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Posted 8/27/2013 1:59 AM (GMT 0)
Hi Guys and ladies

I usually reside over at the chronic pain forum, but I have been reading here a bit, because my friend Purgatory (David) is here.

I have a question for you all. My husband is 48 years old. He had testicular cancer in 1992. I'm wondering what age do you all think that he should have his first PSA test done?

I sure would appreciate your expertise. I know you're not doctors, but you have or have had prostate cancer, and it seems lots of times the patient can answer a question faster than a doctor can. At least that's what I have found on the chronic pain forum.

Take care, and i hope you all are having a peaceful night.

hugs
Loretta
Posted 8/27/2013 2:04 AM (GMT 0)
it's time for him to get a baseline.
Posted 8/27/2013 2:09 AM (GMT 0)
Loretta,

Thanks for post here, and you asked a good question. One that is currently being greatly debated by the "experts" in the medical world.

For starters, does you husband have any relatives that have ever had prostate cancer? Like father, brother, uncle, grandfather, etc.

Until recently, most men were advised by their PCP to have their first PSA test done at age 50. There is good debate and reasoning to get at least a baseline test at age 40. That is what I would personally recommend. With your husband being 48, its right at the age regardless to have the test done in my opinion.

He should also have a DRE (digital rectal exam) done as well, if he hasn't had them before. With that, a doctor can feel the prostate and see if there are any irregularities with it. They don't particularly hurt, just a bit embarrassing (at least for me) and it depends how large the doctor's fingers are, lol.

The PSA test is just a simple blood test, no big deal. Most get results back anywhere from a day to a week. From this first baseline test, it may simply show that his PSA is in "normal" range for his age.

If so, then he and his doctor can determine if he needs to do it every year after that, or perhaps even longer apart.

Better safe than sorry. The PSA score alone does not prove or disprove the prescence of prostate cancer, it is an indicator in general. If the number is high and the DRE shows up something unusual, the doctor may suspect some type of prostate infection. The patient is usually put on antibiotics, and then re-tested to see if it makes the PSA number decline. If not, and the PSA number is high and/or the DRE shows something, then the normal course is to get referred to a good urologist.

At that point, depending on the factors discussed, he may be asked to undergo a prostate biopsy. That is the most sure way to rule prostate cancer in or out currently.

That is my take, based on my experience and knowledge of prostate cancer. I am certainly not remotely a doctor or qualified medical professional.

David
Posted 8/27/2013 2:46 AM (GMT 0)
Thank you davidg. I appreciate your reply.

David I knew you would answer me. I sure do appreciate you explaining to me the information that you did. I do know that Jerome has had the doctor put his fingers up his rectum to feel the size of his prostate. Is that what you were talking about? If it was, then yes he has had that exam before. He has diabetes, so he goes to his pcp more often than you normally would, just to keep an eye on it. Therefor, I don't know how often he has had it.

I do know that his father and brother haven't had PC, but I don't know about his grandfather. He passed away before we got married in 1994, so I didn't meet him.

Jerome's father had something going on with his prostate being enlarged a year or two ago, but it wasn't PC.

Do you know if him having testicular cancer would increase his chances of getting PC? If not, I guess I'll research that.

Thank you so much my friend.

hugs
Loretta
Posted 8/27/2013 3:09 AM (GMT 0)
Loretta - if your husband went to my doctor, a history of any cancer would have triggered her to do recommend a baseline PSA test. I don't know if there is a correlation between PC and testicular cancer.

It's really just to have something on the books to compare with in the coming years.

Andrew
Posted 8/27/2013 3:14 AM (GMT 0)
Loretta -- a PSA test is just a simple check of the box on a blood test.  those against PSA tests say its better not to know if you have prostate cancer unless you are a certain age or at risk, and i'm sure with what you've been through you want all the information you can get.  do it now.  good luck.

ed

 

Posted 8/27/2013 5:40 AM (GMT 0)

momtofourangels said...
Hi Guys and ladies

I usually reside over at the chronic pain forum, but I have been reading here a bit, because my friend Purgatory (David) is here.

