How PSA Test Helped Me - A Personal Story
Editor's ChoiceMain Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology; Men's health; Cancer / Oncology
Article Date: 08 Oct 2011 - 14:00 PST
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Just over three years ago I went to have a normal check up, which included a (prostate-specific antigen) PSA test. The doctor noticed that it was a slightly higher than it should be for a man of my age at the time, 53 years. Everything else came out OK - all other tests and physical examinations detected nothing. The doctor suggested I do another PSA test a month or so later to see whether the level had gone up.
If PSA levels keep going up, it is often a sign that something is wrong, either the prostate is enlarging, or that there is a cancerous growth.
The second PSA test was slightly higher than the first. The doctor and I discussed the pros and cons of "watchful waiting", I concluded that two months of rising PSA levels would interfere with my sleep and make me anxious. So I opted for a biopsy. Several samples are taken from different parts of the prostate gland, and then examined under a microscope for signs of cancer.
I was not looking forward to the biopsy procedure because I had heard varying accounts of discomfort, pain and no pain. Fortunately, it was not as painful as I had expected, perhaps a little when samples were being taken from the base of the prostate, but no more uncomfortable than the average visit to the dentist. During the following 48 hours my discomfort was not a problem.
A few days later the doctor called me. During the visit he explained that they had detected cancerous cells and that I had prostate cancer. I then discussed and researched extensively on whether to treat it with radiotherapy, which today means inserting radioactive pellets in the prostate gland, or go for a radical prostatectomy (have the prostate gland surgically removed).
I decided, that at the relatively young age of 53, my long-term health would have a better chance with surgery.
I underwent the radical prostatectomy ("My Prostate Cancer Operation - A Personal Diary"), went through all the urinary incontinence and erectile dysfunction and came out free of cancer and with everything restored. The urinary incontinence took a couple of months to resolve, while the erectile function took over a year.
This picture was taken the following morning, after my operation
A US federal report has just recommended that most males do not receive routine PSA screenings, as they believe the tests offer little benefit. Several medical groups and patient advocate organizations will be disputing this view. The report says that if about half the men aged 65 to 75 now get a blood test, there seems no point in the other one.
I am aware of some of the arguments in this debate, but will stay within my personal situation. I was 53, not aged between 65 and 75 like the people quoted in the federal report. Had I not had a routine PSA test I would probably still be walking around now with an advancing prostate cancer - completely unaware. By the time I would have started having symptoms, how advanced would the cancer have become? In my case definitely, the PSA test was extremely beneficial.
The American Urological Association says it will carry on recommending PSA screening "for well-informed men who wish to pursue early diagnosis." The Association also warned against over-detection and overtreatment. The Association says it would like to see the Federal Panel's final conclusions before issuing new guidelines.
Skip Lockwood, chief executive of "ZERO - the Project to End Prostate Cancer", a group that believes in PSA testing, said:
"Just because it's difficult to make a decision isn't a
reason to say you shouldn't know."
It is important to find a balance which does not cause unnecessary tests, does not miss out on diagnosing people with cancer, does not over-treat those with the disease, but at the same time controls or cures the cancer.
My opinion is strongly influenced by personal experience, sometimes personal experience clouds judgments, other times it is only by being there yourself that you can fully understand what is at stake. I believe PSA testing, if there is a family history of prostate cancer, should be recommended to patients. Regarding routine PSA screening for all males after a certain age, I would like to see the Panel's conclusions. Recent studies have shown that routine PSA testing does not appear to reduce mortality. Other studies have criticized over-treatment of a disease, and often disease that is not there, because of PSA testing - in such cases it is not the PSA testing that is to blame, but rather what happens after it.
