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PSA: on PSA (applicable for men)
Old 02-27-2014, 09:19 AM   #1
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PSA: on PSA (applicable for men)

That's Public Service Announcement: on Prostate-Specific Antigen, or PSA testing.

I have a five page summary of my research, I'll spare you all that. I read all I could, but discounted everything that was not from the Cleveland Clinic, Mayo Clinic, Sloan-Kettering, American Cancer Society or National Cancer Institute. What follows is based on my unqualified findings. I was an Engineer, not a Doctor. If a medically trained member wants to correct my understanding, that's welcomed.

Background:
For those not familiar. The PSA test measures the blood level of PSA, a protein that is produced by the prostate gland. The higher a man’s PSA level, the more likely it is that he has prostate cancer. A reading from 0-4 is considered a normal PSA reading (though I learned that's a very generic range that's subject of considerable debate). "PSA velocity" or rate of change from test to test is also (understandably) considered an indicator.

My case:
In Dec 2012, my PSA was 1.8
In Dec 2013, my PSA result was 4.38

My GP referred me to a highly regarded urologist (first available appt 6 weeks later). They took a urine sample and he examined me for 5 minutes. Though I had no other symptoms or history, he scheduled a prostate biopsy, a painful procedure followed by days of blood in urine/stool and risks of infection. Prostate biopsies can come back inconclusive, and a urologist might recommend repeating the procedure as a result. As I had researched PSA testing and prostate cancer while waiting for my appt, I asked the urologist 'biopsy is painful and presumably expensive, would retesting PSA first be a good idea?' With no hesitation he said 'a retest wouldn't change my result,' and he added 'I have no idea what a prostate biopsy costs, but your insurance will pay for it.'

Having read that among about a dozen factors, a DRE (digital rectal exam, sorry) and sexual activity 24-48 before the blood draw for PSA could temporarily elevate the results. Of course I wasn't aware of either when the blood draw was taken, only learned after the fact. My GP did the DRE about 20 minutes before my blood draw.

A PSA test can cost less than $50. Prostate biopsies range from $1,000-$12,000 according to online sources FWIW.

I talked to our health care provider through their "ask a nurse" program, they thought a PSA retest was reasonable.

It's not lost on me what the underlying motivations of the various parties involved may be.

I called my GP to request a PSA retest. The nurse was surprised if not put off at my request, asked a lot of questions and discouraged me, but said she'd talk to the doctor. A week passed and she finally called and said they'd ordered a PSA for me. I went yesterday for the blood draw.

The nurse called me this morning, my PSA yesterday was 1.37. She was very surprised!

So I cancelled the biopsy. The scheduler didn't ask me why...

My intended bottom line here:
There's something to be said for patients taking a respectful role in their health care decisions. My point was not to highlight my case. I am sure some doctors rue the day the internet made so much health care information available, though I am sure others welcome patients who try to educate themselves as long as the patient respects the doctors knowledge and experience.

It's a good thing I'm not easily traumatized, some people might have suffered considerable anxiety being led to believe they might have cancer for almost three months. Unfortunately DW was more worried than I was, she's relieved this morning...

FWIW guys.
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Old 02-27-2014, 09:24 AM   #2
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thanks for sharing..great insight. Congrats on the successful outcome
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Old 02-27-2014, 09:27 AM   #3
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Just another episode in "The Treatment Trap". They don't give a crap about your health. Only worried about money and don't car if they make you suffer. Some experts estimate that 60% of all medical procedures are unnecessary.
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Old 02-27-2014, 09:32 AM   #4
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Originally Posted by franco45 View Post
Just another episode in "The Treatment Trap". They don't give a crap about your health. Only worried about money and don't car if they make you suffer. Some experts estimate that 60% of all medical procedures are unnecessary.
Maybe we should just go to the barber for a bleeding instead...
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Old 02-27-2014, 09:32 AM   #5
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Just another episode in "The Treatment Trap". They don't give a crap about your health. Only worried about money and don't car if they make you suffer. Some experts estimate that 60% of all medical procedures are unnecessary.
That's going much too far IMO. I respect doctors, nurses and other medical professionals for the most part, most want to help people at their core! I have friends and family who are dedicated medical professionals.

