The PSA blood test, a key prostate-cancer screening tool for all men, has become somewhat controversial. It should not be.
It twice saved my life. If you are a man, it has the potential to save your life. If you are a woman, it has the potential to save your man’s life.
Widely known by its initials, Prostate Specific Antigen screening is a simple blood test that is covered by virtually every U.S. health insurance program. It monitors the level of a protein produced by the prostate – and by prostate cancer cells. High or rising levels of PSA can be a leading indicator of prostate cancer.
Every man over 50 years old (and, personally, I would say over 40 years old) should insist that it is done at least once a year as part of the battery of blood tests that precede an annual checkup. If nothing else, this will establish a baseline if future problems arise.
A reading higher than 4.0 generally attracts some attention, but that is not a firm guideline and it should be adjusted for age, the rate of acceleration and other factors. More details from actual scientists (a group that does not include me) – normal ranges and so on – can be found at this link: https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/the-psa-test/
Now, regarding the controversy: In recent years, some statistical studies have questioned the value of wholesale PSA screening, with some “experts” recommending against such screening absent a finding by a physician who digitally exams the man’s prostate for a suspicious bump.
The assertion is that many findings of elevated PSA lead to biopsies that prove negative and thus are unnecessary. (Biopsies can produce their own rare complications – more about this at another time.)
My view: This is nuts. It’s a prime example of ivy-tower cogitation by people who crunch data and draw conclusions solely from that data rather than factoring in actual life experience and clinical experience.
There is no obligation, ever, to agree to a biopsy just because you had a blood test. But wouldn’t you want to know that you at least should consider a biopsy or another form of follow-up because maybe there’s a problem?
A suspicious PSA test is the biological equivalent of a vehicle’s yellow “Check Engine” light. It doesn’t require you to poke around any parts, but it sure as hell suggests that you ought to consider looking into what may be going wrong.
In my case, slowly rising PSA results over several years (ultimately reaching 13.1), led in 2018 to an MRI-guided biopsy (again, more on this later) that originally found the cancer, triggering treatment with hormone-reduction drugs and 43 sessions of focused radiation. I did not have any suspicious bumps on my prostate. It was solely the PSA screening and subsequent treatment that saved my life at that point.
We thought we had it corralled, but prostate cancer is notably tenacious and it came back. How did we know? Because, as I mentioned yesterday, my PSA went from undetectable to 6.5 last month and then to 11.6 this month.
Without those PSA tests, we would not have known any of this. Without that last sequence of PSA tests, the cancer would have spread even more than it did and, according to the doctors, it would have claimed me by this time next year.
Prostate-cancer message boards are filled with posts from men – or their survivors – who did not monitor their PSA. The first symptoms of their prostate cancer: severe bone pain, unexplained spontaneous fractures, or other serious problems. At that point, they were found to have PSA readings in the hundreds or even thousands. And they were in very serious trouble.
At the bottom of this blog, you will find this message: Men: Make sure your physician orders a PSA blood test at least once every year. Women: Make sure that your men do this.