PSA Testing: What Should Men Do?

Prostate Policy

It's hard to argue that some information, however imperfect, is worse than no information. It's more reasonable to argue about what happens after the information is in hand.

Since the PSA test itself is not expensive, it's equally hard to argue against prostate cancer screening. This is even true if a positive result may potentially lead to inappropriate, unnecessary and, not incidentally, expensive measures (because sometimes those measures actually are life-saving).

So one should argue not against the test, but against society paying for further measures after the positive test result is known, except under certain well defined criteria. Beyond those criteria is where personal choice should enter either by the preemptive purchase of an add-on insurance policy that specifically covers such further unsanctioned measures, or by paying out-of-pocket for those measures.

The PSA testing "dilemma" provides a perfect example of a reason why liberty-loving citizens should be very wary of one- size-fits-all national health planning that may eliminate personal choice as a factor in decision making.

PSA TESTING

I am now 67 and have had the annual PSA test for years. While my numbers were very low for years, suddenly they started rising - VERY rapidly. Although the DRE were always normal, my urologist indicated that only two things could account for the rapid rise (up to 10); cancer or chronic infection. Antibiotic treatment had no affect, so I had a biopsy, which was negative for cancer cells. My PSA continued to rise rapidly,so another ultrasound-guided biopsy was performed. The biopsy is no big deal, believe me. However, I experienced a serious E. coli infection from the second biopsy, requiring hospitalization on IV antiobiotics. Because my PSA continued to rise, I had a third biopsy. While the results were still negative, I got another E. coli infection which required 3 days in the hospital on IV antibiotics. Bottom line for me is that I now know with relative certainty (from 36 negative cores) that I do NOT have cancer. I am told that my experience with E. coli infections resulting from the ultrasound-guided biopsies was totally anomalous.

I am very glad to know with about as much certainty as you can have in medicine that I do not have cancer and consider the trade-off well worth while.

PSA Test

The first symptom was a slightly elevated PSA level. It was tracked on first a six month interval and then shifted to annual testing when there was no substative increase. In addition to PSA testing I had the DRE exam also. In the first week of January 2007 the doctor felt a ridge on my prostate. The PSA was not elevated furthe, but was at 4.0 which was a treshhold for concern. The doctor requested that I have a biopsy. The diagnosis was T2a stage with a 3+4 Gleason score. I chose robotic assisted laproscopic radical prostetectomy -- removal of the prostate. The tissue indicated a 4+3=7 Gleason score -- about the same -- but a T3b staging. The next step is T4 (major odds against survival. If my PSA had not been tested I would not have known to have regular checkups and my doctor would not have felt the small, FAST GROWING tumor during my DRE. Bottom line is that I would be dead by now. Yes, some with slow growing tumors will not die from prostate cancer. The need for testing is to get ahead of the disease. What you don't know might kill you. If it is slow growing there is term which is watchful waiting. Any professional urologist will prescribe this if your test shows a slow growing cancer. However, if you don't know then it may be too late to do anything except wait for death. I had to undergo Radiation and hormone treatment. I now test no cancer indicators. I owe my life to a PSA test!

Note that in Canada I would not have been able to obtain the level of care that I have received. I was 70 years old and all that Canada provides is castration for 70 year old men. Even then the waiting period is co long that I would have3 already died. Statistics my not lie, but don't let tem use them to set ua up for a premature death even though it is possible to save us for a signifacantly longer life. If National Health Care becomes the law of the land, there will be no way to provide for us in our times of need. Statistics will say that we aren't worth the money or they just don't have the money. Sorry old timer. Even though you are only seventy, we just can't afford it.

Prostate cancer screening

I find this recent report and reactions to it very misleading. I was very recently diagnosed with Prostate cancer through a routine PSA test. It was made very clear to me that the test was only an indication of potential cancer. I was first put on antibiotics to make sure thatthe test was not a reaction to an inspection. I was re-tested for PSA and still came up higher than normal.I had a biopsy as well as a high definition Dopler ultrasound. These tests while not fun were not particularly invasive. At he end of the day, I discovered that I had cancer and had a pretty good idea of the extent of its size and containment within the prostate. After revieweing my potions I opted for robotic surgery. I had the surgery and my cancer was found to be contained within the prostate but it would have spread if I had not acted on it. Five weeks after surgery I have had zero problems with incontinence and while it is too soon to know about potency all signs point to a recovery on that front. I was back at work within a week of surgery and hope to be back to my normal, active program of excercise within another week or two. PSA testing and a proffessional series of follow up and medical care now has me Cancer free and with great potential of full recovery. Without a PSA test to detect my risk, I would now still have cancer and be faced with it spreading elsewere in my body and a premature death. Guys, get your PSA tests and go to an Urologist who is up on the latest techniques available for potential treatment.