There are good and bad in ALL professions - ALL.

Legal, regulatory, the business of hospitals and other factors probably irritate and negatively influence doctors at least as much as patients. My point was simply that patients ought to take an active but secondary role in their health care (same with investing ). Some of the poor health and high expense in health care falls to the patients themselves.
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Old 02-27-2014, 09:41 AM   #6
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thanks so much for telling us your story.

I too am sad about the broken system we are in. I grew up thinking that doctors where caring and smart.
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Old 02-27-2014, 09:46 AM   #7
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thanks so much for telling us your story. I too am sad about the broken system we are in. I grew up thinking that doctors where caring and smart.
I have great docs, they are definitely caring and smart. Docs are human though, meaning they are not all the same. I imagine the OP's docs were being cautious.
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Old 02-27-2014, 09:52 AM   #8
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Thanks, I watched my BIL go through radiation because of the "PSA was high test result". My feeling is he really should have had more tests done before submitting himself to radiated BBs.
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Old 02-27-2014, 10:09 AM   #9
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I am on my fourth Cardiologist after my HA. The first saved my life and was nice until he figured out that I was not going to let him do a lot more "preventive" procedures. The second lied to me on several occasions(The most arrogant person I have ever met)' the third started out pretty much saying that if I didn't do everything as he said, he didn't want me as a patient. The fourth seems pretty good so far and from the getgo, more concerned my lifestyle changes as. Opposed to doing more intervention.
If you have a caring doctor, you are truly lucky.
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Old 02-27-2014, 10:19 AM   #10
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Great post, thanks. Against the recommendations of my doc, I have continued getting a yearly PSA test and graphing it so I can gauge the slope of the curve as well as the magnitude of the outcome. This is the first I've heard about recent prior activities affecting the reading, which doesn't speak well for either me or those ordering the test in the past.
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Old 02-27-2014, 10:30 AM   #11
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Excellent cautionary tale.
My doc considers the PSA too problematic, so together we agree to skip the test at this point in time. He also does not get the test - we are about the same age, late fifties.
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Old 02-27-2014, 10:32 AM   #12
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I hate this prostate threads, because at 49, I am at the point I have to figure out what if anything to do screening wise. I read that 1 in 7 men eventually get this cancer but only one in 36 die from it. Since 36 out of 36 will die from something anyways, I wonder if the treatment is worth potential risks. I read a study in Europe a few years ago that autopsied men from ages of 50 through 80 that died of something other than prostate cancer were studied to see if they had prostate cancer in their body. Kind of interesting in that 50% of the men who died in their 50s had prostate cancer and 80% of all men who died in their 80s had prostate cancer. I am not a "cut that thing out doc"type of person. If I knew I had prostate cancer but it likely wasn't going to be the source of my demise, I would be perfectly comfortable not doing anything about it. It appears these prostate things had a structural design flaw when they were first created!
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Old 02-27-2014, 10:38 AM   #13
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Great post, thanks. Against the recommendations of my doc, I have continued getting a yearly PSA test and graphing it so I can gauge the slope of the curve as well as the magnitude of the outcome. This is the first I've heard about recent prior activities affecting the reading, which doesn't speak well for either me or those ordering the test in the past.
I am not a doctor so not qualified to offer specifics, but if you Google reputable sources you'll find there are at least a dozen factors that can significantly increase or decrease PSA results, I mentioned two above. Glad I know for future reference as PSA is part of my annual physical until/unless the test is completely discredited.
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Old 02-27-2014, 10:39 AM   #14
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You really never know. Long ago, the first time I ever had a PSA test, it was over 9. My doctor and I were both freaked out. So he sent me to a urologist who did his thing and decided to give me antibiotics. They worked nicely and my PSA was back down to a normal range a month later. The problem was simply an infection (prostatitis).
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Old 02-27-2014, 10:40 AM   #15
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I had the biopsy after a jump from consistent 1.3 to 17 (!) after a UTI and then a year of similarly high results. Ended up in the hospital with sepsis that night...highly not recommended!