"My Prostate Cancer Operation - A Personal Diary"
Added after Reading US Preventive Services Task Force report and recommendation - after reading their conclusions, I am inclined to agree with them. The numbers speak for themselves. It does appear that PSA screening has virtually no impact on overall prostate cancer mortality; and patients are being overtreated. I would like to see more studies into why overdiagnoses and overtreatments after PSA tests occur. ("Why Federal Panel Recommends Against PSA-Based Screening For Prostate Cancer")
Written by Christian Nordqvist (Editor-in-Chief, Medical News Today)
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
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26 May. 2012. <http://www.medicalnewstoday.com/articles/235709.php>
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Visitor Opinions (latest shown first)
Nervous about my prostate operation
posted by Nick on 10 Oct 2011 at 3:57 pmI am 64 years old, had 2 PSA tests, with the last one reading 7.1, lower than 8.4. Had the biopsy done and out of 12 cores one showed cancer .86cm. My Gleason score was 3+4=7, which was moderately aggresive. My decision is to have the surgery scheduled for this Thursday 10-13-2011 at the City of Hope. I have seleted the top rated surgeon in this field Dr. Mark Kawashi, who has perfomed thousands of these surgerys with the Da Vinci Robotic system.
So with that said I am counting down my time to the operation. Am I nervous, you bet but I just cannot think of living with this cancer in me. I will check back in afterwards.
teacher
posted by Ian Liberman on 9 Oct 2011 at 7:44 amIf every male got a prostate biopsy at this we would discover cancer also in a percentage of them. We would save enormous amounts of lives but the costs would be enormous and side effects would be damaging to most who did not have the cancer. The inaccurate PSA positive is going to have accurate hits also but studies show the overall accuracy is poor and that unnecessary biopsies occur on many people who do not have the cancer. Epidemiology and the scientific method is everything in all areas of life. Anecdotal evidence is a oxymoron.
How often do urologists screen themselves using PSA test?
posted by Christian Nordqvist on 8 Oct 2011 at 4:36 pmI would be interesting to find out what percentage of male urologists over the age of 50 carry out PSA tests on themselves, and how often. Personally, that would be for me the only true scientifically valuable finding.
Medication as a treatment
posted by David L. on 8 Oct 2011 at 4:11 pmI am 83 and was diagnosed with prostate cancer four years ago. The biopsy was done after my PSA level increased rather suddenly and revealed only a slight amount of cancer in just one of the seven or eight samples taken.
After discussion with my urologist I opted to take Avodart to keep the cancer in check. I already had ED but haven't had incontinence and no discomfort. Annual PSA test show a reduction to nearly a level of one.PSA test are certinly worthwhile at my age.
Don't Mess with the PSA
posted by Homer Whitlow on 8 Oct 2011 at 4:11 pmAll of you have very similar stories. Mine is about the same in that my PSA was 4.0 and stayed that way for a year. During my next checkup, my doctor, with the 4.0 reading decided to perform a biopsy which was positive for cancer. He would not have performed the biopsy had it not been for the 4.0 reading.I had a radical prostatectomy at age 67. I am now 80 and would not be here now had it not been for the PSA!I think it will be a crying shame for the medical folks to take away the only tool we have to take at shot at finding and curing cancer.
PSA test
posted by gilbert on 8 Oct 2011 at 4:05 pmso touching issue. i am 70 years old then have a PSA every year 2 years ago he shown a very elevated reading abnormal, so have 2 doctors the first one say you had too have a biopsy then sure surgery grrrr then went too see my second doctor, then say well i do not know yet but too have a such elevated reading seem no right so he say option number one first take that course of antibiotic probably an infection if not right in one month then we do a biopsy then after one month all back too normal so i do a PSA every 6 months too compare the results
stopped clock
posted by bob wright on 8 Oct 2011 at 4:02 pmSubjective stories about medical tests are inherently deceptive, and self-deceptive. There is practically no test that you could devise that wouldn't either get the occasional result, or the appearance of the occasional correct result. Lacking a time machine we can't go back and run a control, to see what would have happened in this case had nothing been done. "I had my arm chopped off, to stop prostate cancer, and I never got prostate cancer, so the procedure worked!" has the same scientific basis, though it's less obvious when it's the prostate than the arm that's cut off. If however we generously assume that the author would indeed be dead by now had nothing been done, we're up against the problem that the same would be true if all men had their prostates removed at age 40. It would have saved Frank Zappa, who could have written an "It's great, from my point of view!" article, but is in any more objective sense an insane approach for all sorts of reasons, among them the convenient way that it picks the positive and dismisses the "My surgery was a needless disaster" negatives. It's nice that the author feels good about what he went through and believes it cured him of something, but medically it's coming from the same place as any "Holy water cured my cancer!" story.
