Getting PSA results with impossible fluctuation: What's up?

@jeffmarc
I had a PSA test at Quest Diagnostics in Mpls area yesterday. My PSA was 5.1. My December PSA at Mayo was 6.2. Quest has an explanation attached that they use the WHO system which is 20% lower than the Beckman Coulter system. Its important to know which system your baseline came from. I'm not sure What Mayo uses, AI says they use the Beckman. I haven't seen this mentioned anywhere . One more question to add to your lists.

@dribbles
This is a reason why they tell people to go to the same place to get their blood test every time. PSA results don’t always agree between Labs, Looks like you may have found one reason. I don’t think most people have any idea what technology is used for their blood test.

Interesting information.

I am really sorry that I have to say this, but...I was the Director of Clinical and Anatomical Lab services in a few hospitals in my nearly-40 year career. As far back as when I was interviewing for my internship, I did so at a couple of local V.A. hospitals. I was accepted to them, but went elsewhere. Even my youthful, inexperienced eye could see that there was no quality medicine happening in V.A. hospitals and Labs. Later in my career, I did consulting work that involved V.A. hospitals at times. I experienced the same thing...just 35-40 years later. V.A. hospitals and the V.A. system are vitally needed for our veterans who have no other means of receiving health care, but like "anything" our Federal government gets itself involved with, it is a textbook case of low quality, inefficiency, and scary stuff going on.
"Many" laboratory problems occur in the "pre-analytic" phase before actually testing the blood. Any one or more of the following problems can happen in any lab, but they seemingly happen more in V.A. and other low quality hospitals: 1) The wrong patient was drawn; 2) The right patient was drawn, but the wrong patient name/ID label was affixed to the tube; 3) The wrong tube was drawn and didn't preserve the sample appropriately; 4) Some tests are time- and environment-susceptible...they degrade rapidly (especially if drawn in the wrong tube), or temperature can affect them (some samples need to put on ice or rapidly centrifuged and tested vs other more standard tests); 5) Improperly handling can have the correct patient's blood drawn into the correct tube and labeled properly, but some of that sample is withdrawn from the tube and is placed in a plastic instrument sampling cup. The person who labels that cup may have mislabeled it to represent a different sample, which means that YOUR sample will also be mislabeled. There is a saying in the lab: "Where there is 'one' mislabeling, there are actually two." Lastly, the entire clinical laboratory world is computerized. Then there are "analytic errors". This is the phase of testing that is most reliable because automated instruments are doing the testing. But...those instruments are calibrated; quality control is run; scheduled preventative maintenance must be performed, etc., all of which relies on skilled, motivated, and conscientious employees. I will leave it at that from which you may draw some predictable inferences.
There are a handful of well-known Laboratory Information Systems ("L.I.S.") companies selling great lab hardware and software computer systems. But...unfortunately...the V.A. system has its own archaic L.I.S. system that is 30-40 years behind the times. Part of the reason they have it is because it is in fact the Federal government, and they fear misappropriation of the data. So, they concocted this really bad software 30-40 years ago with few updates, that drives everyone crazy. They use the same lab instruments and chemical reagents as all other hospitals, but they just can't seem to do things consistently well. I don't know how much of it is "people" problems or "software/hardware" or "procedural" problems, but I never felt comfortable as an experienced professional, in those hospitals. Now obviously, the system would collapse if there were "too many" errors and low quality. They "get the job done", but I would never send someone that I know to a V.A. hospital, if they could go elsewhere.
My bottom line recommendation is, if you have a choice...if you have the means...find a new doctor at a non-Veterans Administration hospital. The testing will be higher quality, consistent, and reliable.

@bobbyshay, did you are your urologist get things straightened out? What will be your follow-up plan?

Remember folks, the AUA recommended stopping PSA testing all together for nearly five years back in 2013. It’s still a controversial test that many western doc’s use like the Bible. Well, it’s not the bell weather, MRI’S, biopsy’s draw the picture needed for an informed decision.

@harryo54
As a result of this decision not to test, we are saying a greater number of people with advanced prostate cancer than ever used to happen. This was all done because too many people were treated when they were only 3+3.

@harryo54 Actually, PSA testing shouldn’t be a controversial test - but too many people don’t understand it.

A PSA test isn’t a cancer test. The PSA number itself is similar to a “check engine” light in a car; it indicates that something may be wrong, and further checks should be made “under the hood.” Might be as simple as a UTI; might be BPH; might be more serious, such as cancer. Just need to have further checks. No need to panic, or rush to a quick treatment decision, or get overly concerned. Once the nearly dozen other things that might cause PSA to rise have been ruled out, only then should the possibility of prostate cancer be looked into.

Too many guys panic when they have an elevated PSA, think the “c”-word, and jump to radical treatment. That’s why in 2012, the USPSTF recommended against routine annual PSA screening in an attempt to try and stop the insanity: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening-2012

@brianjarvis When you read that study, you really have to wonder where those conclusions came from:
There was only ONE man in 1000 screened who benefitted from PSA screening 14 yrs after diagnosis…
I think we know that numbers can be ‘massaged’ to fit a certain outcome but this was a real fiasco.
I, too, was one of those men who read this flawed study and stopped my testing for a full year; don’t know if it would have made a difference in my case but I am sure it did - for the worse - in many others. Thanks for the article!
Phil

@heavyphil I never stopped PSA testing; started in 2000, and continued annual testing despite all the noise.

I realize that with large data pools - such as are used in population studies, clinical trials, and by insurance companies - matter at the macro-level, but have little meaning on what an individual’s results will be.

(As a retired computer scientist, I remember the old saying - “Numbers will say anything you want them to if you torture them long enough.”

@brianjarvis
I was having dinner with one of my wife’s best friends and her husband. He is 90 she is 77. We had talked 16 years ago when I was having my prostate cancer surgery. He was talking about the fact that he had a prostatectomy as well, But didn’t mention that it was nine years before. He is an OB/GYN, who just retired at 89.

25 years ago he was told he had prostate cancer because he had a 3+3 Gleason score. Because he was a physician, he wanted the best surgeon in the country to do his prostatectomy. Turns out his prostate was almost 200 cc. He found a surgeon At Johns Hopkins that said he would do nerve sparing. He was an innovator in the technique. He went there to have his surgery and it was a fiasco. Nerve sparing was not done, and he thinks that the surgery was done by a trainee. When he asked to see the medical report on the surgical procedure, he received a report that was about a half a page long. As a doctor, he’s familiar with having reports that are 10 pages covering every single step of the surgery. To say he is furious, would put it mildly. After surgery, they biopsied his prostate and found out he was only a 3+2 something I’ve never heard of.. They should’ve never touched him. This kind of treatment is what led to the ending of PSA testing.