So I think I am getting clearer but "firm understanding" is always elusive in this business.
When I was the proud owner of a prostate I read a numerous articles re-inforced by my uro that you should double (approx) the PSA to get a better sense of where you would be if you were not taking the Finasteride. After reviewing with my generalist doc I saw (that while she did annual digital rectal exams) she had only taken my PSA once a number of years ago. The result of that was apparently 2+ and she did not flag anything or even mention it given she assumed it was normal (even though she had prescribed the finasteride). While it wasn't necessary to double my PSA at the 5.25 level (since the absolute number was already a flag) it sure would have been nice to know about
the adjusted level over 4 a number of years ago. I think it is very important to make sure this point is clear for other folks who are taking finasteride who may be assuming their absolute reading keeps them in safe territory. Who knows but I may have lost out on an opportunity to deal with this earlier.
Also I used the adjusted PSA to help stratify my risk level. My diagnosis in October (MSK) was low volume, low risk G6 and strongly recommended for AS with followup in 6 months for a PSA test. My research suggested that the one constant explanatory variable for higher grade Gleason is PSA density. I accumulated data across articles on how the finasteride affected both PSA levels and prostate volume (not the same impact) and determined that by any calculation my density was very high. Armed with this I sought a number of other opinions which set the path for my signature below.
As noted by AZ Guy there is not much out there that academically discussed this topic post surgery with the exception of the references to treatment options including finasteride referenced by JNF, So at a minimum this suggests finasteride will not harm anything and may do some good. The only exception in possibly interpretation of the first absolute level of uPSA reading where I admit to still be a bit wobbly. Having said this I am equally wobbly on possible implications of stopping finasteride consumption as its original effects work themselves out of the system. In view of all of this I will just plead my case to my uro and see if he has any reasons he can articulate for what benefit he expects to get from stopping. You guys have been very generous with your time and thoughts on all of this. Very grateful.
August 2017: Age 57: PSA 10.5 (5.25*2 given finasteride/propecia), FPSA: 9%
August 2017: MpMRI 2 lesions PIRADS 4 one in Distal Apex, Prostate size: 16cc
October 2017: Biopsy G6, 3/16; all RHS
November 2017: 2nd opinion: 4/16.; G(3+4)
March 2017: RALP G(3+4, tertiary 5) Apex bilateral, G(4+3, tertiary 5) Base, extensive EPE, BNI (+), PI(+), Margins (-), SV (-), LN (0/10), Stage: pT3aN0M0
Post Edited (AJMan) : 4/13/2018 8:46:54 AM (GMT-6)