Five years later, PSA still at 7-8 but a careful/thoughtful urologist feels that this is my 'new normal' and watches it every six months.

My GP is very against the PSA test due to the risk as noted above.

I'm pretty sure that that was my last biopsy however.....
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Old 02-27-2014, 12:36 PM   #16
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As far as PSA test goes the doctor who invented the test does not even recommend its use any more. That' tells ya something. reading teh OP I would say the doctor is guilty of attempted manslaughter. Imprudent if not outright unethical practice of medicine and the risk to life and well-being.

I've had my life and quality of life destroyed by following doctor's order. Allowing myself, at their insistence, to be treated for an infection that was could not be shown under a microscope. And believing them when they said I needed to lower my cholesterol. Unfortunate sequalae out-the-azz on all counts. ALL obstinantly denied. Continually "diagnosed" with everything from fake heart attacks (no medical evidence) and brain tumors (side effects of lipitor and other unnecessary drugs clearly listed on package insert). All the thing I said I had they denied until I paid for my own independent tests.

I am on medication for the rest of my life to treat their toxic assaults at "lowering my risk". I, and my insurance, are out hundreds of thousands of bucks. I need surgery to correct some of the effects but do not trust any doctor to do it.

Twice a yr when I have my blood tested and my prescrip renewed all they want to talk about is my cholesterol. They keep doing these backdoor tests that they don't tell em about till I get the bill. They tests are never fasting because they never tell me they're doing them and that's after I told them to stop doing them. Change doctors? Won't matter. I've had several and they are always the same.


And they're getting paid for this.
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Old 02-27-2014, 12:46 PM   #17
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Originally Posted by Midpack View Post
That's Public Service Announcement: on Prostate-Specific Antigen, or PSA testing.

I have a five page summary of my research, I'll spare you all that. I read all I could, but discounted everything that was not from the Cleveland Clinic, Mayo Clinic, Sloan-Kettering, American Cancer Society or National Cancer Institute. What follows is based on my unqualified findings. I was an Engineer, not a Doctor. If a medically trained member wants to correct my understanding, that's welcomed.

Background:
For those not familiar. The PSA test measures the blood level of PSA, a protein that is produced by the prostate gland. The higher a manís PSA level, the more likely it is that he has prostate cancer. A reading from 0-4 is considered a normal PSA reading (though I learned that's a very generic range that's subject of considerable debate). "PSA velocity" or rate of change from test to test is also (understandably) considered an indicator.

My case:
In Dec 2012, my PSA was 1.8
In Dec 2013, my PSA result was 4.38

My GP referred me to a highly regarded urologist (first available appt 6 weeks later). They took a urine sample and he examined me for 5 minutes. Though I had no other symptoms or history, he scheduled a prostate biopsy, a painful procedure followed by days of blood in urine/stool and risks of infection. Prostate biopsies can come back inconclusive, and a urologist might recommend repeating the procedure as a result. As I had researched PSA testing and prostate cancer while waiting for my appt, I asked the urologist 'biopsy is painful and presumably expensive, would retesting PSA first be a good idea?' With no hesitation he said 'a retest wouldn't change my result,' and he added 'I have no idea what a prostate biopsy costs, but your insurance will pay for it.'

Having read that among about a dozen factors, a DRE (digital rectal exam, sorry) and sexual activity 24-48 before the blood draw for PSA could temporarily elevate the results. Of course I wasn't aware of either when the blood draw was taken, only learned after the fact. My GP did the DRE about 20 minutes before my blood draw.

