PSA (prostate-specific antigen) is a routine blood test that gives a snapshot of your prostate health, including possible cancer of the prostate. Men with no risk factors should start monitoring their PSA while in their 40s.
At my last routine physical mine was elevated, so I was referred to a urologist who did an exam and ordered a prostate biopsy. It was performed last week, and I just learned a couple hours ago that the biopsy was negative.
I’d spent the past week in a constant state of worry, going so far as creating scenarios of when, how, and to whom I was going to share my bad news. You can imagine the relief I feel. I don’t want to be dramatic, but I can’t help but look at today as Day One of my new, improved outlook on life. Today is the first day of the rest of my life (sorry for the trite cliché).
Anyhoo, Men of the Dope: Do not avoid nor delay this easy screening tool. When caught early, prostate cancer is treatable.
Needless to say, my advice extends to mammograms, colonoscopies, etc.
A urologist once told me that he does not recommend routine PSA tests because of the high level of false positives. He said that manual prostate palpation is just as accurate without causing unnecessary biopsies because of false positives. I gather that this is a viewpoint shared by many doctors. In the UK, routine PSA tests are not advised at any age. In the US, they are advised only for men under age 70, depending on risk factors, and rarely advised over age 75. I have been getting a yearly PSA test, but I turn 70 this year so I don’t know if my doctor will advise me to keep getting them. If I ever got a positive result, I would have to make a tough decision about where to go from there.
In my opinion, this is good advice. I’m glad I started getting tested when I hit 55 or so. Mine was caught early and I’m cancer free now. The false positives are all too common, but catching early usually does mean easily treatable.
I started PSA screening around 7-8 years ago and for the first few years nothing to worry about. But then my readings started to rise, and last year I was referred to a urologist when the level rose above the recommended level. Something was happening. Did an MRI, something was there. Biopsy confirmed it was cancer. PET scan confirmed the cancer was only there and no where else. Had the surgery this past April, and the pathology report showed the lesion had an extension toward the edge of my prostate, meaning the cancer was trying to escape, but it was removed in time before it could spread.
I have told all my male friends to get this done and/or add it to their other screenings. It’s low risk and high reward, even with the possibility of a false positive - the PSA screenings saved me from a different cancer journey later.
Here is a take on the PSA screening from Ben Stiller - his experience was a lot like mine:
I have a feeling they go back and forth on this. My own PCP, whom I’ve seen for an annual physical yearly going back 3 decades, did them yearly. Then, one year, he said they are no longer recommended and did a digital exam for the next 4 or 5 years. Then, for the past 5 years, I got the PSA instead.
I knew that false positives were not uncommon, but my PSA - which went from 3.x to 4.x to 5.x in successive years, gave me about a 25% chance of a positive biopsy. Hence my worry.
I’m glad the OP is visible to all. My PSA was inching up, and when it hit the line of concern I got an MRI and an exam. It found cancer, but it was early enough I was able to deal with it with Brachytherapy, where they insert little seeds of radioactive material. It was done in a day procedure, and was so painless that I didn’t even take any Tylenol. It helped I had access to a surgeon who was an expert in this procedure. 7 years later my PSA is still near 0. And, if anything, things worked better after the procedure.
Yes, this. For a while, they were doing active intervention for any elevated PSA. They backed off this a lot due to all the false positives leading to extra stress and even possibly unnecessary surgeries. But more recently, they realized that by backing off to the extent they had, they were now missing cancer in some men until it was too late to treat.
My doctor said he recommends active PSA monitoring, but more emphasis on education (“elevated reading does not necessarily mean cancer”) and not jumping immediately into treatment. He also said manual prostate palpation was next to worthless – it will only detect large tumors. He did not find anything abnormal in my prostrate despite the tumors that showed up on an MRI.
I’ve been getting annual PSA tests since I turned 50 a few years ago. About two years ago my primary care doctor retired, and my new doctor went through all the pros and cons of getting them. He presented a handout that showed how many life-threatening cancers the tests picked up compared to the number of false positives and risks of unnecessary treatment. And from I remember, it wasn’t clear-cut what the best option was.
So I asked him what he would do, and he said if it were him, he would get the PSA tests despite the risk of false positives. That was my inclination as well. So I’ve done that, and fortunately they have remained consistently low. Hopefully that trend continues.
I think calling an elevated PSA a false positive is inaccurate. It is not an indication of the presence of cancer, it is an indication that follow-up testing is recommended.
I don’t get why that would be a difficult decision. My biopsy confirmed that I do not have cancer of the prostate and I’m very, very glad I had it done.
I got a recent false positive and this was after going through my treatments. But I knew something had been a little off and decided to wait 3 weeks and retest rather than going to a Urologist or the like. I am so glad I did as it was indeed a false positive.
The follow-up test was my lowest PSA test ever. Which is really good news indeed and kind of expected after the radiation treatments.
I have been on testosterone for the last decade due to a pituitary tumour, so my endocrinologist insists on an annual PSA. My GP feels that there is no need for a DRE if I get a PSA.
My understanding is that it’s a rapid change in the PSA that is more clinically significant than the absolute number.
The same thing happened to me around 15 years ago. It was not a benign procedure – aside from the fact that the needle with the local anesthetic hurt like hell, not long after the biopsy I developed retrograde ejaculation. My current urologist told me that, now that they are able to do meaningful MRIs for prostate cancer, such biopsies should be a lot less common. If your urologist is not recommending an MRI before a biopsy, I would change to a different urologist.
I would also like to say that PSA scores are notoriously unreliable as a predictor of prostate cancer, but they are still the only blood test so they are still taken. Especially note that one high score should never be taken to mean anything, it should be a pattern of scores over a few months. Also, be aware of factors that can temporarily raise your PSA score, including sexual activity within 72 hours before the blood draw.
As for manual digital exams, they’re fine if cancer is the only thing wrong; I also have BPH so that makes a manual exam rather useless for cancer (or so I was told).
If I had normal PSAs for years, and then suddenly got one anomalously high reading, I would talk to my doctor about the chances that it was a false positive, whether repeating the test would be appropriate, and weigh that all against the risks and discomfort of a biopsy. As Roderick_Femm’s experience shows, a biopsy is not a risk-free procedure. All that being said, I would probably decide to have the biopsy to alleviate worry, but I would certainly regret it if it turned out negative but caused a problem itself.
I got the PSA, it was ambiguous, I got the MRI, it was ambiguous, I still got the biopsy and the retrograde ejaculation – which is still ambiguous “only a 5% chance you’ve got cancer anyway, and you should have the biopsy again in 2 years”
Osler was a Canadian.
In Australia, I have never known of a doctor doing manual prostate palpation. It’s just not done. And not a new development. Nurses do manual manipulation for constipation if required, that’s the only thing.
Wow, sorry to hear that. My MRI was ambiguous (two suspicious spots) but we stopped there; 2 years later another MRI showed no change, so we’re still watching and waiting. Frankly, if he wants another biopsy (this is a different urologist than did the first one) he’s going to have to persuade me with better arguments than yours gave you.
PET scan confirmed the cancer was only there and no where else. Had the surgery this past April, and the pathology report showed the lesion had an extension toward the edge of my prostate, meaning the cancer was trying to escape, but it was removed in time before it could spread. 
