveapplebaugh

Per what @retiredguy said, don't feel foolish at all. Its amazing that we all have our common ground, prostate cancer or the possibility thereof, and can access each other, which allows us a chance to ask a bunch of really personal questions and get answers. Its important to feel free to do that and is part of the mental process to find some way to manage what is a distressing and emotional time. Keep asking questions no matter what happens.

I also agree with his suggestion for a fusion biopsy but as @jeffmarc suggested, after the PSE blood test, which looks at 5 biomarkers and lets you know, with 94% accuracy, whether you are likely or unlikely to have prostate cancer.

scottbeammeup | @scottbeammeup | 2 days ago

My doctor told me no sex, masturbation, bike or horseback riding for 48 hours before a PSA test and to always get testosterone tests before 10 AM for accurate comparisons of progress.