PSA testing saved my life and my quality of life
posted by Joe Harkins on 8 Oct 2011 at 3:52 pmIn 1990 I was being treated by a Urologist for frequent episodes of prostate infection that resulted in swelling that shut down elimination and needed urgent E/R catheter sessions to drain me while waiting for antibiotics to work. I was also taking a common drug that reduced urinary frequency and urgency, but whose side effects made me too drowsy to work or play.
The Urologist taught me that the rate of PSA change was more important, at my stage (baseline 4.0) than the actual measurement. In 1992 I switched to getting my care at the local VA where I qualified for very inexpensive care. They were doing PSA tests every six months.
In August of 1993 a routine test came back with a rating of 8.0, double what it had been six months previously. The physician who reported the results was a GP, not a Urologist.
He pooh-pohed the test results, "There's no need to worry until the number is in the mid-teens or higher. That jump is probably either a testing error or maybe you have a cold, something affecting the results. Let's see what it looks like on the test in six months."
But informed by the Urologist, I insisted on a repeat. I had to raise some hell and brought my demand to the V Hospital's Patient Rep who got me a re-test. It came back the same 8.0.
A biopsy was done in the VA Hospital's Urology Dept. The doc said, make an appointment for three weeks from now and we'll have the result for you.
That same doctor called me two days later on Friday night at 9:30pm. I knew he did not call with good news. He wanted me to come in the next morning, Saturday, at 8:am. He was reluctant to tell me more over the phone but I insisted that I am a "tell me the truth no matter how bad it might be" guy.
He said, "You have prostate cancer and we need to help you choose a course of treatment. Time is on your side if you do not delay."
After consulting him and after a consulting session with the original private Urologist, I chose a Radical Prostectomy. It was done two weeks after the diagnosis in the Manhattan VA Hospital.
They took out a prostate, still sealed, no sign of escaped cancer cells, but bigger than a large softball. I forget the weight but the surgeon said it was the largest he had seen in his 15 years.
About 6 mos later I had follow up surgery to install a "bladder sling" that stopped the urinary incontinence. Viagra, and later Levitra, helped IP. I didn't need either chemo or radiation.
Eighteen years and month later I'm now 78. My annual PSA's are zero. In the years since 1993 I have spent multiple, month-long trips alone, starting out with 30 hour long multiple connection flights, followed by riding overnight trains and buses through China, India, Australia, Europe and parts of this beautiful America.
In 1994 I started a web site development and hosting business that now has clients in 7 countries. In two weeks my wife and I will celebrate our First Anniversary. We enjoy the Metropolitan Opera and Broadway shows. We spend afternoons at NYC's Highline Park and around the city. I am on the board of directors of a Film Festival. I am a local elected official in a major political party. I'm a local historical and environmental preservation activist. I have watched grandchildren finish college. I have had (correction: I am having!) a full and rich life that I doubt would exist had I not gotten those regular tests and followed that caring Urologist's advice.
Yes, my is anecdotal and circumstantial. But I am alive and well and full or life, thanks to PSA testing and sound advice that I respected.
Gleason Score - Response to L Bernstein's comment
posted by Christian Nordqvist on 8 Oct 2011 at 3:44 pmThe biopsy had a "fairly" high Gleason score. This was the main factor in my deciding to have the prostate surgically removed.
response
posted by scott werden on 8 Oct 2011 at 3:43 pmThree comments:
(1) The author did not say what the cancer was that was cleaned out. At least some prostate cancers are very slow growing and most men do not even know they have one of these throughout their lives. What is the point of removing one of those?
(2) This is a case of statistics vs anecdote. You can always find an anecdote that will refute a statistic. That does not invalidate the statistical finding.
(3) I have refused PSA for years and will continue to do so. The medical industry is out of control and I prefer to avoid doctors at all costs. Yes there is risk in doing that but at least I now feel like the destiny of my body and life are in my hands and not in the hands of a 3 trillion dollar industry.
Do Not Ignore
posted by Steve Savasky on 8 Oct 2011 at 3:41 pmAll Tests need to be done using the same method.
Do not ignore successive tests showing progressively higher numbers.
Not so sure
posted by Mary Arneson on 8 Oct 2011 at 3:40 pmThis story is exactly what we would expect to hear if the new recommendations are correct.
