Getting a prostate PSA test directly

[ChrisC]

Time2,

Well, I agree that biopsies can be an unnecessary procedure but seriously PSA screening! So, you get a PSA baseline and if it doubles in two years, keep watching it. And if it spikes a lot higher in one period -- yes, go get some other test: like the EXoDX urine test, which I'm told is VA or Medicare approved, but wasn't approved by my insurance company and cost me $125. And if your Urologist thinks something is going on there, let him order an MRI -- pictures don't lie.

I don't have Medicare Part B, but my insurance covers PSAs ordered by my doctors or PAs; out of pocket cost me $3.42 for the PSA.

 

[bmcgonig]

Every man with or without prostate issues should listen to this podcast twice.
Peter Attia and second generation urologist/prostate specialist Ted Schaeffer MD, PHD.


https://peterattiamd.com/tedschaeffer2/

I agree thats a great interview if you are interested in prostate issues. Schaeffer is one of the top surgeons in the country. He did Ben Stillers prostatectomy.

One interesting he has stated is his approach to dealing with a high PSA score.

First he determines the size of your prostate. That is measures in grams or CCs. If the PSA is less than 10% of the size he does nothing saying that you have BPH and the PSA just reflects that. If it more that 15% hes concerned. Eg if your prostate is 60cc and your PSA is 4 that is fine. If the PSA is 9 hes concerned. he might be concerned between 6 and 9 as well i.e., 10-15%.
There are also biomarker tests like 4KScore that does a very good job as prediction if you have a cancer worth worrying about. He will do that after the PSA test.
If concerned then he will order an MRI to see if he can see anything. If its clear he again does nothing.
If the MRI contains something that seems ominous then he will do a prostate biopsy using the MRI as a guide.

The issue and controversy around the PSA test is not the test itself but what we do with the results. Yes, if your doc immediately orders a random biopsy after a couple of high PSAs e.g., two 5s. Thats a big problem.
But if you have a urologist that follows a procedure like Schaeffers then you're in better hands.

Also theres no such thing really as a false positive PSA. Thats a misunderstanding of what PSA is. Its just a protein made by prostate cells. Not a positive or negative for cancer. But if theres a cancer the prostate will make a lot more PSA.

 

[Car-Guy]

I think I've posted this in another related thread some time ago, but a good friend of mine had PC and a high PSA (he had a Gleason score of 8/9 IIRC). He has been on hormone therapy and "some sort" of advanced PC drug for the past two years. He also took 9 weeks of radiation treatment about 18mos ago. He just had his annual full body PET/CT scan last month and there was no detectable cancer. He said the doctors called it full remission. I'm not sure if that's typical but it seems pretty good to me.

 

[check6]

.Even so, it is comforting to get PSA tested once a year and find it is within bounds.

For the last 10 years at my job, I was required to have a physical every 6 months so I kept up with an annual PSA test for the most part. Retired for 14 years and have been lax so I went to the Mayo (love this place) for a consult. Had the PSA result an hour after taking blood (1.3). Whew, good to go. They also gave me a CT...some things are better not known.

 

[Car-Guy]

^^^^^^
I get mine checked twice a year when I go in for prescription refills. (Might as well since I'm there and it's free.) Doc will post the results on his office/practice website in a few days so I can check whenever I like. I "assume" he'd call me if saw a problem. So far, so good.

 

[NXR7]

I always get the standard prostate test and a Free Prostate test. A low percentage of unbound (free) PSA is more likely to be cancer. But I'd wager most people have never heard of it so they don't know to ask for it along with the standard PSA test.

 

[Mansderm]

Life extension has an annual blood test sale that is usually done thru LabCorp. I buy this every year for myself ( female panel) and buy a male panel for each of my sons which includes PSA. It actually includes a lot of tests that I like to see that doctors won't order because they don't want to deal with the insurance denials stating Medically unnecessary. It would require a lot more questioning and documentation than you are allotted for in a regular office visit. The downside to ordering your own lab is some doctors will not discuss the results with you because " they didn't order it." My primary has said that to me and I'm a doc! So I just said fine, I can interpret my own. I still request they scan the results into my medical record.
I think your doc would be in a difficult position if you discovered something seriously abnormal, and still refused to discuss, but if so, you can certainly request to be referred to a specialist in that area. These days, I think you have to be extremely pro active regarding your health. If you are not satisfied or don't understand why things are going the way they are going, ask to be referred to a specialist or for a second opinion.

 

[JJpop]

So the switch is to no psa tests.
So a person at age 40 does not get tested and if he did say his psa was 3.
He goes 10 years and now finally gets it tested and it is 20.
That is good medicine?
Because it is elevated does not mean after one test you have to have a biopsy but you now know you MIGHT have a problem so you can address it.

I have prostate cancer and my psa went from 4 to 9.5 when I was 66.
I had a biopsy, the better one, transper spelling??
Biopsies are to be avoided unless very necessary. Horrible experience but no infections or problems from it I am aware of.
It showed a cancer that needed to be addressed and I opted for HDR Brachytherapy at Stanford. Two years later my psa was at 3 and they were very concerned. I did a full body scan, an MRI and they wanted to do another biopsy.
I did a lot of research and saw a video of the head doc at UCLA saying that sometimes psa levels can bounce around for a couple years after the brachytherapy.
I told them no biopsy at that time continued to get my psa tested every 3 months. It started going down, like 2.6 2.3 1.8. 1.6. My recent three were 0.8 0.8 0.6

I am now 71 and have taken no medication before or after the prostate problems.
I really don’t get the no psa logic.
It gives you information that you have to be smart and judicious with, but it can save you from some really bad outcomes.

