Question QUESTION: I received a letter in the mail with my PCA3 Urine Test results. There was no # given it just stated Result Indeterminant, the urine was collected immediately following the DRE. I assume this means for some reason they could not get a reading. I do have Retrograde Ejaculation from medication could this be the reason, what is your interpatation of it? DRE Normal, PSA 0.45 Testosterone 752, it has always been high. Do you think I should be concerned? Thank-You!
You are smart guy to think the retrograde could fog the results of the PCA3 . The PCA 3 is not the gold standard for detection of prostate cancer. Its still in its infancy and I would not even have it done on myself until I see really solid evidence to efficacy and accuracy. Your T being 752 is a blessing most men would be glad to have, this means your testes are working in optimal condition. The fact your T is up, your prostate is enlarged and mildly obstructive and your PSA is less than 1 means you are in great condition as far as suspicion is concerned. I would do nothing different. Men with very low T under 180 are double as likely for PC as those in a normal range and as for PSA testing, the best method is velocity. This means if your PSA does not increase in an increment of 0.8ng/dl or more within 365 days you should be rather confident that your safe from prostate cancer. Now remember that PC does not play by all the rules and I have had patients with a PSA of 0.3 and a nodule on the rectal exam that have biopsied + for PC. As a whole all looks great on your profile.
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QUESTION: Thank-You for your prompt reply.So you do believe the retrograde fogged the results, it didn't show high, no # at all? The examiner did not do a prostate massage, just a thorough DRE. I think you were confused, I do NOT have an enlarged prostate or mild obstruction. Physicians have told me repeatedly 18 year olds would love to have my T level, however I understand T can fuel PC, hormone shots goal is to lower the T level.
What medication do you take that creates retrograde ejaculation ? Historically alpha blockers such as Flomax, Uroxitrol, Rapaflo and Hytrin have the capability of causing retrograde ejaculation and all of these medications are used for obstructive urine flow of the prostate and this is where I get the inclination that you must have had urinary symptoms to be on such medications. You do not need an enlarged prostate for obstructive symptoms small glands can do the same. Testosterone can fuel some prostate cancers but it has been proven that most prostate cancers are not androgen dependant. I have many patients with prostate cancer that take testosterone shots while on active surveillance , our protocol is biopsies every 3-6 months and some only yearly to evaluate progression of the cancer. Remarkably the majority of active surveillance patients on T do not show any faster progression of growth verses the patients that are hypogonadal (Low T). Very few physicians will prescribe T for an active surveillance patient out of fear of legal ramifications but Larry Lipshultz MD one of the foremost international authorities on andrology has proven its safety record in high numbers. I would say I only speculate the results on the PCA3 are fogged I have no clinical data too support the claim but if we were testing PCA3 for efficacy I guarantee we would exclude patients on alpha blockers as a direct result of contaminated urine via semen.
Invervential urologic radiology , urologic laser surgery, cryotherapy of the prostate and kidney, extracorporal shockwave lithotripsy, holmium laser lithotripsy, urodynamics (video-non video),male infertility, erectile dysfunction, Peyronies disease, hypogonadism ,kidney stones, prostate cancer detection, BPH, voiding dysfunction, bladder cancer and continent diversions.
For the past 20 years performing intervential and diagnostic uro-radiology for a multitude of urologic surgeons from New York, New Jersey, Lousianna and Texas. Founder of DMS medical LLC introducing the Texas Medical Center to the first high power Green Light laser for the treatment of BPH just after its release by the FDA from Laserscope and its sucessful trials at the Mayo Clinc.
Organizations American Registery of Diagnostic Medical Sonographers (ARDMS), American Urologic Assocoation (AUA), American Medical Systems (AMS) Laserscope,Oncura, Allergan and Auxilliam pharmaceuticals.
Publications Comprehention of Urologic Ultrasonography for the Resident Physician (Journal of Urology 2012), Author of the syllabus for the uro-radiology residency course at The Scott Dept of Urology at Baylor College of Medicine Houston Texas (2010 to present). Past Clinical Studies: Principal radiology investigator Allergan Inc for "The treatment of BPH with intra-prostatic injections of Botox" with Larry I Lipshultz MD 2011-2012, principal radiology investigator for Allergan Inc for "The treatment of Peyronies disease by intra-lesional penile injections of Botox" with Mohit Khera MD MBA MPH (2011-2012). Current studies: Principal investigator of "Blood pressure risk factors of intra cavernosal injections of Trimix and PGE1 during Penile Duplex's.
Education/Credentials BS from Ramapo College of NJ, Registered diagnostic medical sonographer with the ARDMS, 2 year fellowship of Uro-Radiology and intervential sonography at Baylor College of Medicine Houston TX, laser safty officer in state of Texas and certified in KTP, Holmium and Lithium Tri-boride laser systems from Laserscope San Jose, California and American Medical Systems Minnatonka Minnasota, trained and certified by Oncura Inc Isreal in ultrasound guided argon cryotherapy of the prostate and kidney.
Awards and Honors Honorary instructor of GU ultrasound course 2012 international meeting of the American Urologic Association. Author of the the AUA course for "Ultrasonography of the Testes and Scrotum" 2012.
Past/Present Clients Baylor College of Medicine (BCM) Lousianna State University (LSU), LSU Medical Center Shreeveport LA, The Methodist Hospital Houston Texas, St Lukes Episcopal Hospital Houston Texas, Memorial Herman Health Systems Houston Texas, Palestine RMC Texas, Doctors Regional Hospital Corpus Christi Texas, Valverde Regional Medical Center DelRio Texas, Current instructor/technologist for two internationally recognized urologists : Larry I Lipshultz MD and Mohit Khera MD, MBA, MPH at Baylor College of Medicine. I served as intervential sonography consultant for Oncura Inc cryotherapy systems. Former lead trainer for Urosource mobile medical services , training new surgeons in PVP or photo-selective vaporization of the prostate for BPH, BNCs and urethral stricture vaporization.