A Personal Question

Does anyone know–or can find out–if I should be overly concerned that my 54-year-old son recently had a blood test showing his PSA count was 20??? Some data: He was, at the time, experiencing a severe bladder infection and was miserable. He was put on antibiotics which seem to have cleared it up, but his urologist didn’t want to do a complete prostate workup while he was still on the antibiotic and has delayed one until he’s been off of it for a week. Is scheduled for another blood test in two weeks which will be up next Friday. My urologist was concerned when I once had a PSA of 4. My last test it was 1.5.

I wouldn’t be too concerned . . . yet.

Any number of things can throw off PSA results. His urologist was right in holding off until he got off the meds.

It’s the PSA trend that counts. If his readings steadily go down . . . that’s what you’re looking for. If, say, his next reading is something like 15, and the next is, say, 10, then that’s a good trend and is no more than a reason to keep testing.

But if his next reading is, say, 20 (which is so high as to be suspect anyway), and then the next is still in the 20’s, then it’s time for the gold standard of tests: A BIOPSY. That will settle this whole thing, but it’s premature to do one now. The trend may very well show good results and obviate the need for a biopsy (which is a very painful procedure anyway).

One high reading is not cause for concern, but it IS cause for a repeat test.

One thing to avoid if at all possible: THE FIREHOSE up the Johnson procedure. I think it’s called a cystoscopy.

My urologist said something like “this may be uncomfortable” . . . which is code for: they’ll hear you scream in the next zip code. If he has to have this procedure done, I’d recommend having it done in the hospital under anaesthesia . . . which is the way I had my second one done.

I had the first done in the urologist’s office . . . and I’ll never do that again.

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PSA is an indicator, but it’s not the Gold Standard that it was once touted to be. My scores had been in the neighborhood of 5. Now I have been on a new drug, and it has fallen to around 2.

The PSA score can be effected by many factors. An infection can make it higher. If you had sex three days before the blood test was done, that will make it higher. Some doctors are backing off on using PSA as a reason for calling for biopsies. Others are using it as a scare tactic to get men to have more biopsies. My personal opinion is that some of those doctors are using it as a revenue function for their practices.

I have had two biopsies that have come up negative. The trouble with the biopsy is that it is not a risk free procedure. It is painful and the after affects are difficult. I had one doctor, whom I shall call “the butcher”, do one on me. I ended up in the emergency room twice. He didn’t gave a rat’s tail about me. All he did was look at PSA scores, say “biopsy” on a regular basis and tell you that you probably had prostate cancer and were going die if you didn’t get it. That’s the way that guy practiced medicine.

Now I have a doctor who looks at treads and is willing to discuss the situation with me. That is the more reasonable approach.

A PSA score of 20 is high. The situation needs to be watched, but does not necessarily mean dire results. It is just a tool, nothing more.

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My brother ran a PSA of 14 regularly.

At first, his urologist did a biopsy after my brother had PSA’s in the 14’s, over a period of a year.

That first biopsy showed nothing wrong, but my brother continued PSA’s in the 14’s. So, after several repeat PSA tests, the urologist did another biopsy. Clear again.

Rinse, repeat, 'till my brother’s prostate was like swiss cheese.

Finally, the urologist decided that unless my brother’s PSA rose significantly above 14, there was no need for any more biopsies.

He still runs a 14 or so, has a PSA test now and then, but NO MORE biopsies . . . WITH the urologist’s approval.

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My son’s PSA test has been postponed until September 7th. I don’t know why yet.