I have a question for you all. My husband is 48 years old. He had testicular cancer in 1992. I'm wondering what age do you all think that he should have his first PSA test done?

I sure would appreciate your expertise. I know you're not doctors, but you have or have had prostate cancer, and it seems lots of times the patient can answer a question faster than a doctor can. At least that's what I have found on the chronic pain forum.

Take care, and i hope you all are having a peaceful night.

hugs
Loretta

Hi Loretta,

Your question is very easy to answer. The standard age in which a man should begin PSA testing is age 50 -- even earlier if there is a family history of PC.

So, with your husband not far from that benchmark age, it would be a good idea if he began building his PSA history (annual blood tests) this year.

Good luck to him!
Chuck
Posted 8/27/2013 11:25 AM (GMT 0)
Hello Loretta and welcome. As David said, the answer to your question is contentious among both patients and the medical community. Here are the recent AUA guidelines on the subject: www.auanet.org/education/guidelines/prostate-cancer-detection.cfm

However, the European Urological Association would say it is time for him to get a baseline test.

Not personally knowing your hubby's full familial history or ethnicity it would be difficult to determine whether or not a PSA test was appropriate. This is something he should discuss with his PCP with an understanding of the test and what potential results mean. Most men on this forum will tell you to go ahead with the test.

Jim
Posted 8/27/2013 4:29 PM (GMT 0)
Loretta,

I very much agree with Jim. The decision to get tested has serious potential harms and benefits associated with it that ought to be discussed with his doctor. It's not a decision to be made casually.

- Allen
Posted 8/27/2013 4:41 PM (GMT 0)
Loretta:

Here is what some experts recently advised:

www.bjuinternational.com/bjui-blog/the-melbourne-consensus-statement-on-prostate-cancer-testing/

"1. Consensus Statement 1: For men aged 50–69, level 1 evidence demonstrates that PSA testing reduces prostate cancer-specific mortality and the incidence of metastatic prostate cancer. In the European Randomized Study of Screening for Prostate Cancer (ERSPC), screening reduced metastatic disease and prostate cancer-specific mortality by up to 30% and 21% respectively in the intent-to-treat analysis, with a greater reduction after adjustment for noncompliance and contamination[2,3]. In addition, the Goteborg randomized population-based randomized trial showed a reduction in metastatic disease and prostate cancer mortality with screening starting at age 50 . The degree of over-diagnosis and over-treatment reduces considerably with longer follow-up, such that the numbers needed to screen and numbers needed to diagnose compare very favourably with screening for breast cancer. While routine population-based screening is not recommended, healthy, well-informed men in this age group should be fully counseled about the positive and negative aspects of PSA testing to reduce their risk of metastases and death. This should be part of a shared decision-making process. "

I think one of the concerns some men have is that knowing is better than not knowing sometimes and that a PSA test can lead to a biopsy, which has a tiny chance of resulting in unpleasant side effects, and that a biopsy can result in treatment.

I believe the vast majority of men here believe in knowing, and in empowering the patient to make his decision.
Posted 8/27/2013 7:01 PM (GMT 0)
I am firmly on the side of test early, test often. I wish I had known in my 40's what I know today. If I had, maybe I wouldn't be sitting in pads now.
Posted 8/27/2013 8:07 PM (GMT 0)
I know Loretta well, not sure she wants to get drug into all the argument side of this that some take delight in, it was a simple question and really only needs a simple answer in my opinion. Her husband is more than old enough to have at least a baseline test to see where he stands.

david in sc
Posted 8/27/2013 8:27 PM (GMT 0)
I'll re-phrase.

Get the test done.
Posted 8/27/2013 9:19 PM (GMT 0)
Purg,

If she just wanted YOUR simple answer, she would have emailed you privately. By posting, she gets my simple answer as well. She seems smart enough to choose for herself. I don't want anybody pushed into making a decision on such an important issue without knowing the facts.

- Allen
Posted 8/27/2013 10:02 PM (GMT 0)
Hello, Momtofourangels.  What a great name. 

Perhaps your question is prompted by a feeling that a PSA test is probably a good idea for your husband at this point in his life.  I say, trust  your instincts.  I think Highlander put it quite succinctly.  Your husband, having already had a cancer in the pelvic area, might want to discuss this with his personal physician.  Waiting until he's 50 for a PSA test may not be medically advisable. 

