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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2004My first PSA test - Result is in
Just a little history. My father died of PCa at the age of 74. He was Dx at the age of 62. His cancer was aggressive. I just turned 37, I decided now would be a good time to get the PSA test done to establish a baseline. So at my request I asked my doctor for the blood test. I still need to get the DRE. The PSA result was 0.8 I have a few questions please. 1)Is 0.8 OK for my age? 2)Do I continue to get tested every year? 3)Does the PSA fluctuate? If so, what is normal fluctuation? Does the PSA tend to go up with age? If so, what is normal? 4)If my PSA was to raise, what is the most imporant: The percentage it raises or the amount? 5)Who is suppose to do the DRE? My GP or is my GP suppose to refer me to a urologist? Thank you everyone! 0.8 is great. Used to be the warning was 4.0. Many Uros now use 2.5. Everything should be OK as long as you stay under 2.5. My father also had prostate cancer and I was diagnosed with it at 66 with a PSA of 4.9. I'm not qualified to give medical advice, but based on my reading and experience it does no harm to comment that yes, that's an excellent score. As for whether it's the percentage or the amount of an increase which counts, well, sort of both and neither, it's the fact of the increase which counts. But the doctor will be looking for a definite trend. For example, annual readings of 0.8 then 0.9 then 1.0 are probably not statistically significant and the doctor would probably not send you for a biopsy based on that. All GP's should be qualified to do the DRE and diagnose enlargement or firm spots. If your GP is a woman, lucky you, because women have such slender fingers. Get annual physicals and rest assured you will not suffer your father's fate. jimhoney standard RRP age 52, cured, no significant aftereffects > Just a little history. My father died of PCa at the age of 74. He was > Dx at the age of 62. His cancer was aggressive. [quoted text clipped - 21 lines] > > Thank you everyone! > Just a little history. My father died of PCa at the age of 74. He was > Dx at the age of 62. His cancer was aggressive. [quoted text clipped - 8 lines] > > 1)Is 0.8 OK for my age? That is fine. > 2)Do I continue to get tested every year? Given your family history, you should probably be tested every year, but recommendations can change based on research. Ask your doctor about it. At some point he may find that less frequent tests are sufficient. > 3)Does the PSA fluctuate? If so, what is normal fluctuation? Does the > PSA tend to go up with age? If so, what is normal? It can fluctuate based on a variety of factors. Sex before the test can raise it significantly and if you have blood drawn right after a digital rectal exam, that might also raise it. At some point in your life, you might have prostatitis, which could lead to a significant rise in a short period of time. And of course there are always measurement errors. My urologist told me the value can vary as much as 0.5 in two successive tests. In addition, as men age, their prostates tend to grow and with that, the PSA goes up. That is called benign prostatic hypertrophy or BPH. > 4)If my PSA was to raise, what is the most imporant: The percentage it > raises or the amount? The current rule of thumb is that if your PSA goes up faster than 0.75 ng/ml per year over a two year period, then you should have a biopsy. I don't know if that applies to values as low as you have. For most men, the difference between using the amount and using the percentage would probably not be significant. But those men probably have significantly higher values than you do. I've done some searching of the medical literature abstracts, and I've never seen the issue of percentage vs. amount addressed. If I were you, I would leave this up to my doctors. In any case, recent research does seem to suggest that the rate of increase is important, perhaps more important than the absolute value. > 5)Who is suppose to do the DRE? My GP or is my GP suppose to refer me > to a urologist? Most primary care physicians can do a DRE, but a urologist of course would be more likely to catch something subtle. I would guess in your case that you could stick with your primary care physician. But ask him about it. If he feels that you should see a urologist, he will tell you. There are other reasons for doing a DRE except feeling the prostate. It does seem strange that your doctor hasn't already done it. Are you sure about that. It is a simple procedure taking a few seconds, and it used to be a standard part of a physical, although it is possible doctors are now skipping it in relatively young men for some reason. > Thank you everyone! ... excellent advice snipped ... > Most primary care physicians can do a DRE, but a urologist of course would be more > likely to catch something subtle. I would guess in your case that you could stick with [quoted text clipped - 4 lines] > standard part of a physical, although it is possible doctors are now skipping it in > relatively young men for some reason. I wish that doctors would take more than a few seconds to do this. My GP failed to find anything in her few second check. My former urologist, perhaps because he was too self-confident, failed to find anything in his lightning quick one second check. My radiation oncologist and her resident, each doing about a 10-15 second check, each independently found the tumor and characterized it the same way. Admittedly, they already knew I had cancer - which made it easier for them to find it. The GP has the excuse that she's probably performed the test a thousand times on men without cancer and didn't have much or any real experience with one that had cancer. The urologist didn't have that excuse. He didn't know that I had cancer when he did the test, but he did know my PSA was high. His inability to find it on the DRE was one of several reasons why I decided not to let him treat me. Alan My prostate was carefully palpated by five urologists after my biopsy verified PC in much of my prostate. Three felt nothing, one thought he felt an induration (a soft spot), and the last one said she felt the slightest nodule. I doubt the pathology changed that much in those couple of months; I suspect it's simply an inexact procedure at borderline levels. I.P. > ... excellent advice snipped ... > [quoted text clipped - 25 lines] > > Alan portions <snipped> > There are other reasons for doing a DRE except feeling the prostate. Leonard, I'm curious. What other reasons are there for doing a DRE, other than checking the prostate? My PCa was initially detected by my family doctor, a female, by DRE who referred me to a Urologist. The rest is history, still in the making. Now that my prostate is gone, I was kind of looking forward to not having the DRE next month at my annual physical. Rats!  