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Prostrate US showed increased size with calcification. Grade 2 prostatic hypertrophy. What is the likely treatment?

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Practicing since : 1998
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Background:- An MRI has shown my pituitry gland as empty sella and my testosterone was very low and I have severe injections since March 2010 and daily GROWTH HORMONE injections for 6 months. In oct 2009 and feb 2010 my PSA was OK at 1.5 ng/ml and then XXXXXXX to 3.6 in XXXXXXX 2011 & 4.0 in Oct 2011 (normal range should be <3.5).
I have just had a Prostrate Ultrasound report which says
"increased size at the expense of the middle lobe with calcifications inside, 43 x 45 x 47 mm with a volume of about 45 cc which corresponds to a grade 2 prostatic hypertrophy" My home is UK and Andorra.
My IGF1 was normal before I started on Growth Hormone. after 3 months on GH at .02mg /day my IGF1 XXXXXXX to 39 nmol/L(normal 10 to 29) which improved my symptoms of chronic fatigue. Then I was told to reduce my dosage to 0.1mg/day, so after 2 months my Igf1 reduced to 29.I, coming within normal range,but mys fatigue increased. Then I increased dosage to 0.3mg and stopped drinking regularly and dieted , so then after 4 weeks my igf1 was above normal at 265ng/mL( normal 55 to 238 ng/mL) and my fatigue symptoms greatly improved.
my questions are
1) What is the likely treatment, the consequences and the end result for my enlarged prostrate ?
2) Can you refer me to anything that shows Growth Hormone dosage can be decided by symptom improvements rather than limiting it to within the normal range of IGF1, which is supposedly unreliable,and how quickly does IGF1 respond to a change in G H dosage ?
Posted Sat, 28 Apr 2012 in Men's Health
 
 
Answered by Dr. Rajiv goel 4 hours later
Hello.

Thanks for posting your query.


1.

Recent studies have shown that in people with deficient testosterone, exogenous supplementation does not lead to increased incidence of carcinoma prostate.

However, your PSA has been steadily increasing over the last 2 yrs, It would help me guide you better if you could get free and total PSA levels estimated and mail the reports to me. You can mail the reports to "" YYYY@YYYY '' do not forget to include "ATTENTION-To Dr.Rajiv Goel in the subject line".

You don't need any treatment for enlarged prostate as long as it does not cause any urinary problems. I will still be worried about the PSA and like to see free and total PSA as discussed earlier.

2. You might find this article helpful ""R. Clemmons, XXXXXXX Malozowski, XXXXXXX R. Merriam, and XXXXXXX XXXXXXX XXXXXXX first published in Journal of Clinical Endocrinology & Metabolism, 96(6):1587–1609 ""

The decision regarding the dosing of GH is left to the teating doctor. You can ask the same question. ""Can Growth Hormone dosage be decided by symptom improvements rather than limiting it to within the normal range of IGF1, which is supposedly unreliable, and how quickly does IGF1 respond to a change in G H dosage ?"".

The dosing is primarily based on all the three variables assessed, that is, the clinical response(How well you have responded to the treatment), Side effects and the IGF1 levels. The goal is to make you symptom free with the least possible dose along with which keeping the IGF1 levels above the mid value for the age adjusted ranges.

Hope I have answered all your queries. Please feel free to write back if you have further queries.

Wishing you good health.

Regards.



Above answer was peer-reviewed by
 
Follow-up: Prostrate US showed increased size with calcification. Grade 2 prostatic hypertrophy. What is the likely treatment? 32 hours later
I am emailing you blood test results
I do not have any free and total PSA results, will get it checked and emailed to you next week.. what should I watch out for ?
In the last 4 months have felts increased need to urinate during day even when bladder not full.
in last month have had to get up once every night only to urinate
i am concerned that nebido injections have caused this increase in PSA and might lead to cancer (both parents had bowel cancer age 65 approx)
Is there a better alternative to Nebido or should I take half normal nebido injection every 7 weeks instead of full injection every 14 weeks ?
i have been given medication called omnic ocas( made by astellas spain) 0.4mg per night
when should I have a prostarte biopsy?
what is significance ofmy ultrasound result ?
 
