Your PSA Scare Turned Out to Be "Just BPH." A Urologist Explains What the Word "Just" Is Hiding.
Why your number went up, why it will likely go up again, and what to do with the good news before the next phone call.
What the research shows
- An enlarged prostate makes more PSA. A bigger gland is one of the most common reasons a PSA comes back high when there's no cancer at all.
- Benign prostate enlargement tends to keep progressing with age. In the long-term MTOPS trial, men's symptoms and risk of complications kept climbing over the years without treatment aimed at the growth.
- The most common first prescription, an alpha-blocker like Flomax, does not change the size of the prostate or affect its growth, according to the Cleveland Clinic.
- When the gland grows enough to need surgery, about 1 in 10 men need it redone within 10 years, because surgery removes tissue but not what drives the growth.
Read the first line again. If your PSA came back high and the scans came back clear, your number didn't go up by accident. It went up because your prostate is getting bigger. And that part of the story doesn't end with the good news.
Most of my colleagues won't like that I'm writing this. I still practice, and I still make both kinds of phone calls every week. But I've made the good call to too many men without telling them what came after it.
The 2 phone calls
The first call goes out from my office a few times a week. "Your PSA came back elevated. Dr. Hartwell would like you to come in."
I know what happens to a man after that call, because they tell me. He doesn't sleep. He sits at the kitchen table at 2 in the morning reading survival rates he doesn't understand. He doesn't tell his kids. He looks at his grandson at Sunday dinner and does math he's never done before.
Then the MRI, maybe the biopsy, and the wait for results, which is somehow worse than the week before it.
Then I get to make the second call. "No sign of cancer. Your prostate is just bigger. A bigger prostate makes more PSA."
I've heard men cry on that call. One hugged his wife in my parking lot so long the attendant asked if everything was all right.
And then, for most of my career, I'd say, "Good news. It's just BPH. See you next year."
Howard got the good call twice
Howard was 63. Retired mail carrier. 7 years on Flomax, never missed a night. His PSA went from 2.4 to 6.1 in a year. He went through the whole week. The call, the MRI, the wait.
No cancer. He and his wife went out for a steak that night to celebrate. I told him it was good news and refilled his Flomax.
A year later his PSA was 7.9. Another call. Another week at the kitchen table. Another MRI. Clear again.
That Christmas morning he was at his daughter's house watching the grandkids tear into their presents. He went to the bathroom and couldn't go. Not a drop. His son-in-law drove him to the ER in his slippers. Catheter. Then a TURP in February.
At his follow-up he said, "You told me it was good news."
I did. I told him what it wasn't. I never told him what it was.
My own father went through the same week at 68. Clear. "Just BPH." He had his TURP at 74 and never told my mother what he lost. I was already a urologist. I didn't tell him either.
So why should you believe me now? You shouldn't. Not yet. Let me tell you about the patient who changed how I make the good call.
Doug
Doug was 64. Retired insurance adjuster, the kind of man who reads the whole lab report, footnotes included. His PSA went from 2.6 to 5.9 in 14 months.
He told me later that week was the longest of his life. He cleaned out the garage so his wife wouldn't have to. He wrote his grandson a letter and hid it in his desk.
The MRI was clear. His prostate measured 58 cc. "Just BPH."
Here's what I didn't know until later. After the scare, Doug had quietly bought saw palmetto, then a stronger brand, 8 months of bottles. He was still up 3 times a night. The stream took so long to start that he'd stopped going to his grandson's away games, because he couldn't sit through 2 hours of Little League without leaving to find a bathroom. He missed the whole playoff run last spring.
At his 3-month check, I was going to start him on Flomax. I'd already pulled up the prescription.
The man in the MRI waiting room
What Doug told me at that visit was about the man who'd been sitting next to him in the MRI waiting room. Same gown, same plastic chair, same PSA scare. They got talking the way men do when they're scared and pretending not to be.
The man told him he'd been taking something called Saika Prostate Intercept, with an ingredient called S-Equol, since his own scare a year before. Doug wrote it on the back of his parking ticket and forgot about it.
"I'd just spent 8 months on bottles that did nothing," he told me. "I wasn't buying another one."
What changed his mind was the second night of getting up 4 times. He found the parking ticket in his jacket at 3 in the morning. "I'd spent a week thinking I was dying," he said. "When I found out it was just my prostate growing, I decided I wasn't going to sit around and wait for the next phone call."
