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It’s Been A 26-Year Long PSA Journey
(At 71y/o….) It’s been 26 years since my very first PSA test, 14+ years since I was diagnosed with prostate cancer, and 5+ years since completion of my proton radiation treatments.
I don’t spend much time thinking about my prostate cancer status these days - except on days like today. This morning, I had my 6-month PSA test. As usual, when MyChart indicated “you have new test results in your MyChart account,” I hesitated just a bit….”
But, the PSA result was good once again —> 0.366 ng/mL. So, I’m good for 6 more months.
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@denis76 asked "What tests exactly?"
My quarterly bloodwork:
ultrasensitive PSA
LFT's (ALKP, ALT, AST, GGT, Bilirubin Total)
TSH
Complete Blood Count (WBC, RBC, Hgb, Hct, MCV, MCH, MCHC, RDW:CV, PLT, MPV, NRBC #, nRBC/100 WBC, IANC)
Creatinine and eGFR (CKD-EPI)
Potassium
Testosterone, Total
Sodium
LDH
ALP (unless its the same as ALKP above)
Automated Differential (Neutrophil, Lymphocyte, Monocyte, Eosinophil, Basophil, Immature Granulocyte)
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1 Reaction@denis76 With regular bloodwork - which most should probably be getting with their annual overall health checkup - PSA & testosterone are just two prostate cancer related markers.
> CMP: Comprehensive Metabolic Panel (about 2 dozen blood markers)
> CBC: Complete Blood Count (over a dozen different blood markers)
And depending on where you are in your prostate cancer journey, there are additional blood, tissue, or urine marker tests, the results of which may play a role in diagnosis.
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2 Reactions@brianjarvis Exactly. They need to monitor not just the cancer's progress (if any), but also the impact the cancer is having on your body, and the impact that the cancer *treatment* is having on your body. Hence the huge array of tests.
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2 ReactionsIt's been two years of no detects for me. But I still hesitate to look at results before doctor visit. I call it living 6 months at a time. At 69, I figure if it does come back, I'll probably die of something else before the prostate cancer.
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2 ReactionsMy psa was 5.2 and went don to 4.5 two months later. We decided on active surveillance for the next six months, testing it every 3 months.
Let’s see how it will go: is a value o 10 ng/ml a sort of threshold value to start ADT or radiation?
@marlon wrote "I still hesitate to look at results before doctor visit. I call it living 6 months at a time."
That's fair, and for many people, it's a good strategy for mental health.
My approach is the opposite: I'm effectively the project manager of my healthcare (I see lots of specialists, but they mostly work in silos), so I'm the one who has to understand the big picture and coordinate across different specialties.
They all have access to my online chart, but seriously, it's likely thousands of pages long after my prolonged hospital stay and all the post-surgical complications, and who has time to read or even skim all of that? They all know the big picture: 61 year old male with oligometastatic prostate cancer (etc etc) but they might not happen to notice an important detail buried somewhere in there (e.g. I'm on blood thinners because I had DVT when I was paralysed in a hospital bed in 2021).
Simply put...
@fag “10” is a PSA threshold that’s often used; but, it’s one of a number of thresholds that together tell the full story.
Others are:
> % Free PSA
> MRI results
> PSA Density
> Gleason results
> Biomarker (genomic) test results
> Genetic (germline) test results
With those also being monitored, you’ll have “active” insight into what might be lurking unseen while you’re on active surveillance.
That also buys you time to thoroughly evaluate treatment options so that you’ll know exactly what you’ll do should you ever have to make a treatment decision.
(PSA can fluctuate for any number of reasons, even at different times of day.)
My PSA was only 4.2, slightly above high normal for my age. And I had BPH at the time. So I was confident that it wasn't cancer. It was the good ol' digital exam that found a lump, confirmed by biopsy. So I dont think you can count on PSA as an indicator alone.
@marlon True. Usually cannot count on PSA alone. (However. I know 3 guys who had PSAs of 11,700, 7,800, and 3,500, respectively. In those cases, PSA was a certainty of aggressive & advanced prostrate cancer.)
But, for everyone else, more than just PSA is needed. And since a lot of guys don’t even get a PSA test because they don’t want a DRE, many guys are skipping prostate screening altogether (which is why some Centers aren’t promoting DREs as much).
Even in this recent Super Bowl, there was a commercial promoting the “finger free” prostate cancer screening:
> (news report): https://youtu.be/XnqU3aRjd-U
> (the full commercial here): https://youtu.be/lMTcZb48aVU
Statistically, they’ve found that even when an irregularity is felt with a DRE, that 50% of the time it’s benign.
> and even if a non-benign irregularity was felt with a DRE, 90% of the time an MRI would’ve picked it up anyway.
So, with many guys not getting any prostate cancer screening for that reason, some centers are trending away from DREs (unless you really want one), and going directly to an MRI following an elevated PSA (after ruling out other simple causes).