A PSA PSA

[kenny]

This PSA is for men or any woman who knows a man.

As you know, I just had surgery for prostate cancer.
They caught it early and my life has been saved - all because of early and annual PSA tests.

All men should get a PSA blood test and digital exam every year starting at age 35.
I don't care at what minimum age he must reach for his insurance company to pay. (probably 40 to 50)
Pay out of pocket if you have to.
Write down your PSA numbers in a safe place since you may change doctors over time.

The result of ONE PSA test usually tells the doctor very little.
Lower PSA numbers are better but you can have cancer with low PSA or high PSA with no cancer - but HOW the annual number changes over time (the more time the better) can tell a good doctor TONS about whether cancer is growing in there or there is another explanation for the PSA numbers going up.

I started getting annual PSA testing while young, around age 38 since my company offered it free.
It was this long record that the doctors used to find my cancer early.
Depending on age, generally a PSA under 4 is not too much of a concern.
My highest PSA was 3.8 but [big]how it changed over time[/big] indicated a biopsy was in order.

My pathology report on the removed organ came back excellent.
The cancer had not yet spread to the outside edge of the prostate.
They also removed the seminal vesicles and lymph nodes (the first places prostate cancer migrates to; they are of no use anyway now) and they were all found to be cancer-free.


MEN: GET YOUR BUTT INTO THE DOCTORS OFFICE!!!!!
WOMEN: GET YOUR MAN'S BUTT INTO HIS DOCTOR'S OFFICE!!!!!
MACHO MEN AFRAID OF A FINGER AND A NEEDLE HAVE DIED OF CANCER!!!!!

 

[ame]

Was there not something recently in the news about how this test was being scaled back or not covered or something? I thought like a month ago I heard something regarding it. I will never understand why such a test would 1) not be covered and 2) not used. The point with this test, and others, is to catch it early so that you have a chance to fight it.

 

[kenny]

Was there not something recently in the news about how this test was being scaled back or not covered or something? I thought like a month ago I heard something regarding it. I will never understand why such a test would 1) not be covered and 2) not used. The point with this test, and others, is to catch it early so that you have a chance to fight it.

Yes, that news story really pissed me off.
Men will die because of it.

What is "recommended" is a can of worms.
Insurance companies do the math to strike the balance of cancer claims and lack of PSA testing claims that maximize their profits.
Letting X number of men die makes them the most money.

They don't care about what's best for your health.
They care about $$$$ and they have powerful lobbyists in Washington and they make huge campaign contributions.

HENCE THIS PSA from Kenny, telling men to get those annual PSA test started at age 35.
Pay out of pocket.
What could it cost? $200 maybe?

$200 is just the price of an iPhone 4S.

 

[KaeKae]

Excellent advice, Kenny. Last spring, DH's caught a change in his PSA numbers. (I'll leave the technical talk to you ) Long story short, the biopsy came back negative, but we were so glad to be able to be sure. FIL had prostate cancer just a few years ago, DH is not taking any chances. He started seeing this doc right after we moved here, four years ago, so I'm assuming those records helped the doctor make the assessment and order the biopsy.

 

[Sha]

Thanks for the important reminder, Kenny. My own husband hasn't gone to the doctor in 10 years.... I'm working on him, though. He'll be going soon enough.

 

[ame]

$200 is just the price of an iPhone 4S.

Only on a new contract!

That said, it's worth the outlay. The amount of money, energy, etc, going into treating it would FAR exceed letting that test pass you by. I think there was also news regarding paps too. Also not good to miss or delay.

 

[jstarfireb]

I think it's great that you're spreading awareness about prostate cancer, but I disagree with starting routine screening at 35. The American Cancer Society recommends having the discussion about screening at age 50 (45 if African-American or a family history of prostate cancer in a first-degree relative under 65):

http://www.cancer.org/Cancer/Prosta...Detection/prostate-cancer-early-detection-toc

Routine population screening is a tricky thing. Part of the reason why insurance companies aren't reimbursing for routine screening is that there isn't clear evidence to recommend it in the general population. That doesn't mean it shouldn't be done, but it means that we don't know whether routine PSA testing causes more harm than it prevents (e.g. unnecessary biopsies and surgeries, with possible bleeding/infection/nerve damage as a result, etc.). The US Preventive Services Task Force sets guidelines for routine medical screening including cancer screening, and their research found insignificant evidence to recommend for or against yearly PSA in asymptomatic men. Note that the ACS guidelines that I posted above are actually recommending only discussing screening with your doctor and deciding whether or not to be screened. Furthermore, they don't recommend yearly PSAs for all men, but only if their initial PSA is over 2.5 (every 2 years if less).

Anyway, as a doctor, I want to make sure people are appropriately informed. Otherwise, I agree with everything you said.

 

[kenny]

My highest PSA score was only 3.8 (not very high) my cancer was not felt (palpable) by three different doctors doing a digital rectal exam, and I'm caucasian in my mid 50s with no family history of prostate cancer.
The only reason my doctors recommended a biopsy was the way my PSA scores changed over time, since I began my annual PSA tests at age 38.

