Any restrictions before PSA test?

I believe that men are told to refrain from ejaculating for 48 hours prior to having a PSA test. If this is true, is this advice true for men who no longer have a prostate? What about restricting vigorous exercise?

(You’d think that after 7 years, we’d know this stuff but apparently my husband and I don’t.)

Thanks for the quick reply, Djin!

I just read that it should be tested at the same time each time if possible. Also not true if you don’t have a prostate?

Melaine said...
Thanks for the quick reply, Djin!

I just read that it should be tested at the same time each time if possible. Also not true if you don’t have a prostate?

Well, certainly the same exact drawn at the same lab. I don't think we know enough about the daily fluctuations of ultra-small PSA amounts. If you have a choice you can go with the approx. same time of day.

To be perfectly honest, in the days when I had a prostate, my uro didn't care if I had my blood draw right before my DRE or right after. When I asked him, he said I could ask my blood draw be done before, but he thinks the amount of prostate prodding he does isn't as important (for PSA) as, say, the real prostate massage (30 seconds I think) the uro needs to do before the PCA3 test urine collection, which is done specifically to increase the expression of this marker from the prostate to the urethra. I believe the literature says that the DRE generally increases PSA by about 10%. If one always does this after the DRE, the increase is baked-in, so to speak. I know many here are sticklers about all the "No's." What's important is a rising trend. If men with prostates always do their blood draw after the DRE, any increase is "baked-in" anyway.

Djin

Thanks for all the replies. Given that my husband is in this weird gray area of watching to see whether the PSA gets high enough to trigger treatment, we want to make sure we feel confident about the PSA test results. I’m sure you can all relate to that desire!

Even then, the doctors seem to be all over the place regarding if and when to do salvage radiation. I really wish there were consensus.

Hi Mumbo. He had been non-detectable for almost 6 years:

Before June 2020: <0.03

June 2020 =0.05

July 2020 =0.06

Sept 2020 =0.06

Nov 2020 =0.06

He got tested today. Probably won’t know for a week.

The first doctor (back in July?) said he should be tested in October and January, but then sent his notes recommending my husband start treatment right away. That threw us for a loop.

Since then we’ve talked to other urologic oncologists and a radiation oncologist. They’re in agreement that it’s too soon for salvage radiation. But I don’t think they agree as to the right trigger number.

Yes, they all say 0.2 is the definition of biochemical recurrence, but some say you don’t want to wait til 0.2.

As you surmised, there a couple of thoughts about “small PSA” increases after surgery. You can go full metal jacket and blast away at the area or you can wait and see where it goes and if it possibly levels off. You can also wait until the PSA is high enough that a high powered scan might find the source, >0.50?, so the treatment can be focused on the problem if found.

The classical definition is you have most probably have an issue at 0.20 and definitely at 2.0 but the concept of early salvage radiation , < 0.10, is as soon as you have enough of sustained increase to take that step, blast away. This can be any number from 0.03 to 0.10 after a couple of increases as best as I can tell.

It really has a lot to do with one’s mental attitude towards such things. If you want to do everything possible, blast away when you agree with one of the doctors with a low number criteria. If you are more cautious and want to be more certain before you pull the trigger and risk treatment effects, you wait until you have enough evidence from the numbers and agree with one of the other doctors.

You can start looking for all the papers that discuss these issues and study them while his PSA is low and stable. At some point you have to buy into one of the theories and move on. It is tough and his pathology is not making a compelling case to pick one.

Thanks Mumbo and Ken.

Mumbo, you have summarized the situation perfectly. Most of the doctors agree that my husband's decision boils down to how much risk he's willing to take. (Note that one doctor said he would not treat my husband, thereby making that decision for us, which I found interesting.)

One doctor likened it to a spectrum. You have men who are much older, with very slow-growing cancer who can basically wait. And at the other end are men with fast-growing numbers who need to act right now. And if they're younger, then that speeds things up as well. This doctor said my husband is in the middle--although he said that back in August, I believe--before the second and third 0.06 test result.

One other thing that I found interesting: my husband's PSA at time of diagnosis was very low (1.7), which I had always worried indicated a more aggressive cancer that produced very little PSA. I asked whether that should play a factor in determining a trigger number. One doctor said that it shouldn't be a factor. And of course another said it might be something to consider when determining a trigger number--meaning a lower trigger number might be safer given his low PSA to begin with. Once again no consensus.

Melaine, that is encouraging. Always remember that your readings are rounded values (they rarely actually say this), so his 0.05 might have been 0.054...and his 0.06 might have been 0.057. Barely any movement. Anyway, stable is good. If he fluctuates around 0.05-0.06 then life is good. It's also good that you've been talking to RO's about it, so that if and when (emphasis on if) something does definitively break, then you're in line and ready.

Keep it up!