 

[crashdox]

other prostate tests

Please look into PHI test vs PSA. And also PSE - that one is VERY new but apparently far more accurate than a PSA.

PHI is supposed to be better than PSA, but apparently PSE is even better.

I only researched these a few weeks ago (late November 2023) and have a note in my phone to ask my doctor about these alternative tests.

 

[street]

Just had my blood work done today I have done annually. My PSA was 2.95 and have been from 2.54 to 2.95 for the 9 years. My blood works results were excellent and was very happy about that.

 

[joesxm3]

Had my Tulsa procedure today. Arrive 10am out by 7pm.

Successful procedure. Separate thread soon.

Thanks for the well wishes.

 

[Healthy Lifestyle]

Wishing you a speedy recovery.

 

[braumeister]

Just to throw out another factoid, a high PSA reading can be caused by a variety of things.

My very first one, at about the age of 50, was 9.1 and it scared the bejeebers out of me. Went to the urologist who diagnosed simple prostatitis, gave me some antibiotics, and the next month it was way down.

Mine is naturally higher than average, simply because I have a very large prostate.

 

[ERhoosier]

All I can say is that this forum is NOT the place to get medical advice.

TRUTH!!!!!!

Especially for highly controversial topics like this with no many individual patient considerations. Academic Urologists have gotten into heated shouting matches at national meetings over it, so it surely will not be 'solved' on open internet forums like ER.

 

[AFHelos]

The test costs little. Get a baseline. Take it from there. Don’t switch labs so the results are more comparable to each other over time.

Don’t let “young” fool you. PSA can reflect many things
: one could be cancer. Having a PSA “record” from an early age doesn’t hurt. It’s just a blood test.

Find a physician who will track and discuss the results over time. Try the blog Health Unlocked if you are looking for a focused blog. Testing too late might really shorten how long you are retired…health and happy retirement are directly related…health being the most significant part of your portfolio.

 

[joesxm3]

My cousin apparent did not test and his first PSA result was 50. Then every core was positive for aggressive cancer. He ended up having RP plus some of his bladder removed plus radiation and chemo. Several years after that he has recurrence outside of the surgery area.

My pastor also apparently did not test and he told me his first PSA wss 54. He had several random biopsies come back negative but his doctor repeated until they hit something. MRI biopsy would have spared some of that pain. He ended up having max course EBRT and has gone 5 years so far without detectable recorrance.

 

[Koolau]

I'm aware of the controversy surrounding PSA testing. Doc and I decided at 75 to quit doing it - based on current available info (and a recent very low PSA test.) Having said that, after reading this thread, I will talk to doc at next check-up and see if anything has changed (and I'll be able to mention some of the things I've learned here.)



Thanks to all who have contributed. Knowledge is power.

 

[ER_Hopeful]

lots of good info, thanks to everyone who chimed in.
Had my first PSA test last week, (super easy online purchase and 5 min. in person blood draw.) Result was 0.8. From what I read here and the linked article, I know there is a slim chance that being false negative but that really put my mind at ease and I now have established a baseline. I figured I'll do this at least once a year (pay out of my own pocket) for monitoring purposes.

 

[joesxm3]

lots of good info, thanks to everyone who chimed in.
Had my first PSA test last week, (super easy online purchase and 5 min. in person blood draw.) Result was 0.8. From what I read here and the linked article, I know there is a slim chance that being false negative but that really put my mind at ease and I now have established a baseline. I figured I'll do this at least once a year (pay out of my own pocket) for monitoring purposes.

Good job.

I am surprised how many people seem overly concerned with getting the test paid for by insurance when it is not that expensive to just buy one yourself.

My PCP cancelled my annual physical and they rescheduled seven months in the future. Quest had a 20% off sale and I bought a full set of labs for about $220. Of course you need to be interested enough in your health to have half a chance of understanding the results.

 

[bltkmt]

Sidebar - my doctor no longer does the "finger check" and seems to rely only on PSA results. Is that common?

 

[MichaelB]

Sidebar - my doctor no longer does the "finger check" and seems to rely only on PSA results. Is that common?

A DRE is needed to set a baseline, but unless PSA changes or there are symptoms of prostate disorder, regular DRE is not needed.

 

[Car-Guy]

Sidebar - my doctor no longer does the "finger check" and seems to rely only on PSA results. Is that common?

We can only hope!

 

[Trooper]

lots of good info, thanks to everyone who chimed in.
Had my first PSA test last week, (super easy online purchase and 5 min. in person blood draw.) Result was 0.8. From what I read here and the linked article, I know there is a slim chance that being false negative but that really put my mind at ease and I now have established a baseline. I figured I'll do this at least once a year (pay out of my own pocket) for monitoring purposes.

Thanks ER. Do you mind sharing the website?

 

[joesxm3]

I order my tests from Quest.

 

[joesxm3]

20% off on PSA test $55.
At questhealth.com

STD tests also on sale