Can you make up your mind which onw is true?

This article is typical how you can play with the numbers.

I says:

Raghavan noted that the overall survival in the European trial was the same for those who had screening and those who did not, while Brawley was uncomfortable with the European finding that 48 men had to be treated to save one life.

But the other study, which included 182,000 European men, found a 20 percent lowering of prostate cancer deaths among men who had such screening.

So which one is true? and 20% of what?

Sitting in a hospital bed right now

I am 42 and have just had my prostate removed - early detection of cancer via the PSA test is the reason, now I can expect to live a long time instead of dying in my 50s or 60s as both my father and grandfather did

This debate is stupid, every man should be tested. The difficult decision is what to do next. But we should all know what our PSA level is.

I am sure glad that my 5 year old will have a father and not lose me to a curable disease!

PSA Tests

All men should have the PSA blood test.

It does NOT detect cancer! It does point to a POSSIBILITY that cancerous cells MAY be forming or have formed.

If, after a couple of years of testing, it is seen that PSA levels are rising SIGNIFICANTLY one then has the next stage of testing which is the taking of tissue samples via biopsy, this is done in conjunction with ultrasound.

Those tissue samples will show if cancerous cells are present and the potential aggressiveness of them.

Only then could any type of treatment be considered.

If, as in my own case, the cancerous cells can be eradicated on site there is no need to remove the prostate.

My own very aggressive prostate cancer was treated with Brachytherapy (seed implants) in conjunction with external beam radiation.

I still have my prostate and all the bodily functions controlled by the nerves that are attached to the outside of the prostate gland.

One very important thing to remember when booking your PSA test is that you should refrain from any sexual activity or any physical stimulation of your prostate of any kind, for at least three days prior to your PSA test, (riding a bicycle or exercise equipment for instance. That stimulation will artificially elevate your PSA levels and therefore give a false reading.

In my own case if I had not had PSA testing done I would now be dead as my own cancer was found to be extremely aggressive.

I had my first PSA test in 1997, I had my first prostate biopsy done in 1998, because back then no ultrasound was used the biopsy missed the cancerous cells, in 1999 with ultrasound the potentially cancerous cells could be targeted.

I have been prostate cancer free since my treatment in 2000

PSA testing is the ONLY indicator that cancerous cells may be growing in your prostate BEFORE it is TOO late to do anything about it.

Have the PSA test, establish a baseline for your own PSA levels, and get the peace of mind that comes with the annual results.

If not for yourself do it for your loved ones, it they who will miss you if you died from treatable prostate cancer.

RE: Jeff of Annual Test found cancer

Dear Jeff,

On behalf of those who know how important PSA testing can be-survivors of prostate cancer victims, thank you for saying men owe it to their families. I hope your treatments went well. Keep letting people know how important testing is!

All the Best

psa test``

For many years I was receiving the psa test yearly. In October 2005 my reading had jumped from 2.4 in 2004 to 4.9. The doctor informed me that anything over 4 required a biopsy, which was done in seven spots of the prostate. Cancer was found in 2 spots, which made in an agrresive form. My age, 76,would not permit removal of the prostate, so I chose to have radioactive seeds imnplanted. That's not a pleasant experience in itself, but the next few months were worse. The upside is that my next psa test in May 2006 gave a reading of 3.1. I have had a test every six months since. My test of March 3rd this year gave a reading of .10, the same as last year. I will be 80 in July and I'm feeling fine.

Prostate Cancer

Research out of the University of Michigan indicates that there is a marker that is associated with aggressive cancers:

http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=351

While there may not yet be testing methods developed around this marker that are ready for prime time, it would seem that one could be tested and use the results in conjunction with a PSA test to determine whether or not second order testing is required.