PSA: Okay today, not tomorrow?
Today you are okay...tomorrow is another story.
This is one of those PSA stories that every urologist experiences at least a few times in their career. The good news for this particular situation is that there is a good ending for the patient.
About eight years ago I saw a patient whom we will call "Jim" for an elevated PSA. Though it was only slightly above normal, he was young enough that we went ahead with two rounds of ultrasound-guided biopsies, all of which returned completely and totally normal.
Since then he has had his PSA followed at least twice a year, with a digital rectal exam (DRE) annually. Because of schedule conflicts, my associate began seeing Jim a few years ago. Last month my associate approached me and told me that Jim's PSA had gone up dramatically, though his exam was unchanged.
The results from another round of biopsies were bad -- extensive amounts of a highly aggressive prostate cancer. Jim has opted for surgery, which considering all the circumstances is a good idea. But that is not the point.
The point that is so important and is so often forgotten is that it is essential that all men continue to follow their PSA and exam regularly, even if they have previously had prostate biopsies that show nothing. So many times I talk to men who feel that once they have biopsies that come back normal, that they are cleared of ever having prostate cancer. There are two problems with this thinking.
First, there is always a risk of sampling error with the biopsies. This means that there may be cancer present but simply missed (not "sampled"). Therefore, no cancer was seen in the tissue that was analyzed. Performing a prostate biopsy is like trying to stick a tiny needle through a plum to find something the size of a peanut.
Sometimes even with the best equipment and skilled techniques we miss. This is unavoidable. At least one in 10 men that have had biopsies that show no cancer still have cancer somewhere in the prostate. This is why so many experts strongly recommend a second round of biopsies three to six months later, if the PSA remains elevated or the exam remains abnormal.
Second, a set of biopsies in the past does not prevent cancer from developing, as I suspect was the case with Jim. Changing the oil in your car once does not mean that you can avoid changing the oil ever again.
To live a full and healthy life, it is essential that you be your own advocate. Demand to have the PSA annually with a DRE. If the doctor disagrees, then thank him/her for his opinion and tell him you want it anyway.
Many men choose to see a urologist as well just for an annual exam by an expert. If there are ever any changes in exam, or elevation of the PSA, then you need to see a urologist for evaluation and probably biopsies. Hoping everything will resolve on its own is a nice idea that rarely happens. Delays in evaluation and treatment can be dangerous and even life threatening.
Related Topics: Men's Top 5 Health Concerns, Prostate Cancer: Separate Fact from Myth
Technorati Tags: prostate cancer, PCa, PSA, wellness
This is one of those PSA stories that every urologist experiences at least a few times in their career. The good news for this particular situation is that there is a good ending for the patient.
About eight years ago I saw a patient whom we will call "Jim" for an elevated PSA. Though it was only slightly above normal, he was young enough that we went ahead with two rounds of ultrasound-guided biopsies, all of which returned completely and totally normal.
Since then he has had his PSA followed at least twice a year, with a digital rectal exam (DRE) annually. Because of schedule conflicts, my associate began seeing Jim a few years ago. Last month my associate approached me and told me that Jim's PSA had gone up dramatically, though his exam was unchanged.
The results from another round of biopsies were bad -- extensive amounts of a highly aggressive prostate cancer. Jim has opted for surgery, which considering all the circumstances is a good idea. But that is not the point.
The point that is so important and is so often forgotten is that it is essential that all men continue to follow their PSA and exam regularly, even if they have previously had prostate biopsies that show nothing. So many times I talk to men who feel that once they have biopsies that come back normal, that they are cleared of ever having prostate cancer. There are two problems with this thinking.
First, there is always a risk of sampling error with the biopsies. This means that there may be cancer present but simply missed (not "sampled"). Therefore, no cancer was seen in the tissue that was analyzed. Performing a prostate biopsy is like trying to stick a tiny needle through a plum to find something the size of a peanut.
Sometimes even with the best equipment and skilled techniques we miss. This is unavoidable. At least one in 10 men that have had biopsies that show no cancer still have cancer somewhere in the prostate. This is why so many experts strongly recommend a second round of biopsies three to six months later, if the PSA remains elevated or the exam remains abnormal.
Second, a set of biopsies in the past does not prevent cancer from developing, as I suspect was the case with Jim. Changing the oil in your car once does not mean that you can avoid changing the oil ever again.
To live a full and healthy life, it is essential that you be your own advocate. Demand to have the PSA annually with a DRE. If the doctor disagrees, then thank him/her for his opinion and tell him you want it anyway.
Many men choose to see a urologist as well just for an annual exam by an expert. If there are ever any changes in exam, or elevation of the PSA, then you need to see a urologist for evaluation and probably biopsies. Hoping everything will resolve on its own is a nice idea that rarely happens. Delays in evaluation and treatment can be dangerous and even life threatening.
Related Topics: Men's Top 5 Health Concerns, Prostate Cancer: Separate Fact from Myth
Technorati Tags: prostate cancer, PCa, PSA, wellness
5 Comments:
Surgery is not always a good idea. There are other more effective and less invasible treatments.
See the RCOG web site in Atlanta for more details. They have almost 10,000 patiens over the years and currently have a 10 year success rate of 87%.
I am one of those lucky ones.
The test for PSA annually and DRE by a specialist is ultra important. Even if your PSA is "in the norm range" don't be fooled. The amount of the change in the PSA reading is important. Your advocate (possibly your wife) or you should keep this number handy from the last reading and compare. My husband is watchful, annuals are done, reading was in the norm range - but me, I always ask for the numbers. The number was in the norm range, but from the last year reading, is had made a jump. The Urologist did a biopsy, and sent it in for a reading. The first lab could not determine the result for sure. The second lab could and did -- he had prostate cancer - but very early. If we had not been vigilant and just waiting until the next year, who knows. In his case, Radium Seeding was successful. That was in 1994 -- and he continues his annual DRE and PSA like clockwork and continues to be free of cancer. His PSA reading now -- is neglible. Insist on both test annually -- and keep track of your numbers.
This is not a comment more like a question.My husband is 33 & is having frequent urination at night weak streams dribbling of urine between bathroom trips.And just really tired constantly like he has no energy. Could this be prostate trouble??
As I entered my 40th year of good health, I wish to maintain this health by monitoring my predisposition for developing prostate cancer. This is a common type of cancer in males over 40 and I wish to do everything possible to use preventative medicine to decrease the chances of this developing in my own life. Some of the things I am doing is trying to get sunlight for Vitamin D, have proper diet and nutrition with supplements and proper rest and exercise.
My PSA has risen in a straight line from 2.6 in 1992 to 20.3 last week. Up to now the annual DRE and two biopsies have not shown cancer. I have my 2007 annual review next week. I seek to know how high PSA can go in an 82 year old man without prostate cancer being detected. And is enough thought being given to the hypothesis that PSA fights the disease rather than just indicates it? PSA is present in women -- in those women with breast cancer who have the good prognosis for recovery. Fortier, A H; Diamandis,
E P; and Yu, H are authors of studies in this line of investigation.
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