A PSA test can cost less than $50. Prostate biopsies range from $1,000-$12,000 according to online sources FWIW.

I talked to our health care provider through their "ask a nurse" program, they thought a PSA retest was reasonable.

It's not lost on me what the underlying motivations of the various parties involved may be.

I called my GP to request a PSA retest. The nurse was surprised if not put off at my request, asked a lot of questions and discouraged me, but said she'd talk to the doctor. A week passed and she finally called and said they'd ordered a PSA for me. I went yesterday for the blood draw.

The nurse called me this morning, my PSA yesterday was 1.37. She was very surprised!

So I cancelled the biopsy. The scheduler didn't ask me why...

My intended bottom line here:
There's something to be said for patients taking a respectful role in their health care decisions. My point was not to highlight my case. I am sure some doctors rue the day the internet made so much health care information available, though I am sure others welcome patients who try to educate themselves as long as the patient respect the doctors knowledge and experience.

It's a good thing I'm not easily traumatized, some people might have suffered considerable anxiety being led to believe they might have cancer for more than two months. Unfortunately DW was more worried than I was, she's relieved this morning...

FWIW guys.
Had same issue as you a couple of years ago. Had routine blood test (A1C) for diabetes. PSA number came back high.

Doctor said, come back and be retested. 2nd PSA test, number was normal again.

Lucky Doctor suggested retest. But the "worry" factor was bad. Also, did
research like you. PSA and prostrate cancer very subjective.
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Old 02-27-2014, 01:10 PM   #18
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Originally Posted by Midpack View Post

...

My intended bottom line here:
There's something to be said for patients taking a respectful role in their health care decisions. My point was not to highlight my case. I am sure some doctors rue the day the internet made so much health care information available, though I am sure others welcome patients who try to educate themselves as long as the patient respects the doctors knowledge and experience.

...
Since almost dying in the 90's, you could consider me almost an activist when it comes to my health care (I'm sure my doctors do). Fortunately, my PSA earlier this year came back so low MD said I won't get prostate cancer even in the next lifetime. Colonoscopy is next up.

Also fortunately, had a coronary calcium heart scan which showed only a 40% risk factor of heart disease. However, more sensitive blood tests show heart risk factor based on lipids. MD says not at risk for a heart attack next week or year, but proactively taking a statin now would substantially lower risk of a heart attack in in 10, 15 years or more. My diet, exercise regimens have been strict for literally decades, and no further improvements possible.

Still on the fence about the statin (really don't want to). Part of life. And yes, I agree that without health, all the financial security in the world is useless.
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Old 02-27-2014, 02:08 PM   #19
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Here is one man's story. He has prostrate cancer and has decided on 'Watchful Waiting'.

Prostate Cancer Update | www.clarkhoward.com
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Old 02-27-2014, 02:45 PM   #20
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Here is one man's story. He has prostrate cancer and has decided on 'Watchful Waiting'.

Prostate Cancer Update | www.clarkhoward.com
Quote:
Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors that do not cause symptoms. Finding a small tumor, however, may not necessarily reduce a man’s chance of dying from prostate cancer. Some tumors found through PSA testing grow so slowly that they are unlikely to threaten a man’s life. Detecting tumors that are not life threatening is called “overdiagnosis,” and treating these tumors is called “overtreatment.”

Overtreatment exposes men unnecessarily to the potential complications and harmful side effects of treatments for early prostate cancer, including surgery and radiation therapy. The side effects of these treatments include urinary incontinence (inability to control urine flow), problems with bowel function, erectile dysfunction (loss of erections, or having erections that are inadequate for sexual intercourse), and infection.

Most men with an elevated PSA level turn out not to have prostate cancer; only about 25 percent of men who have a prostate biopsy due to an elevated PSA level actually have prostate cancer.
Prostate-Specific Antigen (PSA) Test - National Cancer Institute

Not recommending reckless abandon, but careful consideration.
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