Interesting points regarding PSA

Just came across this earlier today and thought there were some interesting points here:

1. PSA stands for Prostate Specific Antigen – but it is far from prostate specific. (many of my patients think it’s stands for Patient Stimulated Anxiety)

2. PSA is produced in women with breast cancer too. (Mashkoor et al. 2013)

3. PSA is a very poor predictor of prostate cancer.

4. PSA is likely more helpful after prostate cancer treatment where a rise (after treatment) may indicate cancer relapse

5. The discoverer of the PSA test, Dr. Richard J. Ablin has been quoted in saying; the “P.S.A. testing can’t detect prostate cancer” on this New York Times article

6. Experiencing the emotion of worry prior to PSA blood draw may elevate PSA score (Cohen et al. 2003).

7. Fat men may have a low PSA and still have bad prostate cancer. In other words, excess weight (or maybe fat) can falsely lower PSA. (Culp & Porter; 2009)

8. Cycling can cause a increase of PSA by close to 10%. (Mejak et al. 2013)

9. PSA molecules are found 1 million times more in semen than in blood

10. Women also put out PSA after orgasms in their ejaculatory fluid. (Wimpissinger et al. 2007)

11.Medications such as statins (i.e. Lipitor), Thiazides diuretics (i.e. Hydrocholorthiazide) and NSAIDS (i.e. aspirin) lowers PSA (Chang et al. 2010)

12. This test cost tax payers $3 billion a year based on medicare payments. Per test, PSA costs about $100.

I still think its something that everyone should be doing, even in their early 40's, especially after being around here for a while.
It isn't a perfect test. Far from it. But until there is something better, that is easily done, and proven, and accepted by insurance, its all we've got

The problem with PSA is when it comes in high, or trends higher, it is the beginning of a sequence of events that no man wants to endure. But for some, that sequence of events will save lives.

The answer is for Dr's to take a few minutes at the time of blood draw, to educate patients in a deliberate way, and manage their expectations as to what PSA can and cannot do.

Yoop...I'm not shooting the messenger. I'm continually shocked at the attitudes of many medical professionals who don't suggest screening, and the needless suffering that causes. The cure to the so-called epidemic of overtreatment is better diagnoses and better understanding of the alternatives..not less screening.

Not shooting at you either Yoop, I know your stance

Yoop, I certainly agree with #4.

No statins are not masking elements for psa

Until the end of my days on earth I will always know that Dave has aggressive stage 4 prostate cancer because of practitioner not doing what his appointment was booked for. If I had booked Dave an appointment at a mens health prostate van they never would have told him at 57 he is to young for psa screenings they wouldnt say you shouldn't be tested because of false reads they never would have said the test is not necessary and they definitely would not have deffered the test. When Dave came home I should have called the ***** back I didn't know then that there was nothing she was doing to protect Dave from the night mare of PC. I was naive I was thinking that there must be some other way she is gathering that Information. From cell counts ? I urine samples? It is just WRONG . I am still I complaints with that so called physical and no I won't just let it go. I would like to know who's job is it to educate the public. At Daves blood transfusion I had to tell a man In his sixties that yes you are at greater risk because your brother has stage 4 PC.No your brother does not have PC because he was a party annimal and a womanizer. The cancer can be hereditary. Or the 45 year old accountant who told me why didn't Dave at 50 have a colonoscomy to find his PC. Until its to late there is no education, we don't talk about it. It is like one of those topics that are dirty to be In the public eye. I just read the news paper where it said over 10,000 people have died with ebola, thats sad but look at our death rates from PC and that not a one year illness that's year after year. Look at our suffering and QOL! The tests may not be perfect I like o this format that someone compared PSA testing to a check engine lite in a car. We recommend pap smears and mamogram s, there is a C125 blood test for women to prevent ovarian cancer . At a physical no one questions our needs for cancer screening so why are we questioning it for men. We all know there are false reads In a pap test as well yet that isn't told to us when we go. There is already 2- 3% increases over ther 2011 and 2013 in the stage 4 aggressive type of cancer that is killing Dave. Those are the years the American and Canadian task put out there that screening shouldn't be done. I already know we are just a number it is our job I guess to put our faces to the statistics. Life is not perfect , tests are not always perfect either. I would be so happg had Dave had a test that said he is tb1 and what do we want to do about it?

