PSA Blood Tests
For years I have been talking about the relative inaccuracy of the PSA blood test. Yet I still believe it continues to save tens of thousands of lives each year. An elevated PSA saved the lives of many of my own patients more than 10 years ago - and they are alive and healthy today.
I still hear of situations where patients and even doctors misinterpret the PSA results. They don't seem to understand what the PSA is and what it isn't. For reasons that I think are totally human, doctors as a group seem to empower the PSA result with far more significance than it really deserves, or was ever intended to have. And just last week the perfect example occurred in my office. In fact, so good it begged to be described in this "mediblog," which sounds so much better than a "blogomed." Let me explain.
It all started with a follow-up visit with a patient. Let's call him Jim. He is a 72-year-old very healthy retired business executive. Very smart, very Internet savvy. Jim has had an elevated PSA for many years. Not dangerously high but enough to be of some concern. Yes, he has had several rounds of ultrasound-guided biopsies, all of which show no evidence of any cancer or even any precancerous PIN or atypia. Even with the risks for sampling error, the odds are good he does not have any large or significant cancer lurking in there. Still, we are following him with regular PSA levels and exams. Just to be sure.
Two weeks ago he had his PSA level drawn. Of interest, he had it drawn at two labs. Why, he isn't sure. He had the PSA drawn that our office ordered and then Jim went to his primary doctor who drew more blood and added on a PSA level, not knowing about the prior draw 30 minutes before. Here's the part that caused him some confusion. The results came back - one result at 7.2 and one at 8.4 - both from reputable labs, using state-of-the-art equipment. Both tests were drawn the same day, same patient, same hour. "How could this be?" he asked. "Is it going up that fast or is it dropping rapidly? What could I have done in 30 minutes that raised it or dropped it so much?"
"Aha", I said smiling like I knew a secret I was about to share. "Just as I expected." After his 15-second digital prostate exam was completed to confirm nothing had changed in 6 months, I explained what I have been saying for many years and have even written about in my book (yes, this is a plug, and a well-timed one at that). The PSA is a test of the prostate, not prostate cancer.
It is not an exact test, nor was it ever intended to be. The level can vary from day-to-day, lab-to-lab. It should be viewed as a ballpark test--information to be used in conjunction with the rest of the exam, history, and past results. Minor fluctuations are not only common, they are the norm. A PSA of 2.8 is the same as a PSA of 3.1 or 2.5. But despite my saying this over and over, year after year, people still look at their own levels as if they are precise results. They would see a change from 4.5 to 4.6 as a major sign of rapid and fatal cancer progression.
Now, though, I have a great example to demonstrate the fact that PSA is indeed a ballpark result. In fact, it is a nonspecific ballpark result so you can't even tell which ballpark it is in. Sure, it could represent a prostate cancer. It could also suggest prostate enlargement, infection, or recent injury such as a catheter placement or even a recent prostate biopsy (you should wait at least 8 to 12 weeks after a biopsy to recheck PSA). Sometimes it is just elevated.
If the PSA is elevated or goes up should you worry? Yes, a bit. If it is a concern, always ask to have it checked again in a few weeks. Then, if it is still up significantly or moving up, and your urine shows no sign of infection, it is time to see the urologist. No, you cannot wait 6 months. Call and make the appointment. It is a no-lose situation. If you have a cancer, then you usually catch it early and can decide what to do while you still have choices. Letting it grow just eliminates options, and shortens your lifespan. It's more likely that there will be no cancer and then you can quit worrying about the PSA level. And then, as most guys do, you can look for something else to stress about or ignore.
Related Topics: High PSA Level? Check it Again, Yearly Prostate Cancer Test May Save Lives
I still hear of situations where patients and even doctors misinterpret the PSA results. They don't seem to understand what the PSA is and what it isn't. For reasons that I think are totally human, doctors as a group seem to empower the PSA result with far more significance than it really deserves, or was ever intended to have. And just last week the perfect example occurred in my office. In fact, so good it begged to be described in this "mediblog," which sounds so much better than a "blogomed." Let me explain.
It all started with a follow-up visit with a patient. Let's call him Jim. He is a 72-year-old very healthy retired business executive. Very smart, very Internet savvy. Jim has had an elevated PSA for many years. Not dangerously high but enough to be of some concern. Yes, he has had several rounds of ultrasound-guided biopsies, all of which show no evidence of any cancer or even any precancerous PIN or atypia. Even with the risks for sampling error, the odds are good he does not have any large or significant cancer lurking in there. Still, we are following him with regular PSA levels and exams. Just to be sure.
