When can I stop PSA testing?

@revecz
I am 78 today. I was 76 when I was diagnosed with prostate cancer. When I got my diagnosis my PSA was 3.75. The norm for PSA is below 4.0. I see someone posted higher levels for ages but I was told by my Mayo PCP and Mayo urologist 4.0 is normal.

What both my Mayo PCP and urologist were concerned about was not the level of my PSA but the continued rise every time tested. I had been a .75 for many years and then started rising in 2017 every time had it done. My PCP started doing PSA test every 3 months.

My PSA continued to rise so referred to urologist who did DRE and ordered a MRI with contrast. MRI showed suspicious areas. Biopsies confirmed prostate cancer of 3+4=7. It was diagnosed as intermediate cancer and my urologist referred me to R/O. R/O went over all treatment options including surgery and radiation and recommended radiation and hormone treatment.

He suggested having a Decipher test done along with PSMA and bond scan. The Decipher test came back low risk not intermediate risk and thus no hormone treatment needed. The PSMA and bond scans negative.

Why would you want to stop PSA testing? It is a simple test that results can lead to diagnosing why high or rising. A rising or high PSA does not mean cancer but could be BPH or infection, etc.

If you have NOT seen a urologist I suggest you do. I think he as an expert medical professional can guide you on your PSA tests and what you should do.

Thanks to all for helpful suggestions etc!

During my annual wellness exam, my primary care doctor does a CBC and Differential, Fasting Lipid Profile, TSH with Free T4 Reflex, Comprehensive Metabolic Panel

Similarly, during my annual wellness exam, I ask my PCP to do bloodwork that my medical oncologist (MO) doesn’t do during my every-four-month prostate cancer follow-up.
> my MO does PSA, testosterone, CBC, & CMP.
> my PCP does lipid panel (cholesterol, triglycerides, HDL, & LDL).

Between the two of them, I’m pretty much covered.

A biopsy wouldn't stop the tests. If they found nothing, you'd continue regular (annual) screening; if they found something mildly concerning (e.g. Gleason 3+3 or maybe 3+4), they might move you to active surveillance, which would mean PSA tests (and maybe others) every 3–6 months. If they found something serious (e.g. Gleason 4+3 or above), you'd still be getting regular PSA tests after treatment, even if you had your prostate removed.

As far as I know, the main reason to stop PSA screening or monitoring would be that you've decided not to seek treatment if they found anything, perhaps due to age, other serious health issues, or something similar. That's a very personal decision.

One other thing. My brother was on active surveillance for about five years and at 76 his prostate cancer finally became something that had to be treated. He had five sessions of SBRT and since then his PSA has been completely under control. He’s 78 now and extremely active.

You are not too old to get treatment.

Trust these commenters. We all have had or are going through prostate cancer treatment. Your age and whether you want to gamble with your life over having a PSA test is strictly your decision. You don't know when the obvious cancer will kill you if you don't consult a urologist and do what he/she says. Your family might have a opinion on wanting you to do something about treatment if it turns out to be cancer. Treatment is not fun and we're all going through it because we value life and loved ones, reasons for us to stick around for a while longer.

To be clear...I am NOT against PSA testing and I've been seeing a Urologist for
six years. I am simply trying to weigh the validity and advice coming out of research centers like MD Anderson, Cleveland Clinic, UCLA, Johns Hopkins, Cancer Association, American Urological Association, Sloan Kettering
All seem to give different advice and recommendations. Just trying to be
informed and open to the complexity of this particular issue

It’s such a simple test I’d keep doing it. One thing my former urologist told me is that PSA slightly rising with no other symptoms is normal with age. Best of luck to you!

Thanks for your response and encouragement