@ucbalumnus, so you did have a test once and the results were good.
I got a new doctor last year. Before I visited him I had already decided not to have a psa test. Then I found myself sitting in the examining room with the doctor and he said he wanted me to have a blood test including a testing of my psa.
And I said, “Ok”.
So much for my master plan. 
It was also years ago at an age younger than what those who recommend PSA screening recommend starting at, so the result is no longer relevant (if it ever was). It was one of the excessive tests and screening ordered by that PCP that I eventually found out was pointless and appeared to be just to run up billable events (so I left that PCP).
When I got my first psa reading, it was high. So I had three more…one every month. My psa dropped after the second and third test., but it was still high. Then it rose to a new high with the 4th test so I said, ok, I will have a biopsy. I do have symptoms. (My grandfather did have aggressive prostate cancer…in his late 80’s. Contributed to his death).
I am about to have the biopsy. I am still wearing clothes. 
I ask the urologist, "What do my psa scores mean?
The urologist said, “You had a couple of lower scores. You don’t have cancer”.
I thought, “Then what am I doing here?”
Then I looked at the ultrasound machine. I said, “You are going to know whether I have cancer or not by looking at the ultrasound machine”.
The urologist said “Yes”.
Then I got naked and by this time I felt I was already committed to the biopsy. There is a joke in the movie Duck Soup where Groucho Marx said something like, “We’re going to war! I already paid a month’s rent for the battlefield!”
I had the biopsy.
@jym626 You and your husband are in my prayers.
Based on the experience of my father and H, I am NOT a fan of skipping PSA tests. Yes, you have to put hem into perspective. Gleason scores and all that are much more significant. But you don’t progress t biopsy unless there appears to be something going on.
BTW, @dstark, H had PSAs that were up and down. He had cancer.
I know its possible to have up and down psa scores and still have cancer. The urologist was making me feel good and the odds were I did not have cancer. I did have the biopsy. The urologist wanted me to have the biopsy.
Sex can cause an increase in psa scores. I would have liked to have known that the day before I had the first psa test.
@dstark, so can a large bowel movement! Hard to predict…
Hope everything works out well.
That I didn’t know!
Thanks.
@Consolation, how is your husband doing? Is he psychologically ok?
You have the date when the biopsy was completed but do you know the date when the results were communicated to your doctor. Do you know if he was working on Friday?
It’s frustrating but there was a weekend involved. I have been present when my daughter revealed good news to a patient after a worship service on a Sunday morning when the three of us were at coffee hour. But I think weekend notifications are rare.
Thank you, @VANURSEPRAC.
I am a believer that knowledge is power. Yes, PSA results are affected by lots of things. Usually they tell you to “abstain” for 3 days before the test. In DH’s case, the elevated PSA scores were first treated as an assumed inflammation (prostatitis), with antibiotics, and then after the treatment course is completed, they repeat the PSA… Also, DH has a FH of BPH, and enlarged prostates put out more PSA. More tissue, more PSA. So they continued to monitor. Most of this was done by the PCP, over several years. When the PSA levels no longer seemed to come down after treatment with antibiotics, and they were higher than PCP was comfortable with, the PCP finally referred DH, begrudgingly, to the urologist. That was almost a year and a half ago. So its not like this is news to us. But DH is young, his brother had his prostate removed at about the same age DH is, and this has been going on for a long time with DH. DH is conservative and cautious in his healthcare (sounds like ucbalumnus), avoids Drs at all costs, whenever possible, so we have taken it very slow. Its his body. I don’t always agree with the choices he makes, but he is comfortable with this physician, who has been comfortable taking the slow approach with him. But its getting time to change course, for several reasons. Since he is pretty private about this stuff, and I have already shared way more than I’d planned to, I will not go into further detail at this time.
But bottom line- I agree with those who say don’t avoid the PSA. Use it as data points. And yes, collect many data points. The urologists are very up on the changes in treatment approaches and options, and what to do with the data. If you have a colonoscopy, annual dermatology mole checks (mine are every 6 mos due to CA) have a PSA test. Be proud, but don’t be stupid.
Now all that said, DH is very much like his late father, who also avoided Drs. whenever possible. FIL wasn’t diagnosed with his Prostate CA until he was in his 80’s. Who knows how long he had it. But at that age they felt the risks outweighed the benefits of surgery, and they said, rightly, that he would probably die of something else. Which was true. And he lived to be 99. DH, on the other hand, has been monitored for about 8 years now. That’s slow and cautious IMO. But things have changed. And he is young. And I am not prepared to think about a bad outcome. I hope and pray all will be fine. We have not had our heads in the sand (well DH did, but that’s another story). How do you think you do not have CA when the biopsy samples say “adenocarcinoma”?? But I digress…
One last thing-- DH finally decided to share the CA dx with our sons about a year ago. They are male. They have been swimming in this gene pool, as we say. They need to know their risks of both prostate CA and BPH. And they need to be vigilant.
