PSA Testing

Been MIA the last few days, apologies, was on a road trip.

I’ve posted on this before, I’m revisiting it now.
I’ve been on a 6 month PSA testing schedule since I finished SRT and ADT 3 years ago. At my last televisit in May, with the Nurse Practitioner, at MY MSKCC Rad Onc , who I consider very knowledgeable, she indicated that I could go to annual testing, saying that after 3 years, yes I could recur, but the chances are very small (and I think she said , even if I became detectable again, they wouldn’t do anything the first time anyway (which I knew)).

I passed, just didn’t feel comfortable. However, I Have been having some thoughts that after this next visit in two weeks, maybe I push it to every nine months.

HOWEVER..LOL…. NOW IM THINKING… My appointment is November 9th. It’s just a couple weeks before I’m scheduled to go to Florida for the winter. It always hangs over my head. AND I JUST REALLY DONT WANT TO DEAL WITH IT. There. I said it!

I’ve always been super diligent about all my Dr appointments, screenings, etc, cancer and non cancer related. But I’m thinking, life is too short, maybe if they think it’s ok, I should just go to a year, and not test again until I get back from Florida, in May. That would be a year.

I need a shrink 🤪😵‍💫. But I’d rather talk to you guys. It’s cheaper.

So two questions.
1. Any opinions generally speaking?
2. Most important… for those of you who have gone through SRT and ADT and remain undetectable for a couple years or more…. What’s your schedule? At what point, if any, did your Onc recommend or offer that you go to annual testing?

Thanks in advance
Ken

Hoping you are well. You know that waiting until May will a. not impact any possible treatment, G-d forbid there is a recurrence and b. not impact your health...

Go to Florida and enjoy...and we both need help...let's split the therapist and co-payments....

I started getting regular physicals around the same time as my prostate issues started. So it was fairly easy to just let my PCP do the psa test.

I didn't go through SRT and ADT, but I was on T-MEDS for a few years after surgery that "required" blood work every six months. I did work out a deal with my URO about NOT seeing him on one of those visits... We agreed that he would call if there was something found.

SO.... go a head and skip the November visit and see if you survive without it. I bet you will.

Pratoman, I'm not qualified to participate in this discussion as I've not had ADT or any other type of treatment post surgery, but my next (and last) URO appt is the 18th of November. Even with PSM and ECE all my PSA's post RALP have been virtually undetectable. After this appt I'm not going back. I get my PSA checked twice a year anyway with the VA and my GP and I see no sense in getting it checked yet again by the URO. If I find that it has gone up at some point, I'll go back but until then I'm good.

Prato - I just had my 4 year visit with urologist on Tuesday and he brought up the same topic. He said their current recommendation is 2 years at 3 mos, 2 years at 6 mos, then annual if the patient is ok with that. Previously it was 5 years before going to annual visits. He said with surgery and ART that PCa would most probably not rise in an annual period to treatable levels if it did rise. However, he said the choice was totally mine and he would support any testing interval I wanted to do. I think he also stopped the need for annual visits since we have little to talk about other than the current state of PCa and he is little help with my orthopedic issues. (it is good to not need an urologist at age 70)

I am certainly capable of monitoring my PSA with PCP so I may have this discussion with him next summer at my annual visit. I know exactly what to do if and when my PSA decides to show up again so it is not like the medical profession is helping me much at the current time. I will think about it again one of these days, maybe when reading posts like this.

jmadrid said...
It is your decission, but avoiding anxiety as much as possible is also a good benefit for your health.

I agree with this. And, as another poster said, the truth can se you free (from anxiety). Knowledge is power. However, we are all so different in how we deal with this and other issues that there really isn’t one best solution. I’m the type who goes for my now-annual PSA test and am in the patient portal a couple hours later to see the results. I have a friend who wants to meet with the doctor to learn the results in case it’s bad news and, therefore, has a wait time of days and the anxiety can build.

The anxiety is real and, as mentioned, is not a healthy place to be. Many folks take meds for this. For me, I took up regular meditation 40-some years ago and found that it really worked for me. When I got my diagnosis, just like other bad news, I approached it calmly and, I hope, rationally, and just something that was really out of my control but something I would deal with.

Enjoy your time in the South.

I worry about things I can control or have some say in. The initial diagnosis, primary and secondary treatment duration, and first PSA tests kept the anxiety state high. After awhile, I realized that I understand what the possible outcomes/next steps will be and that I cannot control or influence any of that. Testing more or less often has nothing to do with it either. So I started to relax a bit after a couple of years. The PSA test is like a Lotto ticket you buy in the morning and wait for the results that night for me (I don't actually buy them, my math is not that bad).

Now for those surgery patients who have not had SRT or ART, there may be more riding on PSA tests and secondary treatment options so that is a different story. Don't know what to tell ADT/RT patients except early PSA tests are usually not very helpful.

As Bohemond said below: "We all have different ways of dealing with uncertainty". That's about all there is to it.

The PSA test is your friend, and we shouldn't hate it, but we all do. 😉

We're all on different protocols, so we understand the range & spectrum that exists ...

Diagnosed in 2013, my PSA has been assessed every month all these years.

Just recently, I "graduated" to an "every two months" regimen.

It's certainly NOT a contest, but I sometimes quietly wonder if I might have more PSA scores in my patient portal than anyone else here?!?! ☺

I know the lab techs so well, I might start receiving Christmas cards & invitations to their family Thanksgiving dinners! ☺

CYCLONE ~ # Iowa State University

pratoman,
like you, i had SRT and ADT for six months following RALP. It’s been about 3 1/2 years since SRT and I get my PSA every 6 months until my 5th year of undetectable then annually after that, as per my uro. I’ve been battling and undergoing treatment for major depression, generalized anxiety, and PTSD for 25 years, so I think I experience an unusual amount of stress around test-time. With that said, six-month intervals are good for me, as I think waiting a full year between tests would cause me undue, prolonged worry. I wish you all the best with your decision on testing intervals.

I just scheduled my annual PSA check for Dec 16. My first annual interval. I have family coming into town for Christmas and thought about rescheduling. Maybe the week before? Maybe January? I dunno there is no easy way to avoid the anxiety. I figure the truth is the truth and I just have to deal with it.

Labcorp's uPSA has been "back" to an undetectable of <0.006 for a while, and should remain there. (Lab's using ROCHE's assay for their test had to go to <0.014 for a time while some governmental red tape/approval got sorted out).

Djin

Great news for both you and your wife. Celebrate as much as you can and don’t look back. I hope for only good news from now on. My best to you and your wife.
Jack