Sue and RandyJoe, and others - I feel your angst and pain, and as I said in an earlier post in this thread: "Those that have known me over the years here know my stance on testing - I'm all for it and don't buy into the crap about over testing."

There have been a number of threads on this topic - and of course the VAST majority out here believe that PSA testing IS absolutely needed. The "other side" argues that over-testing leads to over-treatment, which IMHO is total bu!!$#it. My stance then, and now, is that NO ONE should be allowed to deny me the opportunity to be tested simply because the "general population" isn't educated enough to manage the testing versus being over treated. . . . . .

Seeing these horror stories about PSA tests makes me feel that I should relate my story.

I had a great General Practitioner who referred me to a specialist because my PSA was 3.1 and had increased by 1 point in the previous year. ( I was 52). The visits with the specialist didn't go well. First after waiting 1 month for an appointment with a Urologist I got to see his Nurse Practitioner who did a DRE on me said it was fine and there was nothing to worry about. AS I was leaving I complained that my doctor had wanted me to see a specialist and not someone with less qualifications than his own... They rescheduled me ( wait yet another month) to see the Urologist/specialist who I thought I was originally supposed to see. Fast forward one month and the Urologist tells me that PSA level doesn't mean anything. I told him my GP was concerned about the rate of increase. He tells me that is called "PSA velocity" and it doesn't necessarily mean anything either. He then does another DRE, tells me everything feels fine, that doing a Biopsy is risky and did I even want to know if I had Cancer!!!!

I returned to my family doctor and told him that I didn't think my visit to a specialist had gone the way he wanted... I figured if all he wanted done was a DRE he could have done that himself. He agreed and set up a referral to another Urologist.. This Urologist was an old crusty sort who told me that while my PSA was rather high it did not automatically warrant a biopsy and asked some questions to see if there might be other reasons for my PSA to have increased. We determined there might be so he asked me to alter a few things and we would retest in 3 months.

We did the PSA retest and it came back at 6.1... so we then did a biopsy and 11/12 of the sample came back as adenocarcinoma with 6 being Gleason 7 and 5 Gleason 6....

He said that my hardheadedness at pursuing this may have saved my life. I have had a radical prostectomy in January and my 3 moth Post-op PSA is now undetectable.

Mike

PS - if anyone in NH wants the name of a great General Practitioner I would be happy to supply his name... he's the guy who determined that I had a problem way before anyone else... a very sharp cookie!

MDK, keep preaching it brother! That is exactly the point we're all making. My PSA went from non-detect in 2011 to 1.0 in 2012 to 2.0 in 2013 and 3.3 in 2014. I came up 3/12 as G6, and post surgery biopsy at G7.

There are different dimensions to the PSA testing debate. I have been tested annually since I was 51, almost 20 years ago. This allowed my doctor to see any significant changes, and to refer me to urologists when it went over 3.0. It took years of further monitoring and biopsies before any cancer was finally found, at age 68.

So, instead of feeling "over-treated", I feel confident that I know what is going on inside my body. The second milestone was when the uro-oncologist called me with the cancer result, and advised that I not treat it now, but go into their AS program. That program mandates semi-annual PSA and f-PSA testing, plus MRI's and biopsies as deemed necessary.

So, even as someone with (so far) low-risk prostate cancer, I am darn glad to have had continuous PSA testing since age 51. Why would you not want to know? Why? Knowing can give the confidence that you, not some disease, is still in control of your life.

I am blessed with a PCP who was willing to start ordering PSA's when I was in my mid-40's simply because I shared my family history and I thought it was important. He's also the guy who biopsied some suspicious moles and had his partner come in and look before the biopsy and they agreed it had to be done. Good thing, too.

And, when my PSA doubled more or less 2 years in a row, he didn't hesitate to send me to the Uro.

There are other internists in this little town who discourage men from getting baseline PSA readings. I don't get it, I really don't. I'd really like to hear, from one of those non-believers in PSA, what their logic is.

MDK yours is a good story and one that I only wish could have happened for us . Very happy for you that you were persistent and your Dr followed by going that much more for you. Our urologist is a great Dr to and when we first got to him after a 4 week wait with a psa of 80 .He said to Dave and .I , think I can fix this!! But stage said diffrent😳