OK, off my soapbox for now.
Checked the web sites for screening guidelines at two large multispecialty medical groups in the area. One does not recommend PSA screening for average risk men. The other has a weak recommendation to offer optional PSA screening (with different age ranges for average and high risk men).
Also, urologists have a business reason for recommending PSA screening, since it increases the potential pool of patients.
Colon cancer screening has a much higher strength of recommendation (A grade for age 50-75) than PSA screening (D grade, recommends against) by the USPSTF. Even then, however, it does not specifically recommend colonoscopy (which is invasive and incurs medical risk) over non-invasive methods like yearly FOBT.
http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening
http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/prostate-cancer-screening
“About 80 percent of men who reach age 80 have prostate cancer cells in their prostate”, according to http://www.webmd.com/prostate-cancer/guide/prostate-cancer-risk-factors , so it is not like he was especially unusual.
Sending good thoughts to jym and all who are facing prostate cancer themselves or with loved ones.
Very grateful for the PSA test here. FIL died in the late 70’s (in his early 50’s) of prostate cancer. He was initially misdiagnosed and was gone within a year of onset of symptoms. DH and BIL were PSA monitored starting in their early 40s. Both had prostate cancer treated by 50 and have been cancer-free for well over 10 years. Glad to have been vigilant.
Obviously, this is an illness with a wide range of outcomes and treatment approaches. Statistics are one thing and using what you know about family history may be another. Screening recommendations, as well as patient interest in testing PSA will vary.
Ucbalumnus,
Yes older men do have a higher frequency of prostate CA. That’s well known. No one claimed it was unusual. Was just noting it as a positive occurrence. Older adults have a higher incidence of lots of things, like Alzheimer’s and other dementias. But dementia occurs in younger patients too. Just with a lower frequency. The difference is, dementias presents with symptoms- Prostate CA often does not. Or not until it is advanced.
And “having prostate CA cells” can mean a few or a lot. That’s a very vague and, IMO, useless, statement. My point was that he didn’t go to the Dr and didn’t have his PSA done until that age, and when other symptoms presented. It could have been brewing for years before. But your argument will be that it is a non-issue since it wasn’t treated and didn’t kill him. True. But if this history is going to continue to be dissected , I do not wish to participate in that. So will not choose to share further.
These are all decision points re: assessing risk. There are virtual colonoscopies that are not invasive but are reportedly less accurate. But, feel free to avoid it-- your choice. Not interested in debating the efficacy of this or of routine physicals, which the PSA could be considered a part of. And as Dstark mentioned, it’s elective. You can decline. And I don’t want to bother to look up what the insu co paid the dr for ordering labwork or the lab for processing the PSA, but it’s a bit offensive to suggest the primary motivation of running the titre is for income generation. The allowed amount is only a few dollars. @jordansmom1 can address that. And even if the results are elevated, it’s the patient’s choice whether to follow up with any further evaluations or procedures.
So sure, if a person is low risk, they can choose to not have it done. Each person makes their own decisions. For us, we are dealing with personal choices. I agree with @travelnut. It, like other diseases, has a range of outcomes and treatment approaches.
My comments will, of course, reflect my bias of working in urology for the past 10 years. First of all, I am a huge proponent for people taking personal responsibility for their healthcare. It sounds like ucbalumnus reviews the data and makes informed decisions about what is best for him. It also sounds like he has a healthy skepticism that physicians are making recommendations in his best interest but more likely their recommendations are driven by reimbursement said physician receives.
I will point out that the USPSTF is a group of primary care physicians (internists and family practice ) who make these recommendations without the input of the specialist who treats patients with these diseases. When they made a similar recommendation regarding screening mammograms, there was a huge public outcry and they later modified it. The AUA did modify their own recommendations for PSA testing a few years ago to include no PSA testing for men under 40 or over 70 but case by case discussion for men 50-70, which is the highest risk group. Keep in mind that prior to regular testing, 25% of men presenting with prostate cancer for the first time were symptomatic and had metastatic disease, which is particularly painful. As I mentioned earlier, the new prognostic indicators will help parse out the highly aggressive cancers. The use of active surveillance gives patients less invasive options after being diagnosed (dstark, in active surveillance, patients are closely monitored every 3 months with DRE and PSA as well as repeat biopsy annually sometimes along with MR guidance called a MR fusion biopsy).
