PSA: on PSA Test (for men) - Part 2

[braumeister]

All my docs have had me do the blood work a week or two before my annual visit. What they do is to review my record ahead of time and set the blood draw up for whatever they feel is worth checking. Sometimes that includes a test or two that I haven't had for years (such as Vitamin D), but always turns out to be reasonable.

As a result, I've never had to have a followup blood test. And it's nice to have all the numbers available to discuss face to face.

 

[Midpack]

Agreed. I am guessing my GP’s wanted patients to do blood draws with the physical so 1) I’d use their in-house lab instead of an independent, 2) so they wouldn’t have to deal with two appointments for me and 3) in case they want to add other non-standard blood tests. These days they don’t even have to do a follow up call, they just email the bloodwork results and their recommendations.

 

[audreyh1]

Our PCP just has us come in a week before to get blood drawn. No doctor visit - simply an early morning blood draw, and much of the testing is done in house. They always have a crowd of people getting blood drawn first thing.

At the end of each physical I get the orders for which blood tests to do a year later. I keep a copy because I always confirm with the phlebotomist what tests they are drawing for. Occasionally we’ve called ahead and asked for a test or two to be added, for example DH wanted to check his Vitamin D levels, and they approved it before the blood draw appointment.

 

[LRDave]

I live 2 hours from my PCP now, so I make a mid morning appointment having fasted the night before, get my bloodwork done FIRST and then into the exam. I get a nice report back in a week or so that includes analysis of the bloodwork.

I don't see a downside to the DRE (except for the short-lived, mild discomfort) as long as it doesn't precede the bloodwork. A prostate swollen enough to be noted by the DRE almost certainly needs additional diagnosis - yes?

 

[JJpop]

My question to those who refuse to have a PSA test is how will you determine if you might have prostate cancer? I understand that one needs to due due diligence with any results, but you need to do something.
I have a physical every year and my blood work has been good. About 2 years ago all of a sudden my PSA was 4.2. My doc said wait 3 months and take it again. It was now 5.5. We did a special MRI at Stanford and it showed abnormalities. I did a biopsy and I had low grade cancer. I did a 4K and and one other special lab test,a Decipher,I believe, and it showed the cancer was more serious. My PSA went to 7.4 and then up to 9.7. I had HDR Brachytherapy done and go in for my first 3 month checkup in a couple weeks.
My urologist,a surgeon gave me my options. He said being 67 and in good health, he was pretty much in favor of doing a prostatectomy. I did a lot of research and thought HDR Brachytherapy sounded best because it was the easiest recovery and least side effects normally.

 

[Midpack]

My question to those who refuse to have a PSA test is how will you determine if you might have prostate cancer? I understand that one needs to due due diligence with any results, but you need to do something.

At least to age 70, I’m not suggesting refusing a PSA test, I’m only advocating retesting avoiding all the other known factors that can elevate PSA results. PSA is a highly flawed test that has led to more unnecessary needle biopsies and prostate surgeries than not. That doesn’t mean it’s never useful.

I’ve had a high PSA reading twice now, both times MUCH lower/safe on retest. A high reading could indicate prostate cancer, but the odds are against it.

I’ve posted lots of links, here’s yet another good summary.

Despite a standard FDA approval resting primarily on whether a device is “safe and effective”, the highly ineffective PSA and its 78 percent FALSE POSITIVE RATE was given an FDA approval in 1994. The high false positive rate is because the PSA leads to the detection of mainly benign and non-lethal prostate conditions and, commonly FAILS to lead to the detection of the 15 percent or so of important, potentially lethal high-grade prostate cancers.

The Highly Unreliable PSA

Although marketed as “potentially life-saving”, the PSA blood test is associated with a very high false positive rate; leads to the detection of mainly non-lethal diseases; is NOT cancer-specific; its limits of “normal” are artificial; is commonly NOT the same result on repeat studies as it fluctuates normally; can be artificially raised or lowered by several processes without a cancer being present; often rises with age as the prostate grows; is normally high with big prostates and, MOST IMPORTANTLY, commonly fails to indicate the 15 per cent or so of potentially lethal high-grade prostate cancers with significant amounts of pattern 4 and or, 5 disease as these cancers often make little or no PSA. Furthermore, should an elevated PSA lead to a significant prostate cancer being detected, the elevated PSA is commonly caused by the enlarged benign portion of the prostate and NOT the cancer.

https://urologyweb.com/is-psa-testing-for-prostate-cancer-bad-health-advice/

 

[Bestwifeever]

Neither DH nor I have ever had bloodwork done before routinely meeting with our docs. Not been a problem--the techs do it in the office at the end of the visit and we get contacted about the results, or call back for a follow-up visit if something is detected.

I just had a colonoscopy and apparently one of the polyps removed several years earlier was precancerous (thanks awesome new doc for carefully reviewing all my earlier results) so will have another in five years when I'm 75. I get annual mammograms too and will continue to do so. DH gets PSAs and will continue to do so--he had prostate reduction surgery several years ago after chronic UTIs, and the removed tissue was biopsied then.

