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When should my son get a PSA

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Posted 9/1/2013 4:24 PM (GMT 0)
When considering genetic propensity for prostate cancer, it is worth noting that a BRCA mutation is not the only genetic feature that has been shown to increase the odds of prostate cancer, or of aggressive prostate cancer.  There are a number of SNPs that have been associated with increased odds of prostate cancer and, in some cases, of aggressive prostate cancer.  There are many articles that have been written about this.  I am linking one, here, just as an example (it is probably not even the best example, but just one I happened to have read recently):

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0060083

Some companies offer "direct to consumer" genetic tests.  So someone who wants to see whether he has certain SNPs (and genetic mutations) that have been associated with increased risk of CaP can take a simple "spit into a test tube" test and find out.  These genetic tests don't measure only those SNPs that have been associated with prostate cancer, but also with a number of other conditions/diseases as well.  So you can find out your risk for colon cancer, and for Alzheimer's disease, Parkinson's, and for various drug interactions, etc.  They also do not measure ALL of the SNPs that have been associated with prostate cancer, but only some of them.  

At one time, these tests were pretty expensive, but at least one of them that I know of is now available for $100.   They are (like many things in medicine) somewhat controversial.  Some say "what will you do with this information; all it can do is scare you."  Others say DTC genetic testing is dangerous because a doctor should interpret and advise concerning the results. But for those who want it (other than in certain places where it is not lawful), it is available. 

Posted 9/1/2013 7:52 PM (GMT 0)
My Son went foir his physical at age 33. Asked the Dr. about PSA and explained about our family history. Dr said. He would agree that he be checked. It was covered by his insurance.
Posted 9/1/2013 8:19 PM (GMT 0)
Given his family history, I'd send the certificate now.

right now.  why wait?  though i'm sure some would like him to wait till he's 54....or was that 74?

ed

 

Posted 9/2/2013 5:27 AM (GMT 0)
Azsunshine, thank you for passing along this information!  My son is 40 and a smoker.  We have yet to covimce him to get the test. cry
Posted 9/2/2013 2:35 PM (GMT 0)
The hard part for me will be convincing my son to do the PSA

MEL
Posted 9/2/2013 2:54 PM (GMT 0)
Why, because he'll resist it or because you think it might be too early and don't want to open up a potential can of worms?
Posted 9/2/2013 3:02 PM (GMT 0)
My son was reluctant at first because he thought it would include a DRE. My GP did not require the DRE so he had no problem giving a little more blood along with his yearly physical blood draw.
Posted 9/2/2013 3:09 PM (GMT 0)
David

I don't believe it is too early.

He may or may not resist. He and I will be going to a Tigers game in two weeks and I plan to discuss this topic in detail. I have mentioned it very briefly in the past.

I will be attending the annual PC CONFERENCE in LA next weekend. I will most definitely ask the question, hoping to get ammunition either to start him at age 35 or wait until age 40. I was surprised Umich said 40. But I don't want to foist my PC anxiety onto my son.

Anyway, I expect to get confirmation on age 35, but we shall see.

The next step could be finding a doctor that agrees and will write the lab orders, but I bet Dr. Lam would do it, if he feels age 35 is the time to start getting the PSA data.

mel
Posted 9/2/2013 6:04 PM (GMT 0)
If a young man would get his PSA baseline at 35, then again at 40, what would that tell, I wonder...? Both values would probably be similar, and more testing would be needed IF the value(s) were concerning.

My point being, I think that once PSA baseline is established, you gotta test it every year to get meaningful data. 5 years of not testing in between will not give a trend. But that is a hard thing for a 35-year-old to do, remember his annual PSA test. Unless you remind him.
Posted 9/4/2013 2:41 AM (GMT 0)
Mel- I started around 42 at the insistence of my mother. Had she not been so persistent,I would probably not have started until much later(old man) disease. Iam forever grateful mom! My personal opinion:
family history: 35-40
everyone else: early 40's
Like others I believe in getting a baseline. Thats just me
Posted 9/4/2013 3:00 AM (GMT 0)

SpecialLady said...
If a young man would get his PSA baseline at 35, then again at 40, what would that tell, I wonder...? Both values would probably be similar, and more testing would be needed IF the value(s) were concerning.

My point being, I think that once PSA baseline is established, you gotta test it every year to get meaningful data. 5 years of not testing in between will not give a trend. But that is a hard thing for a 35-year-old to do, remember his annual PSA test. Unless you remind him.

What I've heard is that if that first baseline test comes up very low, a young man cas safely wait a few years until his next.