Men who have had rising PSA levels, had cancer on biopsy, and underwent prostatectomy would list themselves as success stories. What if they are wrong?
What if many of their cancers would have remained indolent? What if the aggressive ones would come back after radical surgery anyway? What if more men die (or die sooner) from surgery than would die if the cancers were just left alone? That's what the epidemiologic studies are telling us.
Epidemiology is harder to grasp than anecdotes, but reliance on anecdotes kills people.
It worked for me - PSA saved my life
posted by Dave on 8 Oct 2011 at 3:29 pmThis pretty well mirrors my experience. The biopsy was positive, I had the prostate removed in 1999 at age 61 and now I am living a good life. The PSA may have saved my life.
Gleason score prostate cancer
posted by L. Bernstein on 8 Oct 2011 at 3:24 pmI note that the article does not mention the Gleason Score of the biopsy which denotes how agressive the cancer is.
In my case the Gleason score was a deciding factor on whether or not to have a prostatectomy.
Another Saved Life - PSA
posted by Cliff Abbott on 8 Oct 2011 at 3:21 pmMy experience is very similar. After numerous elevated PSA scores over several years, my doctor recommended a biopsy, in which over 50% of the samples were positive. Three weeks after my 54th birthday I underwent the robotic radical prostatectomy, I missed a total of 6 days of work, dealth with incontinence issues for about a month and was sexually functional within 2 months. Had I waited to notice symptoms instead of having the PSA tests, things would have turned out much differently.
Keep the psa
posted by Joseph Hayes on 8 Oct 2011 at 3:15 pmI work at University of Central Missouri and Blue Cross Blue Shield is our medical provider. Every fall they offer the psa as part of our wellness schedule. I took mine at age 51. It came back elevated but not much. I went to a urologist in my city and followed up with the psa2. Still elevated and a biopsy was advised which revealed my cancer. Before I went further, I took my pics of the cancer and the stats to another doc who confirmed what the first one warned. My cancer was advanced. Back to the first doc and a radical was proposed. I had known several men that had opted for the alternatives and the majority said they wished they had it to do over again. My brother is a lab director and he steered me to the radical simply because it was the gold standard of removing the cancer but their were risks. He told me of the consequences of choosing the wrong doctor for the surgery so I made sure mine met the criteria after many questions about life after surgery. Being such a nerve sensitive event, I had two surgeons operating on me. I stayed in the hospital for three days and was back at work on light duty in ten days. The cancer is gone, and has stayed gone for ten years now. I worried about the short spell of minor incontinence but my docs said I needed to get back "in the saddle" as soon as possible so they prescribed viagra, which elevated my blood pressure to the point I couldn't take it. Levitra the same way, but I did find balance with the cialis. Since I was a smoker my sex life had waned somewhat before the surgery so today it is as good as I could have ever anticipated. I went to the psa screening just for a break from work. Everything happens for a reason I suspect, but had I not gone I'm pretty sure I wouldn't be writing this today. Keep the psa.
Response to Herb Kaufman re PSA testing
posted by christian Nordqvist on 8 Oct 2011 at 3:05 pmMy main concern when the second (and third actually) PSA tests showed slightly rising levels were the anxiety I would have to go through not knowing whether or not I had anything. That is why I opted for a biopsy early on, I wanted to know. However, the PSA tests were what alerted me in that direction.
Herb
posted by Herb Kaufman on 8 Oct 2011 at 2:55 pmFunny thing about this article. I just got a phone call from my older brother who told me he just had a biopsy and was found clean. He was told by a urologist four years ago that, based on a PSA and an x-ray scan that he had prostate cancer. Four years later hefinds out that he never had the disease and had been worrying over nothing for years. There HAS to be a better way than a PSA.
PSA screening should stay
posted by Marino de medici on 8 Oct 2011 at 2:55 pmI west through the same experience. I agree completely. Luckily i had the same positive outcome, i recommend the PSA test.
Concerns
posted by Rick on 8 Oct 2011 at 2:24 pmPSA results can come out high for one interesting reason...masturbation, or if you engage in sex daily.
To get an accurate PSA, do not engage in sexual activity for a week before getting the blood test.
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