He ordered a bottle. He didn't tell me.
Week 2, he slept through the first trip of the night.
Week 4, he was up once. The stream started without the waiting.
Week 8, he sat through a full double-header without getting up once.
| Test | After the scare | 3 months later |
|---|---|---|
| Flow rate | 9 ml a second | 14 ml a second |
| Symptom score | 19 | 9 |
| Times up at night | 3 | 1 |
I ran the flow test twice. "Doug," I said, "I was about to put you on Flomax. What did you do?"
He put the bottle and the parking ticket on my desk. I closed the prescription without sending it.
See what Doug took
What I found when I went looking
I went home expecting to find nothing. Doug's 8 months of bottles had already told me what most supplements do. The largest NIH-funded trial ever run on saw palmetto tested it at up to 3 times the normal dose. It did no better than a placebo.
S-Equol was different.
Your prostate grows because of a hormone called DHT. It's 5 times stronger than testosterone, and as men age, the body makes more of it. DHT locks onto your prostate cells and tells them to grow. That growth is what pushed your PSA up.
Flomax never touches DHT. Finasteride shuts DHT production off all over the body, which is why it costs so many men their drive. Surgery takes out grown tissue and leaves DHT where it was.
S-Equol works a different way. It binds to the DHT itself, so the DHT can't lock onto your prostate cells. It doesn't shut anything off. Your testosterone stays where it is, and so does your drive.
Saika adds stinging nettle root, whose lignans block a protein called SHBG from docking onto prostate cells and pulling hormone signal into the tissue. 2 ingredients aimed at the same hormone from 2 directions.
Most men can't make S-Equol on their own. It takes the right gut bacteria to turn soy into it. A study across 4 countries found 59% of Korean men make it, and only 14% of American men. Taking it directly skips the gut.
Before I said a word to another patient, I checked the label myself. 12 mg of S-Equol and 50 mg of stinging nettle root per serving, with a small support blend of vitamins, minerals and green tea extract. Every dose printed. No proprietary blend.
Doug wasn't the only one
Once I started telling men about it on the good call, I started hearing the same thing back.
Phil, 61, a high school principal, cleared after a biopsy last winter. Up 3 times a night then. Up once now.
Larry, 67, a retired bus driver, already on Flomax when his PSA jumped. 10 weeks after adding Saika his symptom score had dropped from 20 to 11, same Flomax dose.
Mike, 58, an HVAC tech, the youngest man I've seen go through the scare. He'd started planning service calls around gas stations. He doesn't anymore.
Ernie, 70, a retired Marine, told me the scare was worse than anything he saw overseas. He sleeps through most nights now and says that's the part he didn't expect.
What I tell every man after the good call now
The good call ends differently now. If your scare came back BPH, this is the whole plan.
- Celebrate. You dodged the worst news a man can get. Take the steak dinner.
- Keep every PSA check your doctor schedules. Don't skip a single one. Nothing on this page replaces cancer screening.
- Get your starting numbers. Your symptom score, the 7-question form every urology office has, and how many times you're up at night, counted for a week.
- Take Saika every day. 2 capsules, 1 in the morning and 1 later in the day. Keep taking anything your doctor prescribed.
- Rescore at 8 to 12 weeks. If the numbers moved, keep going. If they didn't, use the guarantee.
When to call your doctor instead
If your PSA keeps rising, if you see blood in your urine, if you can't pass urine at all, or if you're getting infection after infection, call your urologist now. Saika is not a treatment for any of that, and it is not a substitute for PSA monitoring.
What to expect, and when
Weeks 1 and 2. Most men notice little. Some notice 1 fewer trip a night.
Weeks 3 and 4. This is when most men in my practice notice a change. Fewer trips, an easier start.
Weeks 8 to 12. Rescore. That's the number that tells you whether it's working for you.
60 days. The guarantee window. If nothing has changed, you get your money back.
You have 2 ways to spend the time until your next PSA
Wait for the next call
"Just BPH," see you next year. The gland keeps growing, the number keeps climbing, and one day the phone rings again.
Use the good news
Score yourself now. Take Saika. Score yourself again in 12 weeks and let the 2 numbers decide.
I don't get paid by Saika. I'm telling you this because I told Howard it was good news and sent him home with nothing, twice.
