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Dramatic Drop in PSA from 4.35 to 0.35 in 45 days

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Posted 6/8/2021 3:47 PM (GMT -5)
I am 85 years old, and have been getting testosterone replacement therapy for two years. During that time my PSA went from 2.1 to 3.78, to 4.35. At that point, 45 days ago, my urologist took me off the testosterone, put me on several medications to shrink my very swollen prostate. A month later my PSA dropped to 0.35. Is that possible, and, if so, is there any danger in a PSA dropping so far and so fast?
Posted 6/8/2021 4:10 PM (GMT -5)
Welcome Dune21.

Often docs will use Avodart/Proscar to deal with enlarged prostates. They can have dramatic changes in the size and subsequent expression of PSA, often reducing it in half. If you are on such a drug I would expect a reduction, but yours is more than I would have estimated. Just what are you taking?

Many of us have used such drugs to lower testosterone to fight prostate cancer and have rapid reductions in PSA. I went from 59 to undetectable in less than 90 days. While it isn’t natural, it doesn’t necessarily do direct harm, but may present you with side effects of low testosterone like weight gain, low energy, low libido and such. Having a natural level of testosterone is always best and often treatments can put you on a yo-yo causing some problems.
Posted 6/8/2021 5:54 PM (GMT -5)
Doctor put me on Cipro, Finasteride, Bethanechol, and Tamulosin. Except for the testosterone replacement therapy, I had never been on any medications before. I haven't seen any of the side effects that you mentioned, but my libido is now back to zero without the testosterone.
Posted 6/9/2021 5:41 AM (GMT -5)
dune, your doctor is treating you for infection (cipro) as well as enlarged prostate (finasteride). Prostate infections can cause wild fluctuations in PSA.
Posted 6/9/2021 6:01 AM (GMT -5)
Your doc is trying a lot. As Hal says one drug, finasteride, is for BPH enlargement. It is known as Proscar and acts on the DHT ( dihydrotestosterone) and is a common drug for BPH. Another, cipro, is for infection, another cause of inflammation. Tamsulosin, Flomax, helps with urinary voiding, as does bethanechol (increases urinary voiding and saliva production). Two of these can help reduce the prostate size and thus less PSA expression. The other two makes it easier to void the bladder offsetting a side effect of a large prostate.
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