PSA Anxiety

hello, everyone. because i don't visit the forum every single day, i'm not sure if this topic has already been covered. my question is how do you handle PSA anxiety, especially when it's your first couple of times having a PSA blood draw after being treated? january 21st of this year i had my first PSA test. the day before and the day of my PSA blood test i was extremely stressed.

when my PSA came back 4.04 after it being a 12.68 in october 2019, i thought that was great progress. but my nurse and RO felt the PSA should've been lower, since it's been a year. so, they ask'd me to come back in six weeks. on the 16th i go back to have my next PSA and i'm trying not to stress about it.

how do you PSA anxiety?

Hi Sammas,

I can give you my take (no charge, of course). I was high-risk before my surgery and remain high risk for BCR (a rise in my PSA that may lead to salvage therapy). Yet I have very little PSA anxiety, which I think dates back to the little anxiety I had before any of the numerous (negative) biopsies I had over many years before my positive biopsy. I believe this philosophy can apply to men before or after a PCa diagnosis.

-- I want to know my prostate-cancer status. I don't take the ostrich approach. The PSA test is just an indicator (a crude test showing that men with prostates may need further investigation since PCA is only one possible cause of a PSA rise, or a sensitive test for men who have been treated).

-- A test result showing no change is good news. For men post-treatment, it's a reminder that their treatment has worked up to now, that PCa is in their past. For men with prostates, this good news means their prostates are healthy cancer-wise. For a couple of years after my surgery I was tested every 3 months. When these tests started coming back with very low PSA, I began to look forward to more good news, rather than dread bad news, which, of course, was always possible.

-- I knew that when my last biopsy came back positive we had very likely caught my cancer early or even very early. Early diagnosis is the biggest weapon in the prostate-cancer war. This also holds to a certain extent for recurrence -- the more serious the cancer, the more likely you'll probably want to begin salvage therapy on the early side.

-- We have to be thankful that, however crude or sensitive, we have PSA as a sign that further investigation for PCa diagnosis or recurrence needs to be investigated further. The though, for example, of being told I have Stage IV cancer of anything is frightening. Some cancers give us little warning they are at work in our bodies.

-- My post-surgery PSA has been very low; however, it went up from <0.014 to 0.036 at my last 6-month test. My uro isn't alarmed, but wanted my next test in 30 days (which will be at the end of this month). My rise could be a fluctuation or glitch, in which case my PSA should come down. Or, if I am indeed on the rise, it will stay about the same or go up, depending on my rate of rise. If I am headed for BCR and salvage therapy, so be it: I'll confront that, just as I confronted PCa. I'll have no choice . But I do have a choice (or just have the mental constitution) that I won't give in to PSA anxiety. Put another way, if I am fortunate to live, say, another 10 or 20 years with no rise in PSA, and look back, just think of all the unnecessary anxiety I could have expended about PSA in that time.

-- Bottom line: if your next PSA result is good, all anxiety you spent leading up to it was unnecessary and pointless. If your next PSA requires investigation, so be it. With regular testing, you should be on top of early diagnosis and treatment. You can apply my thinking to biopsy anxiety too.

--- PSA anxiety may be a self-fulfilling phenomenon. In which case it can be avoided. If it is not, I do think you can work on your attitude to diminish it.

I may well hold a minority view, but it's my honest view, so I know it's possible.

Djin

Sr Sailor said...
Sammas:
A signature would be nice. I gather from an older post that you had HD brachy?

PS: I hope that your next test will show a lower PSA value.

yes. i had HDR brachytherapy and about six months of casodex 50mg.

I have PSA anxiety everyday. There is no difference prior or after the blood draw.

I too suffered from PSA anxiety following RALP and for a year thereafter. At one point my PSA rose to .03. The anxiety interfered with my sleep. So I tried a different technique. I surrendered and assumed that my PSA would continue to rise and I formulated a plan to deal with it once it did. Presto! My anxiety disappeared. I just passed by 5th RALP anniversary and my PSA is now undetectable on the Labcorp test. It has remained a constant .01 on the other test for the last 3 years. I am at high risk (pT3a) and close margins. I assume it will return. When it doesn't it's a big bonus and time to celebrate! If it does return I'll put my plan into motion. That was my solution and continues to be my solution. Nothing works for everybody. I wish you well.

Tomorrow I have my 2 year psa test after brachytherapy. I pretty much get zero anxiety before the test, it's after that I get it. Why, because I feel the numbers aren't going down fast enough even though I'm told not to worry. So as long as it drops any amount, tomorrow, I will be fine. Will post results. Fingers crossed.

First of all, I think one thing I have learned is that we need to assume there will be PSA fluctuations, up and down, along the way.

A fluctuation simply means you have to "ride the wave" --- and a fluctuation is different than an upward trend.

So --- don't let minor fluctuations or a slight uptick send you into a dungeon of despair.

Remain proactive and vigilant, of course --- but PSA fluctuations, from time to time, are to be EXPECTED ---- just like other components that are reported on our lab work, after a blood draw.

Some fluctuations are bound to occur, from time to time. I think that's a helpful perspective to remember ...

My dad stands beside all of us here as a prostate cancer patient.

I asked him how he has dealt with PSA anxiety, all these years now ...

He simply said, "To get to the clinic, I always have to drive across the river bridge. When I get to the bridge, I just say a little prayer, while driving over the river - and this calming ritual works for me and takes away my anxious thoughts each time."

Dad's simple ritual takes away his anxiety, on the way to the clinic.

In my case ----my oncologist sees me monthly, and watches various components of my lab work.

Because my PSA is assessed frequently, my oncologist has taught me to expect fluctuations, which are different than upward trends.

Learning that difference has helped me lessen my PSA anxiety a GREAT deal.

Reach of us have different preferences. I DEFINITELY prefer to have my oncologist share my results in person, so we can discuss results together --- with his words of wisdom, expertise, and interpretation.

I get to the lab in advance --- so that my results are fully processed before I meet with my oncologist.

I used to go to the main lab, but the oncology department actually has a small lab of their own --- so I now have my labs done there instead.

There's no waiting there ---- everyone knows me, and results are processed much quicker for the oncologists.

Easier said than done ---- but worrisome thoughts will not change one's PSA values --- so stay busy --- physically and mentally --- and put your trust into the wisdom and expertise of your doctor.

When all else fails, there's nothing more calming than a walk outside!

Some experiences to share with you today ~~~
CYCLONE ~~~ # Iowa State University