Mel - Tigers game is a good place for a talk.
Posted 9/4/2013 3:12 AM (GMT 0)
"Mel - Tigers game is a good place for a talk"
Like tonite when they are losing(lost) :D
Posted 9/4/2013 5:05 PM (GMT 0)
My dad had a prostatectomy and radiation.... lived for many years later.. My two uncles also had PCa late in life. I was fortunate to get a baseline early enough before I started trending. My dad pushed me for years to get a PSA baseline. I wish I listened to him. A certificate is a wonderful way to encourage it ! You'll see my trend line.. it was nice to have that initial base set ! It served me well !
Posted 9/5/2013 12:45 PM (GMT 0)
Mel,

I was 41 when the GP said I should get one, but that was due to an "irregularly spongy" DRE. I got yearly physicals starting at 20 and the questions he'd ask about urinating at night and with difficulty or pain were part of his yearly screening... as was the DRE. So for me, it was more the physical exam that was responsible for the alert to get a PSA test. I don't know that it works that way for most guys.

At the very least, I would suggest to your boy that he needs annual physicals and that DRE's should not be skipped. Sadly, there are a lot of cases here where once a nodule or irregularity was felt on a DRE, the cancer was established and required first and second line treatment... and sometimes continuing treatment. At 40something, all those treatments and the thoughts of life potentially not lasting as long as one had hoped are scary. Not that it isn't the same for older guys, but... I'm sure you understand what I'm getting at.

The baseline doesn't hurt and it could help. If it has climbed over .70 per year or has escalated beyond that, something is amiss and it would indicate he'd better talk to a URO. It's just info on one's health to be used wisely. For my money, a good GP who knows what he's digging for on a DRE is of more value when you are young than a PSA, but 40 is still my minimum for no symptom screening to establish a baseline.

With you having it, I would say that he would be wise to shave a few years off and have a couple leading up to 40. It's in this manner that I intend to counsel my son when his time comes in 37,8, or 9 years.

Best,
Dude

Good luck with the Tigers, btw. As long as it isn't the Yankees or BoSox, I'll be a happy man. smilewinkgrin
Posted 9/5/2013 4:02 PM (GMT 0)
Mel, I've been following this thread, and have finally decided to add my two cents.

First, I completely understand your feelings regarding your son and prostate cancer.  My son just turned 42, and I talked him into getting a PSA test last year during his annual physical.  Happily, his numbers were extremely low, and we all felt good about that.  Knowing, as usual, trumped ignorance.  I would always rather know something than live my life in happy ignorance.

But the other thing I find interesting is the absence of comment in this thread by those who make the PSA test out to be something akin to an instrument of the devil.  Where are the usual comments about the horrors of over-diagnosis and overtreatment?  Where's the insistence that you spend several hours educating him on the role of the prostate gland, the dangers of the PSA test, the terrible side effects to which he's potentially exposing himself if he consents to the test?  I'm not seeing any of that.

So, I find myself wondering, are the folks who are so opposed to PSA testing quiet because we're now dealing with an actual individual, a guy with a name, Mel's son, someone we might actually know, rather than the nameless masses? 

I personally would have no problem waiting until he's 40 for that first PSA baseline test, but whether he does it now or then, I hope he has it done and monitors it at appropriate intervals as he grows older.  That's certainly the smart thing to do.

Here's hoping he never has to fight this battle.  Good luck to both of you.

Posted 9/5/2013 4:39 PM (GMT 0)
you guys have kids my age. I'm teaching my son to drive while he's on his learners permit. That too is serious (and I think dangerous) business.

Clock - I thought the same thing. That's why we have to be careful how insensitive we can come across when making comments on what we think might not relate to anyone directly but which often relates to most people in one way or the other. On a P2P platform that's something to avoid imo.

Hope neither of your children have to ever fight this battle, if they do, however, they'll have some informed and balanced guidance.
Posted 9/5/2013 4:46 PM (GMT 0)
Clock, I actually think that the folks who are generally opposed to early PSA testing have shown admirable restraint and common courtesy. I personally appreciate their approach. To use Mel's son as an opportunity to push any kind of agenda - one way or another - would not be in the spirit of HW in my personal opinion. We have plenty of threads in which to debate ODOT so kudos to those who have chosen to give Mel suggestions and double kudos to those who have chosen not to use his personal question as an opportunity to lecture anyone.

Jim
Posted 9/5/2013 5:01 PM (GMT 0)
Davidg, Maybe you remember when you first came to HW, I remarked that we older guys need to listen to you and others your age. I mentioned at that time that I have a son your age, and that I fully understand that a man in his early 40's will view things differently than a guy who's 68.  A lot of us on the forum probably have sons in your age range.

As a member of a younger generation, your thoughts on prostate cancer, like your thoughts on many other topics, come from a different perspective.  One that we sometimes may have a tough time relating to.

That's why it's so important for you and other younger guys to keep posting here.  Your lives are no less important than our older lives (really, obviously more important), and your perspectives on prostate cancer related issues are invaluable.