Two weeks ago he had his PSA level drawn. Of interest, he had it drawn at two labs. Why, he isn't sure. He had the PSA drawn that our office ordered and then Jim went to his primary doctor who drew more blood and added on a PSA level, not knowing about the prior draw 30 minutes before. Here's the part that caused him some confusion. The results came back - one result at 7.2 and one at 8.4 - both from reputable labs, using state-of-the-art equipment. Both tests were drawn the same day, same patient, same hour. "How could this be?" he asked. "Is it going up that fast or is it dropping rapidly? What could I have done in 30 minutes that raised it or dropped it so much?"
"Aha", I said smiling like I knew a secret I was about to share. "Just as I expected." After his 15-second digital prostate exam was completed to confirm nothing had changed in 6 months, I explained what I have been saying for many years and have even written about in my book (yes, this is a plug, and a well-timed one at that). The PSA is a test of the prostate, not prostate cancer.
It is not an exact test, nor was it ever intended to be. The level can vary from day-to-day, lab-to-lab. It should be viewed as a ballpark test--information to be used in conjunction with the rest of the exam, history, and past results. Minor fluctuations are not only common, they are the norm. A PSA of 2.8 is the same as a PSA of 3.1 or 2.5. But despite my saying this over and over, year after year, people still look at their own levels as if they are precise results. They would see a change from 4.5 to 4.6 as a major sign of rapid and fatal cancer progression.
Now, though, I have a great example to demonstrate the fact that PSA is indeed a ballpark result. In fact, it is a nonspecific ballpark result so you can't even tell which ballpark it is in. Sure, it could represent a prostate cancer. It could also suggest prostate enlargement, infection, or recent injury such as a catheter placement or even a recent prostate biopsy (you should wait at least 8 to 12 weeks after a biopsy to recheck PSA). Sometimes it is just elevated.
If the PSA is elevated or goes up should you worry? Yes, a bit. If it is a concern, always ask to have it checked again in a few weeks. Then, if it is still up significantly or moving up, and your urine shows no sign of infection, it is time to see the urologist. No, you cannot wait 6 months. Call and make the appointment. It is a no-lose situation. If you have a cancer, then you usually catch it early and can decide what to do while you still have choices. Letting it grow just eliminates options, and shortens your lifespan. It's more likely that there will be no cancer and then you can quit worrying about the PSA level. And then, as most guys do, you can look for something else to stress about or ignore.
Related Topics: High PSA Level? Check it Again, Yearly Prostate Cancer Test May Save Lives
9 Comments:
Your commemtary is full of common sense. It seems to me that there is room to mention PSA velocity which can remove some doubt about the inaccuracies of the reading itself.
Always request a 2nd biopsy before letting some anxious urologist do a biopsy based on one result.
Good information. I currently have a higher PSA reading (9.73) than a year ago (1.0). Since seeing the doctor a couple days ago, I've found I have symptoms of an infection (mild burning sensation while urinating, head of penis sore 3 - 4 hours after urination, some lower back/hip discomfort). Can an infection (what type) cause an elevated PSA reading?
Thanks...
I am a 62 year old male that has had prostate issues for over 30 years. My PSA level rises and falls by 2-3 points from year to year. I have had 3 biopsies, all negative. The recent test was 12.5 and last year was 4.1. (Ihave had previous readings as high as 7.2) Needless to say this is a cause of concern. There is no history of prostate cancer in my family and most relatives lived into their 80's and 90's.
How is it that some men have psa levels in the hundreds and even higher and appear to be doing fine.
I have a friend with a psa in the hundreds in spite of having brachytherapy about nine years ago. Can you explain this
Post prostate surgery my first PSA was 2.8 and 2nd a month later was 5.2. My Gleason score post surgery was 3+5 and all post op pathology edge and lymph node tests were negative. My onocologist stated that the PSA test is 99% accurate post surgery and nothing but prostate cancer cells can account for these numbers. Is that correct??
I had a UTI a couple of months ago and my PSA remains raised at 4.6. My Dr suggests I should have a biopsy done and this is scheduled in a couple of days time. In the run-up to this I have been scouring the internet for information on PC and as a result have totally bewildered myself with sometimes contradictory information. Until I read your article, I had forgotten that PSA is an indicator of function and not of cancer. I'm glad I read your clear explanation of what PSA is and more importantly, what it is not. I am 49 years old
Hi, my Dad PSA has come back as 7.What dose this score relate to? The doctor has suggested that he goes for a biopsey.
age 76--post prostate surgical removal (10 years) shows a psa slowly climbing to a high of 5.6 and now it's back to 4.2---digital exam is negative---I am checked every 3 months----I believe i"m on the right course----
Opinion please--??
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