It is 12/27/2013 and would you believe I have been off of HRT for almost 3 weeks?!? Well, I can't believe it either.
If you have poked around my site much, you know that HRT was a life-changing experience for me and cleared out mental fog, anxiety, fatigue and gave me morning erections for the first time in my life. So I was not happy when my HRT clinic director told me I had to stop.
What happened? Well, I had a high PSA reading of 6.3. I was absolutely shocked, because my PSA readings have always been below 1.5, which is pretty good for a guy in his early 50's on HRT. Ideally, it would be below 1.0, but HRT bumps it up a bit as does exercise, intercourse, etc. My lasting reading was 1.4, so this was a quadrupling of my PSA.
Actually, my clinic director did not take me off immediately but asked me to retest the following week with abstinence and minimal exericse. The result? A PSA of 5.0! The usual jump-up-and-down prostate cancer screening level is around 2.5-3.0, so this did not look good. They said, "Don't come back until you have urological clearance" and sent me on my way.
The next couple of weeks were very stressful. The urologist felt my prostate and it was quite small (30 mm?), i.e. I did not have an enlarged prostate. An enlarged prostate can cause an increase in PSA, so this was good and bad news. My urologist pointed out that it just eliminated another non-cancer possibility and he highly recommended that I get a biopsy, because he said it could definitely be cancer.
For those of you who have never had a prostate biopsy, it's a relatively benign procedure. You have about a 1 in 50 chance of getting a nasty go-to-the-E.R. prostate infection from it, but, overall, it's not too bad. But let me tell you what is bad: waiting the 7-10 days for the pathologists report! This is agonizing as you and your loved ones wait to see if you have prostate cancer or not.
Managing prostate cancer, if you have it, is ugly and controversial at this point. If it's bad enough, urologists can remove the prostate, but you can end up with medium term incontinence and erectile dysfunction as the nerves heal. There's also radiation treatment, but that is risky: the prostate ends up so scarred that urologists can not do a prostectomy, which leaves you potentially at the mercy of a future advanced stage prostate cancer. Yes, there is a new ultrasound treatment for handling prostate cancer, but it's only available in Mexico, so it's still quite a mess and not a road that I wanted to go down!
The story has a happy ending however: I got the biopsy results back today and they found no cancer in any of the 12 samples. Furthermore, there were no precancerous (PIN) samples either. They also found that a couple of the samples had signs of inflammation, which is actually a good thing - relatively speaking - as I'll explain below.
So I asked my urologist his take on the results and he said that the good news was it was extremely unlikely that I had cancer at this point. The biopsy does not sample everwhere on the prostate, but he said that it was still very unlikely that I had cancer at this point. He went on to say that the root cause was likely inflammation based on the pathologist's report and he sees fairly often a spike in PSA that will go away after a few months. Of course, I tried to pin him down on what would cause the inflammation and he had virtually nothing to say on the subject. Basically, he said, "We don't know."
NOTE: I was tested twice for bacteria and both came back negative. So it appears I have some kind of mild abacterial prostatitis. This was a complete surprise to me, since I do not really have any symptoms. Many men suffer quite a bit with this type of chronic prostatitis, but I would not have even noticed if it was not for the high PSA reading.
I then asked him if the plan could be for me to try to lower my PSA through natural means and test it monthly in order to get my urological clearance back for HRT as soon as possible. He then shocked me by saying that
1. He would give me urological clearance for HRT effective immediately, because it was extremely unlikely that I had a prostate cancer. (And, I assume, even if I did, it would show itself by a rising PSA on an ongoing basis.)
2. I should NOT test my PSA monthly, because my prostate is now inflamed from the biopsy and likely would give me high reads for a couple of months.
Of course, I was overjoyed to get permission to go back on HRT and even more excited to know I very likely did not have PC. However, the whole experience was very sobering and I realized that my ability to stay on HRT depends on keeping my prostate extremely healthy. I have to guard against an enlarged prostate, inflammation of the prostate, precancerous growth and, of course, cancer itself.
Now this is no small task as one of the men on The Peak Testosterone Forum pointed out. He struggled with chronic, abacterial prostatitis and said that he has noticed that the key is to keep good blood flow and nitric oxide to the prostate, because the prostate does not have particularly good vascularization. Let me actually quote some of his commentary: 
"Naw, I do not believe that I have CPPS. My main symptom especially during flare ups is I feel I cannot empty my bladder completely. CPPS symptoms seem to be more severe. Pain in the genitals or anal area, very painful urination, and painful ejaculation.
The prostate gets very little blood flow. So it is extremely difficult to "flush" any irritants from it. That is why I try to limit the toxins I take into my body. I try to limit my ingestion of chemicals and pesticides. So, if one eats foods high in pesticides, for instance, these poisons eventually end up in the prostate. It takes I long time for the prostate to eliminate these things. Also, in my case, I believe Kegels increase oxygenation and blood flow to the pelvic area. Moreover, Kegels sorta give the prostate a massage.
So, I will try to anything that helps blood flow. Exercise, reduce systemic inflammation, beetroot juice, etc. I am hoping that by improving my arteries and blood flow it will in turn help with my prostate issues. I do feel much better than a year ago...certainly my eating and exercise habits have helped more than the antibiotics and Advil that the uro's prescribed me."
This is a case, I believe, of the patient have much better ideas and knowledge than the docs!
When you look at the big picture, I have to guard against inflammation and prostate cancer primarily and this caused me to implement some important changes to my lifestyle:
I know that to many of you, some of the above measures will seem extreme. However, they are all research-backed as I how in my pages on How to Lower Your PSA, Flaxseed and Prostate Cancer and A Potential Prostate Cancer Cure. Plus, I never want to go through the stress again of wondering if I am going to leave my family in a tough situation, since I provide the great majority of our income. And who wants to die a grisly death from cancer? I knew a man once who died of prostate cancer that metastasized and it's fugly - that's not the way I want to go and if I can do anything in my power to avoid it, I am going to do it.
Finally, I do NOT want to ever be off of HRT again. I'm a believer in the Replacement Philosophy (in general) and I think having youthful testosterone levels is healthy for most men. However, this whole experience made me realize just how fragile HRT is: one high PSA reading could take me off of HRT for months and that's not something I want to deal with again.
If I can get my PSA down by doing the above, I may go off of a strict vegan diet and then monitor my PSA after eating some Low Fat Meats. One thing at a time though. I am just glad not to have cancer...