Prostate cancer is a very difficult thing to detect.
Some with high PSAs don't have cancer.
Some with low PSAs do.
There are other tests that add pieces to the puzzle.
Then there is age, family history and race.
A 70 year old man with my test results would probably not have a prostatectomy.
Prostate cancer is often slow growing so something else would take that man's life first.

Knowledgeable urologists understand that the most useful data is how the PSA changes over time.
The more years of PSA data, the more useful it is in indicating whether cancer is growing in there, or whether the PSA is high for other reasons.
That's why starting PSA tests young is smart.

If I followed the recommendations and waited till age 50 the years of data would not have been there for the doctors to recommend a biopsy and the cancer would still be growing in me right now, silently.
There are no obvious symptoms with prostate cancer till it has spread beyond the prostate.
By the time their "recommendations" allowed me a biopsy it may have been too late; it may have metastasized.

I suspect those recommendations are compromises based on money.
No thank you.
Mathematicians calculate for insurance companies how many cancer claims offset the money saved by not testing.
X number of human lives are expendable for them to optimize profits.
Insurance companies have lobbies in Washington so I do not trust government recommendations either.

I am delighted I did not follow their recommendations.

If anyone cares to learn more please read the book, "Surviving Prostate Cancer" by Dr. Patrick Walsh, Professor of Urology at Johns Hopkins.
It is thorough and very easy to read.

http://www.amazon.com/s/ref=nb_sb_ss_i_0_25?url=search-alias%3Dstripbooks&field-keywords=surviving+prostate+cancer+by+dr.+patrick+walsh&x=0&y=0&sprefix=surviving+prostate+cancer

 

[Lawsman]

This is from MD Anderson's website. Bottom line, PSA tests most effective to find trends


Tracking Your PSA: Be Proactive
MD Anderson Recommends Men Monitor PSA Scores to Find Trends

MD Anderson News Release 09/09/2010

Experts at The University of Texas MD Anderson Cancer Center advise men to keep a record of their prostate specific antigen (PSA) test results to help determine if they are at increased risk for prostate cancer.

“Recent reports have debated the usefulness of the PSA test, but men should not write off this exam,” says John W. Davis, M.D., assistant professor in MD Anderson’s Department of Urology.

“It’s still an effective way to track trends in your prostate over time,” he says. Doing this increases the chances that your doctor will find prostate cancer as early as possible, when it’s most successfully treated.”

Most men age 50+ should get tested

The prostate specific antigen, or PSA, test is a simple blood test. It measures the amount of PSA in a man’s bloodstream. PSA is a protein produced by the cells of the prostate gland.

“Starting at age 40, all men should talk to their doctor about the PSA test,” Davis says.

Recent guidelines by the American Cancer Society stress that men should talk to a doctor before getting tested. A doctor can explain the possible benefits and risks of prostate cancer screening and treatment.

MD Anderson recommends that men age 50 and older, with no family history of prostate cancer, get a prostate cancer screening exam every year. African-American men and men with a family history of prostate cancer should begin annual screening exams at age 45. Both a digital rectal exam and a PSA blood test should be performed.

Tips for tracking your PSA levels

“If you decide to do the PSA test after talking to your doctor, start tracking your PSA levels as soon as you begin testing,” Davis says.

He suggests the following tips when recording PSA test results:

Download MD Anderson’s PSA tracking tool at www.mdanderson.org/focusedonhealth.. It’s an easy way to track your PSA levels. Use it to start a discussion with your doctor.
Note the testing standard used to find your PSA level each year. Knowing this standard helps doctors compare measurements from one year to the next.
Ask your doctor for the actual PSA number. Don’t just record the results as normal or elevated.
“Lower PSA levels may suggest you have a lower risk for prostate cancer,” Davis says. “But, a low number, or normal result, does not mean you will not get the disease. This is why tracking trends over time, even among normal results, is so important.”

Monitor PSA trends

When monitoring trends in your PSA levels, Davis suggests looking for these warning signs:

Doubled PSA score: Has your score doubled in a year?
Velocity (or speed of increase over time): The amount of PSA in the blood is measured in nanograms per milliliter. A greater than 0.35 nanograms increase over time is linked to a higher risk for prostate cancer.
High PSA score: Between 2.5 to 4 nanograms is considered high and may put you at increased risk.
Other factors increase risk

“Your doctor also should consider other factors that may increase your chances for developing prostate cancer,” Davis says.

Those factors include:

Race: African-Americans get prostate cancer twice as often as white men.
Family history: Your risk is higher if your brother, son or father had prostate cancer.
Age: As you get older, your risk increases.
Abnormal digital rectal exam: An abnormal exam result increases your risk.
“Remember, not every man should get a PSA test,” Davis says. “Your doctor can help you decide whether or not the PSA test is right for you as well as when to begin testing.”