Saika Prostate Intercept has a 60-day money-back guarantee. You email "this didn't work" and your money is back the same day.
Don't take my word for any of this. Ask your urologist why a bigger prostate raises PSA. Look up S-Equol and DHT. Read the saw palmetto trials. Read it the way I did, expecting to find nothing.
Last month Doug kept score for his grandson's whole tournament. 3 games, 1 Saturday, and he never left the bleachers. His grandson asked him why he was grinning in the 9th inning of a game they were losing.
You dodged the worst news a man can get. Don't ignore the problem you actually have.
Saika Prostate Intercept
- 12 mg S-Equol and 50 mg stinging nettle root in every serving
- 2 capsules a day, 1 in the morning and 1 later in the day
- Every dose on the label, no proprietary blend
- Runs alongside what you already take
- 60-day money-back guarantee, refunded the same day you ask
What customers say
"I was running out of options"
"I'd been dealing with prostate trouble for almost 6 years. Tried saw palmetto, changed my diet, even gave up my evening coffee. When my doctor started discussing surgery, I got nervous about the possible side effects. I came across Saika while researching my options. I've been taking it for 9 weeks now. I'm still following up with my doctor, but I like knowing exactly what's in the capsules."
"My wife was more worried than I was"
"I'm 71, and after 43 years of marriage, my wife knows when something is bothering me. I'd been waking up several times a night and was getting frustrated. She encouraged me to speak to my doctor and look into my options. That's how we found Saika. I've been taking it for 2 months. It's easy to fit into my morning routine, and we're continuing to keep track of how I'm doing."
"I just wanted to enjoy retirement"
"I retired at 68 thinking I'd spend more time fishing and visiting the grandkids. Instead, I found myself planning drives around bathroom stops. My son helped me research prostate health, and Saika was one of the products we came across. I've been using it for nearly 3 months. I still take my doctor's advice seriously, but I appreciate having a straightforward supplement without a dozen mystery ingredients."
Questions men ask me
Will this lower my PSA?
I won't claim that, and you shouldn't buy it for that. Keep every PSA check your doctor schedules. What men notice is their nights and their stream, and that's what the symptom score measures.
Can I take it with Flomax?
Yes. Saika is a dietary supplement meant to run alongside what you already take. Keep taking everything your doctor prescribed, and show the label to your urologist or pharmacist.
Will it shrink my prostate?
I won't promise that, and you should be wary of anyone who does. S-Equol binds DHT so it can't tell your prostate cells to grow. What that means for your nights and your score is what the 60 days are for.
How is this different from saw palmetto?
Saw palmetto leans weakly on the enzyme that makes DHT, and in the 2 biggest US trials it did no better than a placebo. S-Equol doesn't try to stop DHT being made. It binds the DHT that's already there.
Where should I buy it?
Only at getsaika.com. Listings on Amazon and other marketplaces using the Saika name are not from Saika, and there's no way to know what's in them.
What if it doesn't work?
Email support@getsaika.com and write "this didn't work." Your money is back the same day. You have 60 days.
P.S. Score yourself this week, before your first capsule. Without a starting number, nobody can tell you what changed, not even you.
P.P.S. Your PSA went up because the gland grew. The good news told you what it wasn't. This is what it was.
P.P.P.S. Howard got the good call twice and went home with nothing both times. You got it once. You still have time to use it.
- McConnell JD, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. New England Journal of Medicine, 2003;349:2387-2398.
- Cleveland Clinic. Alpha-blockers. Health Library.
- British Association of Urological Surgeons. Transurethral resection of the prostate (TURP), patient information leaflet.
- Systematic review of reoperation rates after surgical treatment for benign prostatic hyperplasia (119 studies, 130,106 patients). Frontiers in Endocrinology, 2023.
- Barry MJ, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA, 2011;306(12):1344-1351.
- Akaza H, et al. Cancer Science, 2012 (equol producer rates in men by country).
- Lund TD, et al. Equol is a novel anti-androgen that inhibits prostate growth and hormone feedback. Biology of Reproduction, 2004;70(4):1188-1195.
- Schöttner M, Gansser D, Spiteller G. Lignans from the roots of Urtica dioica and their metabolites bind to human sex hormone binding globulin (SHBG). Planta Medica, 1997;63(6):529-532.