Who you gonna call when you get really sick, as most of us will at some point? I'm glad DH and I have always had docs we trust and who listen to us as they recommend treatments.

 

[Kroeran]

I have significant mileage on this issue.

My doc is a research specialist on this and we chat prostate cancer policy during the exam.

Notwithstanding past misuses and misunderstandings of the screening tests, annual PSA blood draws are useful if you don’t overweight its significance and always retest a few months after. Been through 2 such spikes.

He is dismayed at the overcorrection with PSA screening.

I take all the PSA draws I can get and go very slow with biopsies, done two. Happily clear.

I chart my PSA velocity, how much it goes up each year.

What you are scanning for is a deviation from the trend that persists, ie does not at least partially reverse, a couple of months after a first mark of a deviation.

If it persists after retests and double checks, bump up to the fancier blood tests. As evidence mounts, move toward the best talent you can get access to.

If all the data points to risk, Biopsy was no biggie. Make it easy on yourself and ask for anxiety meds and distract yourself with a video or podcast.

Read deeply and don’t delegate key decision points.

My general observation is that in this phase of life you need to be on the watch to catch things while they are small
enough to cut out. You need to celebrate problems that arise that are treatable, not hide from them.

 

[Teacher Terry]

Now that I don’t need a Pap smear I don’t go yearly. I go when I am sick and they hand me the blood work and say go when you are well. I am debating if I will have my last colonoscopy now at 66. From what I read at this age on average it extends your life by a day. I have to weigh against risks since my lining is thinner. I had one 11 years ago and no polyps. My 2 older siblings still get them because of polyps.

 

[JJpop]

I have significant mileage on this issue.

My doc is a research specialist on this and we chat prostate cancer policy during the exam.

Notwithstanding past misuses and misunderstandings of the screening tests, annual PSA blood draws are useful if you don’t overweight its significance and always retest a few months after. Been through 2 such spikes.

He is dismayed at the overcorrection with PSA screening.

I take all the PSA draws I can get and go very slow with biopsies, done two. Happily clear.

I chart my PSA velocity, how much it goes up each year.

What you are scanning for is a deviation from the trend that persists, ie does not at least partially reverse, a couple of months after a first mark of a deviation.

If it persists after retests and double checks, bump up to the fancier blood tests. As evidence mounts, move toward the best talent you can get access to.

If all the data points to risk, Biopsy was no biggie. Make it easy on yourself and ask for anxiety meds and distract yourself with a video or podcast.

Read deeply and don’t delegate key decision points.

My general observation is that in this phase of life you need to be on the watch to catch things while they are small
enough to cut out. You need to celebrate problems that arise that are treatable, not hide from them.

Everyone should read this common sense post.

 

[Gearhead Jim]

My employer started offering PSA tests as part of the annual physical, starting in 1992 when I was 47 years old. I keep a graph of the results.
From 1992 to 2008, my yearly graph zigged between .8 and 1.4
In 2009 it jumped to 1.6 when I had prostatitis, back to 1.2 the next year, and has trended downward since then, always below 1.0

That's good news, but the graph allows me to easily identify spikes and trends. I recommend the same to all the guys.
At age 75, it would take a pretty scary PSA for me to do much, but I still get the (free) test.

 

[Midpack]

I have significant mileage on this issue.

My doc is a research specialist on this and we chat prostate cancer policy during the exam.

Notwithstanding past misuses and misunderstandings of the screening tests, annual PSA blood draws are useful if you don’t overweight its significance and always retest a few months after. Been through 2 such spikes.

He is dismayed at the overcorrection with PSA screening.

I take all the PSA draws I can get and go very slow with biopsies, done two. Happily clear.

I chart my PSA velocity, how much it goes up each year.

What you are scanning for is a deviation from the trend that persists, ie does not at least partially reverse, a couple of months after a first mark of a deviation.

If it persists after retests and double checks, bump up to the fancier blood tests. As evidence mounts, move toward the best talent you can get access to.

If all the data points to risk, Biopsy was no biggie. Make it easy on yourself and ask for anxiety meds and distract yourself with a video or podcast.

Read deeply and don’t delegate key decision points.

My general observation is that in this phase of life you need to be on the watch to catch things while they are small
enough to cut out. You need to celebrate problems that arise that are treatable, not hide from them.

Everyone should read this common sense post.

It is a good post, and I haven't mentioned PSA velocity, so as a public service I will share my actual results to show velocity and how far off PSA results can be - I didn't in post #1 as I knew it might alarm some folks.

My point is also to show how far afield false positives can be, and how easy it is for a knowledgeable patient to get a truly representative retest result. My GP was alarmed at my PSA result, and insisted I see a urologist as soon as possible - I knew odds were it was wrong, and didn't panic at all (this time - I did panic in 2013). You might be horrified at my false positives, I share to show why you should not panic if you get a high result. Hopefully your GP or urologist knows how to proceed, but I'm here to tell you some still don't in 2020...you MUST educate yourself if your GP and/or urologist recommend a biopsy without an educated retest.

