Basic PSA Question for anxious person.

Posted by jenson @jenson, May 18, 2023

I have bad anxiety around cancer and had a PSA test today.

The results were 1.94. So on the little diagram on the results, it’s right in the center of normal.

You’d think I’d be happy. I’m kind of okay but fussing with the fact that I do not remember the PSA level I had done a few years ago (a dr bundle it into reg blood work) but thought it was lower and don't think I can remember where to retrieve that. And also know (I think - too much time online) that 1.9 is at the high end of the normal range for my age group (I’m 52) and therefore still at an increased risk relatively speaking.

Should I even be worrying about this? What is your view/interpretation of this? Is this in fact high for my age? And would it matter what my level was say 5 years ago in this instance?

Sorry if these are overly anxiety driven questions.

Thanks.

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slick64 | @slick64 | May 19, 2023

First, just relax. Your level is ok and you need to know where your level has been or going. The only way is for your doctor to keep track of your number. I’m 59 and last Sept my doctor looked at my numbers and they bouncing around a bit, had a biopsy and found cancer. I finished radiation and hormone therapy last week and all is well. I’d be concerned but don’t let run your life.

madisonsmiley | @madisonsmiley | May 19, 2023

First, prostate cancer is very treatable, especially if diagnosed early. The 5-year relative survival rate for most people with local or regional prostate cancer is nearly 100%. I am 66, my PSA prior to treatment was >200.0, and I have Stage III prostate cancer . One of the physicians on my team said that they expect to see me in 15 years, and chances are I'll die from something else before I die from prostate cancer.

Second, do some research on prostate cancer, PSA tests and systemic TRUS guided biopsies, and their reliability so you have a better understanding of this diagnostic technology. I was having negative biopsies (3) with a PSA well into double digits with the systemic TRUS guided biopsy method. If you have a biopsy, an MRI Fusion Guided Biopsy appears to be the current best practice.

Here are a couple of good consumer friendly articles from the NY Times on the efficacy of the diagnostic methods.
https://www.nytimes.com/2020/02/24/well/live/prostate-testing-PSA-cancer-screening.html
https://www.nytimes.com/2023/05/08/health/prostate-cancer-screening.html
Also, here is an excellent consumer friendly books on prostate cancer by Mayo staff.
https://mcpress.mayoclinic.org/product/mayo-clinic-on-prostate-health-3rd-edition/
Stay away from websites that are not .org. Here are a few good ones:

cancer.gov

cdc.gov

pcf.org

jenson | @jenson | May 19, 2023

In reply to @slick64 "First, just relax. Your level is ok and you need to know where your level has..." + (show)

Thx. You said my level is ok but then ended with I’d be concerned. Not sure what you mean?

mikewo | @mikewo | May 19, 2023

In reply to @madisonsmiley "First, prostate cancer is very treatable, especially if diagnosed early. The 5-year relative survival rate for..." + (show)

I agree as long as the biopsy in a transperineal fusion guided biopsy under a local.

bens1 | @bens1 | May 19, 2023

Jenson: as others have indicated here, establishing a trend with PSA helps to give you an indication of what may be happening. You may want to take a PSA test more often. If your budget or insurance permits, you might want to take a prostate MRI. That may help you decide whether additional steps are needed.

slick64 | @slick64 | May 19, 2023

In reply to @jenson "Thx. You said my level is ok but then ended with I’d be concerned. Not sure..." + (show)

When diagnosed, my primary care sent me to a surgeon, who sent me to an oncologist. We did a test on the cores to see how aggressive my tumor was. During that consult, the first, he stated to look into treatments and actually act on treatment instead of just doing nothing and wondering. You have to do your research but if you’re going off only one psa, that’s not a factor. You need a few to establish a base line. I’ve been with my pcp for 20+ yrs. The concern is to actually look into what it all means and understand what it means.

wellness100 | @wellness100 | May 19, 2023

The only thing I would add is if you are seriously concerned, with or without symptoms is have an MRI. It is 90% accurate. You can have a second opinion on that. If you are still not sure, then do a PMSA/PET scan. The two together is supposed to be 98% accurate.

edmond1971 | @edmond1971 | May 20, 2023

I would start with your urologist (and your own self-education) and explore what is causing the slightly elevated PSA. It could be a benign condition such as prostatitis (inflammation) or the beginning of BPH (enlargement), and it could also be cancer. I also encourage to get a better handle of your medical records and find that PSA result from the prior test, and make sure you have a complete physical with an EKG, complete panel of bloodwork, and have this information with you for the rest of your life. Your baseline health today will be incredibly important as a point of reference as you get older. --- Prostate cancer has great chances of curative outcomes with early detection, so get another PSA test at least quarterly until the signal lowers. Be positive and don't be lazy, and you'll be in good hands.

proftom2 | @proftom2 | May 20, 2023

It seems like you are headed in the right direction, which means you're doing the right things. Have you had the "Watchful Waiting" conversation with your primary care doctor? I started having that conversation in my early fifties.

roberdc | @roberdc | May 20, 2023

Your PSA is low enough that it is a benchmark. Start working with a urologist you trust. If you trust yours now, just let him monitor it. If it elevates and the digital exam shows anything then it's time to start the MRI's and biopsy. The biopsies have their own risks, so I would not rush into those.