SignatureJerryW jweindel at flash dot net 2/11/04 PSA 2.6, Suspicious DRE (age 62) 2/23/04 Biopsy: Gleason 3+4=7, T2a, left lobe 5/18/04 RRP, Path: Gleason 4+3=7, T2c, both lobes Tumor organ-contained; lymph nodes clear, seminal vesicles clear Both nerve bundles spared 7/13/04 PSA <0.1 10/12/04 PSA <0.1 > portions <snipped> > [quoted text clipped - 4 lines] > doctor, a female, by DRE who referred me to a Urologist. The rest is > history, still in the making. I don't know all the possible things they can find. One possibility is a tumor in the rectal wall within reach of the doctor's finger. I'm hardly an expert on that, but I think such tumors are rare. On the other hand, since the procedure is so simple, it is worth looking. > Now that my prostate is gone, I was kind of looking forward to not having > the DRE next month at my annual physical. Rats! My urologist usually does a DRE at my regular checkups. I think he wants to be sure nothing funny is going on in the prostate bed. I doubt if he expects to find anything, but again the procedure is so simple, he might as well check. Often he has a medical student with him, and the medical student gets to probe and see how it feels when no prostate is present. I don't mind it at all. I long ago decided it was all just plumbing, so I'm not self conscious about it. Once I lost my hangups I found the procedure was not even uncomfortable. The main thing I did not like about the DRE was that my doctor seemed to use a large amount of the K-Y jelly and then after the procedure handed me a Kleenex, like that was going to be enough for me to clean up! (snip) Often he has a medical student with him, and the > medical student gets to probe and see how it feels when no prostate is > present. I don't mind it at all. > > I long ago decided it was all just plumbing, so I'm not self conscious > about it. Once I lost my hangups I found the procedure was not even > uncomfortable. David S. wrote: > The main thing I did not like about the DRE was that my doctor seemed to use > a large amount of the K-Y jelly and then after the procedure handed me a > Kleenex, like that was going to be enough for me to clean up! Yes, that is sometimes an annoyance, but it doesn't loom large among the usual annoyances of daily life. > (snip) Often he has a medical student with him, and the > [quoted text clipped - 4 lines] >>about it. Once I lost my hangups I found the procedure was not even >>uncomfortable. > Just a little history. My father died of PCa at the age of 74. He was > Dx at the age of 62. His cancer was aggressive. [quoted text clipped - 8 lines] > > 1)Is 0.8 OK for my age? Yes, a good "score" according to my readings. > 2)Do I continue to get tested every year? Dick's father's history of PCa suggests a risk of hereditary PCa. He should also look into the possibility of PCa in the cases of his maternal grandfather, uncles and cousins. If a close female relative has been diagnosed with breast cancer, that is also a headsup for possible risk of PCa. Stephen Strum, medical oncologist, recommends that the son of a PCa *or a breast cancer* victim begin having yearly PSA tests at age 35. Further guidance can be found at the Prostate Cancer Research Institute website, http://prostate-cancer.org/index.html > 3)Does the PSA fluctuate? I understand tht it fluctuates on a daily basis, but not by much. > If so, what is normal fluctuation? I suspect that that depends upon the individual. It can be affected by physical activities such as ejaculation, by infection, by benign hyperplasia, by a DRE, many things. > Does the PSA tend to go up with age? I understand that it *can* increase with age, for many reasons only one of which is PCa. If so, what is normal? Until recently, the max normal was considered to be 4.0. There is support for a cutpoint of 2.5. > 4)If my PSA was to raise, what is the most imporant: The percentage it > raises or the amount? Generally, according to my readings, PSA velocity and PSA doubling time are markers for metastasis. So initially, the raw number would be important. The regular tests contemplated by Dick should be very helpful. > 5)Who is suppose to do the DRE? My GP or is my GP suppose to refer me > to a urologist? That's difficult to say; it's a subjective test that depends upon the skill of the medic. In my case, my internist felt a hard spot and referred me to a urologist. The latter confirmed it. Dick is being prudent, as he should be. Women should be regularly tested for breast cancer, men for prostate cancer. I've read that the two diseases have certain similarities and hereditary links. I've seen a bumper sticker that says, "Real men know their PSA." Regards, Steve J __ "Never give in--never, never, never, never, in nothing great or small, large or petty, never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.'' --Sir Winston L. S. Churchill You first should drop whatever worry you have regarding your father's PCa. About 10% of PCa is heredity-based and almost always, that is only when your father or brother gets PCa in his 40s. You probably have no more of a chance of getting PCa than anyone else. However, it is said that all men get PCa if they live long enough. Therefore, you should get PSA tests regularly and compare them to past results. Likely, at 37, 38, 39, 40, etc., they will remain about .8 for you. If it rises, then worry about prostate ails, but not necessarily about cancer. You should be okay for now and more than likely for the next few decades. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (3 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > Just a little history. My father died of PCa at the age of 74. He was > Dx at the age of 62. His cancer was aggressive. [quoted text clipped - 21 lines] > > Thank you everyone! >Subject: My first PSA test - Result is in >From: "Dick Smith" smith_bp101@hotmail.com [quoted text clipped - 13 lines] > >1)Is 0.8 OK for my age? Yes >2)Do I continue to get tested every year? Why not? >3)Does the PSA fluctuate? If so, what is normal fluctuation? Does the >PSA tend to go up with age? If so, what is normal? Yes. Several points, due to sexual activity, infections, DREs. Increases slightly with age. 2.5 is not "normal", but not yet risky enough to justify a biopsy. >4)If my PSA was to raise, what is the most imporant: The percentage it >raises or the amount? amounts- > 0.75 per year. >5)Who is suppose to do the DRE? My GP or is my GP suppose to refer me >to a urologist? My GP got the PSA results, then she made an appointment for me with the urologist that visited the clinic every Friday. >Thank you everyone! |
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