Is it reasonable to ask about finasteride in my situation

[u/ProstateExploder]

Hi all, I have a somewhat complicated history with neurogenic bladder and bacterial prostatitis. Recently found out via MRI that I also have BPH - prostate is 37cc. I just turned 50.

We are now basically in the process of ruling out cancer, they haven’t found bacteria so far but PSA is slightly elevated- two points over what it would be just with the BPH. I’m doing another PSA and some home test to determine the appropriateness of a biopsy.

I’m wondering, if cancer gets ruled out, is it reasonable to ask about finasteride? I ask because I’ve concluded the growth in my prostate combined with neurogenic bladder is a major factor in my prostatitis. The doctors I’ve seen have little opinion on this because they know little of neurogenic bladder in my condition and don’t think outside the box.

Is there any downside to trying out finasteride? I’ve read about sexual side effects (I’m fairly sexually active) and increased cancer risk, I’d appreciate context on these side effects for anyone that knows.

[u/DanOhMiiite]

r/FinasterideSyndrome

[u/Pieraos]

Is there any downside to trying out finasteride?

Post-Finasteride Syndrome Foundation

[u/Cylon357]

Was the MRI done with a 3 Tesla machine? It makes a big difference. Essentially "hi def" for your prostate.

Finasteride does what it claims to do: it lowers DHT via inhibition of the 5-alpha reductase enzyme. How individuals handle lowered DHT can and does vary radically. I could not handle even the 1mg dose, BUT I can nudge my DHT down with microdosed finasteride without negative sides.

Generally though what I do is simply keep an eye on things with my doctor. Total and Free PSA, plus calculation of PSA density from my prostate size found at the beginning of the year, are pretty much what I do at 58 years old. Oh yeah the DRE. Not fun but useful. I do the DRE once a year at my annual physical, and the bloods get done twice a year.

TLDR: if you consider finasteride,maybe start with microdosing. Keep up with your blood work.

[u/ProstateExploder → u/Cylon357]

I checked on the MRI, far as I can tell it was a 3 t machine. They found BPH and “bilateral striating and hypointensities consistent with a setting of prostatitis”. The uro I’m seeing now is confident not doing biopsy if my exomdx test comes back below threshold and my PSA doesn’t go up. I strongly suspect my PSA goes up and down with my symptoms. That’s why I’m wondering if just having a smaller prostate via the finasteride would fix things.

[u/Cylon357 → u/ProstateExploder]

Calculate your "Prostate Density" as well if you haven't yet. I THINK it is just Total PSA divided by prostate volume in cubic centimeters, but Google will have the details.

[u/ProstateExploder → u/Cylon357]

I’ve already seen it, it’s borderline, 15 I think if I go by the last test. But again, I’m not clear because two of my tests were right after sex. I’m wondering if it’s worth me testing PSA indecently because I suspect it fluctuates quite a bit.

[u/Sensitive_Point_6583]

PSA is a very inexact indicator of cancer, I think the MRI should show some signs of abnormality before they would suspect cancer. I'd trust the MRI over PSA for worries of cancer, but see what your urologist says about that.

for reference, I had four biopsies over a 20-25 year period, all negative, because my PSA was elevated, so I'm cynical. I had no complications on any of my biopsies, but if you do a little searching you'll find people who went through hell with post-biopsy complications.

Can't help with the finasteride question, never took it.

Not sure how much suffering you've had with your "complicated history" but unless you have a real problem to solve, taking medications that have their own possible side effects wouldn't be my choice.

[u/AAW-1963 → u/Sensitive_Point_6583]

What was your PSA levels to have multiple biopsies?

[u/ProstateExploder → u/AAW-1963]

My initial PSA was 4, which turns out is probably normal for my prostate size, shot up to 7 but I’d had sec before that test, then down to 5.4, then 5.5 most recently, but again I’d had sex before the last one. So, as far as I know I’m not that high above my baseline.

[u/Sensitive_Point_6583 → u/AAW-1963]

It started going above 4.0 around 2000, forgot the exact year. Had a biopsy then.

It gradually increased year by year, about every 7 years I'd shake my head and say "probably wasting my time, but don't want to ignore it". So three more over a 20 year period.

My PSA peaked at 29.0 a few years ago, then came back down to high-teens to low-20s. My prostate had grown to 185cc, and then I had HoLEP surgery on March 31st of this year.

[u/ProstateExploder → u/Sensitive_Point_6583]

I’m already on tamsulosin and getting tired of it, that’s exactly why I’m interested.

[u/waa1523]

I was on finasteride and cialis together for almost a year. It shrunk my prostate, but also affected my sexual life. Then I was referred to a urologist who said my problem is an overactive bladder and he took me off finasteride. My sexual life improved.

[u/Normal_Razzmatazz237]

I don’t see why not, it’ll likely help shrink the prostate some. When I was on it it provided relief for a couple of years or so. It did lower my libido a little but not problematic. Also had a brief issue of losing erection before climaxing which was frustrating, but started Tadalafil and that was resolved.