My comments are provided mostly to benefit, I hope, those folks
concerned about acquiring PCa or those recently diagnosed.  This
information is likely known to those of you have have dealt with PCa
for some period of time.

I know this subject comes up at times in this forum so below I will
describe my circumstances so, if by chance, it is helpful to others
concerned about PCa or perhaps just recently diagnosed.  In my opinion
there may be, amongst the general male population, some degree of
comfort if their PSA tests are what some physicians may call "normal".
That is less that 4.0.

I strongly urge all males 40 years and older (35 years if family
history of PCa) to have annual PSA's & DRE's and then keep your own
record of the results. Ask your physician for a copy of PSA lab test
result and his DRE finding.

while the actual PSA result is important to know what else to look for
is an upward movement in the results over time.

There is a general rule of thumb that if the PSA velocity (PSAV) is
more that .75 ng/ml per year further investigation to rule out PCa is
advisable.  I agree with that. BUT also important is the PSA doubling
time (PSADT) which is a measurement in months (or years) that it is
taking your PSA to double in value. A PSADT less that 12 years is
deemed to be suitable for further PCa evaluation.

My case:
...............PSA.......DRE
May...1993.....0.4......Normal per family Internal Medicine M.D.
July..1994.....0.6......Normal per "
May...1995.....0.6......Normal per "
May...1996.....0.7......Normal per "
Aug...1997.....0.8......Normal per "
Mar...1998.....0.9......Normal per Urologist
Mar...1999.....0.9......not done - at least I do not believe it was.
Jan...2001.....3.9......Normal-but likely missed by M.D. in my opinion.
June..2001.....3.8......"Big, Ugly" nodule on prostate

Biopsy results:
Gleason 4+4=8
5 of 9 biopsy cores positive for cancer.
% cancer in 5 cores was 50,70,80,90 & 100%.
Biopsy indicated peroneural invasion was present.
DNA ploidy was diploid per Dianon Systems.

Now a look at the 7 year pre-2001 historical PSA results will show a
low score - below 1.0 for 7 years.  The PSA velocity was about 0.10 -
well below the 0.75 deemed to be a red flag level.

However the PSA doubling time was a fairly fast 5.1 years and much
faster that the 12 years deemed to be a red flag level.

My medical oncologist treating my case says that, in his opinon, even
when my PSA was at 0.9 that PCa likely existed and tests should have
been done to rule in or rule out PCa based on a PSADT of 5.1 years.
Unfortunately that was not done at that time.

However during my years of innocence, before 2001, whilst I did have
some awareness of PSAV I was not aware of PSADT and neither were my
physicians, I think.

Of course there is more to the story but I'll stop here.  A final
closing comment is that just because someone has M.D. after their names
they are not necessarily - and most likely not - very knowledgeable
about PCa.  Soak up as much knowledge as you can then question , yes,
challenge, yes, demand that your doctor be very good in treating PCa.
If he/she is not then fire them and find someone who is.