As you can see, some men on the forum have serious misgivings about the PSA test.  I'm not one of them.  If my doctor hadn't performed a PSA test at each of my annual physicals after I turned 50, I never would have known, much less been convinced, that I might have prostate cancer.  It was the escalating PSA results that finally convinced me to see a urologist for a biopsy.  I don't want to see anyone pushed away from having a PSA test.

I thought Purg's original response covered the bases pretty well.  Good luck.

 

 

Post Edited (clocknut) : 8/27/2013 4:06:04 PM (GMT-6)

Posted 8/27/2013 11:12 PM (GMT 0)
A very good question....I have to think about our sons....Age 39 and 44. I know that Peter's father had
prostate cancer, but we didnt know about it until much later. Although, some cancer is so slow growing that even if you have it, it moves so slowly that the treatments can have more effect on you than the cancer. He often wishes that he had waited...although he waited until he was 65....Yes, cancer was there, and it was said to be aggressive...but with all of the treatments: radiation, lupron, salvage surgery, and more...he is still here, twelve years later, enjoying life, traveling, and even though in pain in different areas, can keep it at bay for a while.. I dont know what the answer is,,,If Peter had gone in when he was 50, we would have probably not have had the pleasurable sex life that we did for another ten or fifteen years...although, he might not have been here at all....and THAT is what I focus on...He is HERE....Di
Posted 8/28/2013 5:06 AM (GMT 0)
MOm...Id say go ahead with the baseline PSA.....its a simple bloodtest that could very well save him from a later on advanced diagnosis. never hurts to practice preventative medicine. To be truthful...I wish I had done mine earlier that 50 as I might have been able to just have surgery and be cured....unfortunately my first one was at 50 during a routine physical exam and I was already advanced.

As what some are saying here to scare you away from getting it done....that has nothing to do with screening...but the aftermath of the treatments from the detection. I would suppose most patients these days with all the info readily available on the web would do plenty of research if your PSA test warranted a biopsy and further treatment. Absolutley no harm in a simple poke to the arm....just good clean common sense to get him tested in my opinion.....good luck in your choice.
Posted 8/28/2013 6:22 AM (GMT 0)
Thank you all for your replies. I have already discussed it with him, and he is going to talk to his PCP about getting the test done. He also told me that his doctor hasn't done the test in the rectum to feel his prostate in about 2 years. I told him I felt it was important for him to get the doctor to perform it on him, and get the PSA test done as well. He agreed.

He doesn't have an appointment with his PCP, so he's going to get one set up. Hopefully sooner rather than later. He and I would rather know what we are going up against, rather than not knowing. I'm sure you all can understand that. Not saying that he does have it, but if it were to turn out that he did.

hugs
Loretta

ps. David is right, that I wasn't looking for arguments.

:-)
Posted 8/28/2013 10:25 AM (GMT 0)
Loretta, my walking partner's husband had testicular cancer back in the 80s. A few years ago he was diagnosed with prostate cancer and so far so good. He survived the first against all odds and catching the second when he did promises another good result.
(His battle against polio aftermath not so good but he will be able to live with those effects)
Posted 8/28/2013 1:52 PM (GMT 0)
Loretta,

Thankful your husband sees the wisdom of having the PSA test done, hopefully it will come back with a nice low number, what we would call 'age adjusted' for his age, and can feel like he did a good thing for his own personal health. If for some reason it came back high, then its better to know that, then not know that. The best hopes with a high starting PSA number is a prostate related infection, this is something that can be brought under control with antibiotics.

The other tip, is he shouldn't have sex for at least 48 hours before the PSA test, and the blood should be drawn for the PSA test before the doctor does the rectal exam. If not, the PSA number could be showing a false high.

On the other remark of mine, I only meant that I knew you well enough, that you wouldn't be interested in all the technical debate/arguments currently being engaged on the subject of screening. Even the medical experts can't agree on that subject.

I will feel better knowing your husband has done this, and so will you.

david in sc
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