 

[gnawbone]

I get a physical every year and it includes a PSA. Mine started going up, gradually - 2.5, 3.2, 2.9, 4.2, 5.3, 6.4 - you’ll notice I had a dip along the way. But when I had 3 increases in a row and it went over 6 my GP recommended a urologist and a biopsy - result: Prostate Cancer

I had HDR Brachytherapy and today, 8 years later my most recent PSA = 0.02. I will live longer because my MD knew what he was doing. I too am not an MD but I’d run from any MD that would tell you to not get a PSA test.

Remember, 50% of all MDs graduated in the bottom half of their class.

 

[Gearhead Jim]

^^^
Can you tell us your age when the numbers started going up, and age at the operation?

 

[braumeister]

I get a physical every year and it includes a PSA. Mine started going up, gradually - 2.5, 3.2, 2.9, 4.2, 5.3, 6.4 - you’ll notice I had a dip along the way. But when I had 3 increases in a row and it went over 6 my GP recommended a urologist and a biopsy - result: Prostate Cancer

The other side of that coin is that a higher reading doesn't intrinsically mean anything except that you have a lot of PSA in your bloodstream. It can be a useful indicator, along with a DRE, so I have it checked every year.

For those of us who are cursed with large prostate glands, the readings start out high and creep higher as we get older. Mine has ranged between 3.5 and 8 for a couple of decades with no sign of cancer (confirmed by multiple biopsies). My urologist (a very good one) says the high PSA readings don't surprise him due to the size of the gland.

 

[bmcgonig]

My question to those who refuse to have a PSA test is how will you determine if you might have prostate cancer? .

Since the time screening was deemphasized there had been a marked increase in people finding out in the ER after it has metastatisized.

 

[jldavid47]

• A high PSA reading can be caused by many things that aren’t cancer. Occasionally (approx 15%) of men with prostate cancer have low PSA results. It’s not a highly predictive test for prostate cancer, it’s a possible indicator.

No kidding. In my case I suddenly showed up with an elevated PSA reading a few years ago. I did some research finally ending up on the Mayo Clinic website and my answer was staring me in the face. Apparently if the prostate is stimulated prior to taking blood it can cause an elevated PSA reading. My doctor had done the prostate exam prior to drawing blood. He recommended getting retested in a few months. I waited for my next physical bwecause I was "sure" of the cause.



When it came time for him to do the prostate exam I requested that he draw blood first and told him why. He said he had never heard that but said "Let's do a science experiment." (I like my doctor. He listens and doesn't think he knows everything). So. sure enough, my PSA reading was totally normal. He wrote on my results "You were right!"


So, if you get a suddenly high PSA reading, don't ignore it but don't panic either. There are a lot of things that can cause a false positive.

 

[target2019]

Ignore or do not have a PSA at your own peril,unless you are old. No doctor is perfect and no test is perfect but to simply dismiss it is foolish. I have prostate cancer and went through the whole deal.

Wise words...

 

[Midpack]

Since the time screening was deemphasized there had been a marked increase in people finding out in the ER after it has metastatisized.

Source please?

https://cancerstatisticscenter.canc...961360040.1582146794-1191361705.1582146794#!/

 

[Midpack]

Ignore or do not have a PSA at your own peril,unless you are old. No doctor is perfect and no test is perfect but to simply dismiss it is foolish. I have prostate cancer and went through the whole deal.

Wise words...

Who advocated ignoring or dismissing PSA results?

I think this is closer to what most are saying?

So, if you get a suddenly high PSA reading, don't ignore it but don't panic either. There are a lot of things that can cause a false positive.

 

[bmcgonig]

Source please?

https://cancerstatisticscenter.canc...961360040.1582146794-1191361705.1582146794#!/

Your graph doesn't address what I wrote.

It's just that since people are not getting tested, they are finding out that they have cancer in the ER.

Doesn't mean that the cancer rate is rising, just that it is being discovered later.

 

[target2019]

2018 and 2019 data would be required, I think.
https://www.webmd.com/prostate-canc...ancer-death-rate-down-but-prostate-cases-up#1

 

[bmcgonig]

Evidently there HAS been a more recent trend after the graph I posted, glad you asked - though 5% YOY isn’t my definition of a “marked increase.”

So unless you’re using a better test, at a minimum a properly prepared for PSA is a good rough screening tool. But an elevated reading isn’t a reason to panic, a follow up retest in 4-6 weeks avoiding other known causes for elevated PSA at a minimum.

https://www.news-medical.net/news/2...ths-are-on-the-rise-shows-new-ACS-report.aspx

I'll repeat it again [emoji4]

A marked increase in the number of people finding out in the ER.

 

[Midpack]

I'll repeat it again [emoji4]

A marked increase in the number of people finding out in the ER.

I just asked for a source, that’s all.

 

[Gumby]

It has always been my habit to discount claims of urgency made by people who stand to profit from them. The language quoted in Post 148 is by Jamie Bearse, CEO of ZERO, an organization that raises money to fight prostate cancer. Of course he is going to want everyone to be committed to identifying prostate cancer.

That said, my PSA level is checked every year as part of my yearly physical. If it spiked, I would have it checked again.