Obviously, your best bet in making any healthcare decision is to know the facts and find a healthcare team you can trust.
I seem to remember, maybe it was 15-20 years ago by now, the recommendation that normal vaginal deliveries should have the mother and child hospitalized for less than 24 hours. I think there was a lot of pushback to that driveby delivery recommendation too.
I also think it’s worth it to question the motivation of the USPSTF. Are these recommendations best for overall health or to reduce government spending on healthcare?
I am of the opinion that for me it is not so much a question of whether or not I will get prostate cancer but when. My father had it, his older brother died of it and his younger brother had it. My PSA has been steadily rising and I will likely have a biopsy soon more because of my family history than just my PSA.
I have read about a new treatment which has recently (I believe last November) been approved for use in the US called HIFU (High Intensity Focused Ultrasound). It’s for early stage prostate cancer. It’s been done in other countries for about 10 years. The major advantage is that it doesn’t require surgery or radiation. They claim it has a lower incidents of side affects and can be redone, unlike surgery. The downsides are that occasionally it has to be redone and currently insurance does not pay for the procedure though that might change as it becomes more available. I’m keeping an eye on this and other procedures. I guess I’ll make my mind up when actually faced with the decision.
I’m the OP and I am glad I posted this. Lots of interesting viewpoints. I just want to share a few more.
First, as I said in my original post, I’m just a bit irritated that my pathology report was completed within 24 hours of my biopsy, yet I wasn’t given the results until six days later, when I had my follow-up appointment. I just think it’s wrong to tell someone there is a severe enough risk that they have cancer to do a biopsy, and then not tell them the good (or bad) news in a prompt manner.
I do understand the need and desire for a follow-up visit so they can assess for the possibility of infection, continued bleeding, and so forth, which they could not do after a single day. And perhaps it does provide another opportunity to bill. I found out during the pre-op planning that the urologist who performed the surgery was paid a grand total of $325 under my insurance. They refused to allow him to use his own surgery center, so I had to do it in the hospital, which I’m sure is going to cost both me and the insurance company more money. This meant a special trip for the doctor. His surgical center is only a couple of hundred yards from the hospital, but still it’s a special trip for a guy who does all his surgeries on one day.
I might add that when the doctor’s receivables clerk told me he was only going to get $325 I expressed shock because I found the reimbursement so low (she didn’t complain; I had a $500 deductible and couldn’t understand why they only wanted $325). She said an insurance company recently reimbursed them $1,000 for an $18,000 procedure. I suggested that he could just refuse to do it, and she essentially said he was going to do it regardless of what he gets paid, that once someone is a patient, he is going to treat them.
With all of this said, I feel the whole process is designed to be disempowering to the patient. I have chronic sinus infections. I also get infected in the back of my neck. My ENT, who admitted me to the emergency room for this back in 1996, says I am the only patient he has ever treated with this problem. At any rate, I tend to have periods when I feel like my whole body is infected. I can always tell when this is happening because my face will suddenly develop a bunch of zits or whiteheads (gross, I know). All of this infection can include infection of the prostate, which causes the PSA levels to rise. I have had some of the symptoms of enlarged prostate, but no pain, but the most recent biopsy showed lots of “acute inflamation,” which is consistent with a low-grade prostate infection. I just think more of an effort should have been made to consider my medical history of infection as a possible source of raised PSA levels.
I’m not going to say that I absolutely will not have another biopsy. But before I do, I’m going to see what effect some massive doses of antibiotics will do to clear things up. I’m going to be a lot more assertive in making more of the decisions myself. I don’t have a family history of prostate cancer; if I did my choices might be different.
I would just suggest that people at least listen to the counsel of @ucbalumnus and others, who point out the limited value of PSA screenings and biopsies. I believe there is a real chance that if cancer is detected that the biopsy runs the risk of spreading the cancer. Cancer of the prostate is natural and to be expected. If untreated people with cancer of the prostate usually die of old age, not prostate cancer. I think it’s actually a bit surprising that in two biopsies they have now done something like 22 cores and two center samples and have found nothing.
I think all of us need to educate ourselves a bit more on this subject. It’s kind of a case of preventive medicine gone mad.
By the way, here’s an older but interesting article. I would suggest that anyone facing these problems do a lot of reserch.
Neither H nor my father had any known family history of prostate cancer.
We have no known family history of colon cancer, yet my sister developed it.
@dstark, he’s okay. It is what it is. 