I can almost guarantee that Mel's son might better relate to your thoughts on the PSA test than he would the thoughts of 68-year-old "Clocknut."

Posted 9/5/2013 6:31 PM (GMT 0)
I'm on page with Clock on this one, well said. I also 100% applaud those on the other side of the fence for their absolute integrity in this thread - now that's what this HW brotherhood is all about. . .

My weigh in on this would be to give him the gift certificates to be tested now. I know the current school of thought is with family history, start at age 40 - but if I put myself in Mel's shoes and it were MY son, I would weigh in on testing now.

Let me caveat that with the decision to test now becomes easier with someone as knowledgeable as Mel to guide his son in the equation. Based on that I don't believe there will be any potential issue of OT. Someone mentioned earlier in this thread to let him (the son) decide; given the set of circumstances presented I disagree with that. With the combination of family history and Mel's knowledge - test now. I also don't agree with asking his PCP for an opinion on when to test - again Mel's knowledge and history trump that....

My son is now 33 and I continue to agonize over at what point I should have a conversation with him about getting his baseline. Fortunately I'm the only one in family history to have been DX'd with PCa, but I still have been, so . . . My son is fully up to speed on my entire journey, so that will help. I also had a discussion with my brother who was 49 at the time of the beginning of my journey and encouraged him to get his baseline immediately. He did and thankfully he came back with a PSA of <1.0.
Posted 9/5/2013 8:45 PM (GMT 0)
Guys,
I can speak for myself on this. I am not against screening a young high risk man whom is well educated about the disease. I would think that most members here are pretty well educated and can be great resources for their sons. My position on screening is due to patient education issues, doctors that are quick to treat.

I even have no issue in a man deciding to get a PSA test that is otherwise healthy at any age at his own discretion. I do not care for screen early guidelines that are not customized to each individual but rather population based at earlier and earlier ages when we don't really have any data on earlier screening for men.

But that is a moot point for any man here who has a positive diagnosis and young sons. These young men are not what is on topic to the ODOT discussion and screening. These sons in my book are at high risk and fully within screening guidelines across the board due to that fact. I think the comments here show a disengagement with the facts about over screening, over diagnosis, and over treatment that have been expressed, at least by me.

Peace. (And educate your sons and get them screened, I would recommend at age 40 or when they feel it's right for them)

Tony
Posted 9/5/2013 9:09 PM (GMT 0)
Tony - very, very well stated! I actually think those words bring the two sides closer together.

I started to pull down and quote sections of your most recent post, but then realized I would have been copy/pasting the whole thing!

Well done.
Posted 9/5/2013 9:39 PM (GMT 0)
I was always told by oncologists/urologists and surgeons that prostate cancer in very young men is likely to become a threat to life. As such, I see that as high risk. Therefore, makes sense to get a baseline with or without family history because if you got it, you got it. And if you got it young, there is a higher risk of it being life threatening than if you were in the same situation at 70.
Posted 9/5/2013 9:43 PM (GMT 0)
As Tony said, I don't think the "over-testing; over-treating" crowd would argue against my son being tested. In my mind, he is high risk. Remember, he has a family history: his Dad and BOTH sets of grandfathers.

I still intend to ask that question at the conference at an opportune time. Frankly, if the preponderant thought is to wait until age 40, then I'll rethink matters. I kind of suspect that many will agree that age 35 is good to get  a baseline.

Mel

Posted 9/5/2013 9:56 PM (GMT 0)

clocknut said...
Davidg, Maybe you remember when you first came to HW, I remarked that we older guys need to listen to you and others your age. I mentioned at that time that I have a son your age, and that I fully understand that a man in his early 40's will view things differently than a guy who's 68. A lot of us on the forum probably have sons in your age range.
As a member of a younger generation, your thoughts on prostate cancer, like your thoughts on many other topics, come from a different perspective. One that we sometimes may have a tough time relating to.

That's why it's so important for you and other younger guys to keep posting here. Your lives are no less important than our older lives (really, obviously more important), and your perspectives on prostate cancer related issues are invaluable.

I can almost guarantee that Mel's son might better relate to your thoughts on the PSA test than he would the thoughts of 68-year-old "Clocknut."

You know one sad reality/truth is that guys 38-45 still feel invincible and typically avoid doctors so I don't think they listen too much. Of course a good talk between a father and his son can go a long way, soecially during a special day at a baseball game.

I think the main difference for us, to be perfectly frank, is that we're looking at surviving another 40-50 years, not another 10-30. It's hard to see that far ahead when you start going downhill so early.
Posted 9/5/2013 10:07 PM (GMT 0)
the is no common ground between the two sides.  the message they are sending is unless you are in a high risk group PSA testing is more dangerous than prostate cancer until you are 54 years old.  you are better off not knowing.  if you believe that than lets hold hands and sing kumbaya.

ed

 

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