The co-authors of Invasion of the Prostate Snatchers, blog alternate posts weekly. We invite you to post your comments.

Tuesday, April 12, 2011

Who's Afraid of a PSA?


The straight answer? Every guy who’s ever been told his PSA was elevated for his age, and that he needs to have a biopsy. Because from that point on, things can happen fast. It’s the prostate cancer version of baseball’s famous Tinker-to-Evers-to-Chance double play—PSA Test-to-Biopsy-to-Surgery.

The PSA is a simple blood test for prostate-specific antigen, a protein produced by normal prostate cells. Cancer cells, however, produce more PSA per unit volume than benign cells, so an elevated PSA can be cause for concern. Since 1986, PSA testing, although not perfect, has served as the gold standard for widespread screening and early diagnosis of prostate cancer. Controversy arises from the fact that, at the first sign of an elevated PSA, your family doctor is likely to send you to a urologist who will almost certainly perform a biopsy—all too often opening the door to unnecessary radical treatment.

Avoiding False Readings 
There are other factors besides prostate cancer that can influence PSA test results. Here are some of them:

BPH: Benign prostatic hyperplasia, prostate enlargement caused by age or infection, induces an elevated PSA not indicative of cancer. 

Infection: Consider the possibility of infection. Some years ago, when my PSA spiked unaccountably from 7.4 to 20.3, my wife, Jeanne, who is a medical intuitive and practices Traditional Oriental Medicine, suggested to our family doctor that he put me on a course of the antibiotic Cipro. Which he did, and after ten days my PSA had dropped back to 9.25.

The 48 Hour Rule: It is possible that strenuous exercise, heavy lifting (like lugging suitcases through airports), sexual activity, and even bicycle riding before a PSA test will negatively effect the result. However, a false elevation is guaranteed if you get your PSA checked immediately following a Digital Rectal Exam (DRE) or too soon after intercourse. So don’t have a blood test for at least a week after a DRE, and avoid ejaculation for 48 hours before the test. 

Inconsistent Lab Work: Standardization of tests, or assays, from one lab to another, is still lacking. This makes comparisons between PSA tests done in different labs unreliable. If you have two or more PSA tests, make sure they go to the same lab for analysis. 

If any of these factors apply in your case, ask for a repeat PSA. 

When a PSA Makes Good Sense 
Early PSA testing makes the most sense if you fall into any of the following categories:

Family History: If you have a family history of prostate cancer, it’s advisable to begin PSA testing at 40 and repeat the test at six-month intervals.

African Americans: All African-Americans are advised to begin tests by age 40 regardless. The death rate from undiagnosed prostate cancer for African-Americans is currently two-and-a-half-times that for Caucasian men. This is partly for genetic reasons, and partly from reluctance to submit to a DRE—85% of cancers occur in the peripheral zone of the prostate gland, and therefore can be felt by the doctor performing the exam. A DRE is an essential diagnostic procedure.

Men Over 75: Nowadays, men over 75 are apt to be spared testing entirely. So you can always avoid the anxiety, and have a good time. On the other hand, you might just go for the PSA test anyway, and while you’re at it, have a thorough physical. I know a number of grateful men who never would have discovered that they had a serious heart problem or high blood pressure, if they hadn’t started with a PSA check. How long has it been since your last physical? 

The Politics of PSA Testing 
The best clinicians do not mindlessly screen all of their male patients. They decide which men should be tested based on age, symptoms, family history, expected longevity, general medical condition, physical examination findings, and—a significant factor—the patient's own request for the test. The goal of early detection remains to identify patients who have clinically significant cancers at a time when treatment is most likely to be effective.

Remember that, ultimately, the big decisions are all yours to make. Trust is crucial. So never hesitate to go for a second opinion. Bottom line, regardless of its shortcomings, the blood test for prostate-specific antigen is still the most useful and widely available method for detecting the presence prostate cancer. And if you want an encouraging statistic, here’s the really good news for men over fifty: 28 out of 30 of you who are reading this blog, and who do have prostate cancer, will die with it, not of it.

As you probably noticed, there is no “MD” after my name. Which means that my experience, my facts, and my emotional involvement are open to scrutiny and comment. In these blogs, I will be writing about matters that I know are of concern to men with prostate cancer, and to those who love them. You don’t need an MD after your name either, to point out something I’ve missed, or correct me if I’m off base. I welcome any PSA questions, advice or stories—reassuring or cautionary—that you’d care to share.

1 comment:

Anonymous said...

I am 83 years old
I still do daily strenuous work in my small grape field...digging post holes, lifting and maneuvering cut-down telephone poles for posts, pruning vigorous vines that are too many for the vine to handle with grapes too, in the sun, 5 days a week...a lot of exercise, so much so that I maintain a weight of 185 lbs. all season from burning the blood pressure is always 116/70 something...

But often I get UTI and am given an antioxidant for 10 first bout with it this year was Feb 2016, and again this July with the same medicine...both followed by a PSA...

the first reading was at about 7,

...and the second this July was given right after I returned from the field performing the above very strenuous and sweaty work...(within an hour I got a call from the lab, and had a PSA within that hour after showering)...that second reading was 9...also I had just finished taking the UTI medicine)

The doctor advised me to make an appointment with their Urologist which I did for this July 28th...

I am not in a state of denial, but am not yet comfortable with the 9 reading...

Your thoughts??? send to