 
Answered by Dr. Rajiv goel 12 hours later
Dear,

Good to hear from you again.

I have gone through your symptoms as well as reports. Thank you for sending them.

Please do get your free and total PSA (Prostatic Specific Antigen) done and write back to me. There is nothing specific that you need to watch for.

You should continue the same dosing of Injection Nebido till the next PSA levles are done and then, the dosage can be changed accordingly. You should also continue the medication Omnic Ocas.

Prostate biopsy shall be required if the next PSA is more than 4 ng/ml. Else it is not required to be done.

Your ultrasound study suggests Grade 2 Hypertrophy of the prostate, it does not signify a major problem.

Hope I answered all your questions. Please accept my answer in case you do not have further queries. Wish you Good Health.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Prostrate US showed increased size with calcification. Grade 2 prostatic hypertrophy. What is the likely treatment? 2 days later
I am emailing blood results on free psa for your comment.
Am I going to be at less risk by having 3 weekly injections of
"TESTEX prolongatum" (will UPLOAD DATA SHEET) rather than nebido every 13 weeks ??? I live in Andorra next to Spain, and dont speak the local lingo !

The best dosage of IGF1 that improves my mental exhaustion/lethargy symptoms is 0.3mg of GH per day, but that makes my IGF1 above normal at 265ng/ml only 2 weeks after increasing dose to 0.3,mg/day. ..the normal range of igf1 is 55 to 238 ng/mL
The only way to keep igf1 within normal range is 01.mg GH per day, and my quality of life is miserable. What are risks of keeping GH dosage at 0.3mg /day?
 
 
Answered by Dr. Rajiv goel 15 hours later
Dear,

I have gone through your reports and your chances of having prostate cancer are very remote. There is nothing that you need to worry about.
However, I shall advise you to be on strict follow up with 3 monthly PSA determination.

Changing the dosing schedule is not going to lessen your likelihood of any complications. I suggest that you continue nebido injections.

I hope I have answered your query.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Prostrate US showed increased size with calcification. Grade 2 prostatic hypertrophy. What is the likely treatment? 7 hours later
please answer the 2nd part of my question above, which was.......
The best dosage of IGF1 that improves my mental exhaustion/lethargy symptoms is 0.3mg of GH per day, but that makes my IGF1 above normal at 265ng/ml only 2 weeks after increasing dose to 0.3,mg/day. ..the normal range of igf1 is 55 to 238 ng/mL
The only way to keep igf1 within normal range is 01.mg GH per day, and my quality of life is miserable. What are risks of keeping GH dosage at 0.3mg /day?
 
 
Answered by Dr. Rajiv goel 10 hours later
Hello,

Good to hear from you again.

GH (Growth Hormone) of 0.3mg/day is usual adult replacement dose and if you feeling clinically better, that's great and you can continue the dose 0f 0.3mg.

I may not really chase behind your IGF-1 (Insulin-like growth factor 1) levels as your IGF-1 level of 265ng/ml and a good clinical response with GH of 0.3mg is acceptable, though your IGF-1 is above the normal reference range.

GH therapy of adults with GH deficiency has generally been regarded as being quite safe, although concerns remain regarding the potential for cancer risk and tumor regrowth (contraindicated in those patients with active cancers).

GH can also cause the worsening of glycemic control, but in general been minimal or transient. GH treatment in patients with Diabetes mellitus may require adjustments in anti-diabetic medications.

Gynecomastia (Male breast enlargement) has been reported in normal elderly individuals receiving GH in high doses, but not in the dose levels of 0.3mg/day.

Of course, your thyroid and adrenal functions has to be monitored if you are planning for long term GH therapy.

Regards
Above answer was peer-reviewed by
 
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