The stick and…the wait

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Today is PSA Day. Again.

And each one sends the Anxiety Clock aflutter until the result arrives.

Tick-tock, tick-tock, tick-tock.

PSA, the tell-tale prostate specific antigen blood test, is an imperfect leading indicator of prostate cancer’s existence, ebb and flow, but it’s the least intrusive (aside from the needle stick). Hence, it’s the best way to track the disease as it does its thing.

For a stage four metastatic patient undergoing various therapies, it’s an absolutely vital tool. A downward PSA trend suggests that the cancer is relatively under control. An upward trend, any upward trend, even a tick upward, rings the alarm bell.

That would mean that the pesky cancer cells have figured out how to thrive despite current therapies and their attendant side effects. In turn, that would mean that new tests, new scans and, most significantly, harsher therapies will be required.

For a four-stager, this is inevitable, but it’s something to be delayed as long as possible.

So, you would think that the patient’s physicians would be careful to check PSA at every opportunity, right?

Like so many men, those with or without prostate cancer, I nearly always have to press my primary-care physician to include a PSA test on a lab order for more routine blood tests. That was the case again yesterday, when I learned that, once again, a PSA test was not included on the order for today’s routine labs.

The guy knows I have stage-four prostate cancer so…what the heck?

My oncology expert, of course, is better about this. But even there, I had to press for more frequent PSA tests. During our last visit, he scheduled me for standard-of-care PSA intervals of four months.

No, I said. The last time we waited four months, all hell broke loose, putting me where I am today – stage four, metastatic, advanced, full involvement of the lymphatic system, long-term prognosis about as poor as it gets.

We settled on every two months, a reasonable compromise. By the way, this is not an insurance issue – I could be wrong, but I do not know of a single case in which any man has been denied reimbursement for a PSA test, regardless of interval.

The takeaway for every man: You must request a PSA blood test at least once a year, more often if you have or suspect prostate cancer. The takeaway for everyone: You have to be your own best medical advocate.

So, whenever another physician orders a blood test of any sort, I demand the addition of a PSA. That’s where we are today, and in a couple of days, we’ll know the results.

Tick-tock, tick-tock, tick-tock.

10 thoughts on “The stick and…the wait”

  3. Thanks for the reminder, old friend. After almost 10 years since radiation, my prostate is slowly ticking upward. (Still pretty low at 1.02, but has begun to tick upward now at about .25 each PSA.) My urologist has scheduled me to be tested again in 6 months. I am calling him to say let’s do 3. Hope your next PSA is stable!Bill

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  6. For those of us with other problems, a monthly PT/INR test is requested — but not always included in their regimen. The fact that that test requires a separate blood collection tube is always the tip-off when undergoing the procedure. Where’s Marcus Welby when you need him?

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  7. The state of medicine today is ruled not by doctors but the complicated “marriage” of doctors, insurance companies, health-care corporations etc. Thus, one must always be on top of our needs. And it’s nerve-wrecking. I realize, though, that the wait is much more frustrating that the test, in your case. Hang in there! We need you around.

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  8. Good luck Marty! We got results last week that my husband’s PSA went from 72.5 to 1.1 in 6 weeks of ADT and Erleada. Because we know at some point we will want a PSA before his every 3 months appointment with his MO, we requested that his PCP set up a standing test order for the next two years anytime we need reassuring or more up-to-date info. We also have a standing order for Vit D, B 12 and Calcium levels. Maybe this system could work in your favor too? Hope this helps, Lisa

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    • Hi Lisa. That is GREAT news about your husband’s PSA. ADT and Erleada are my main meds these days, too, along with Prolia. Although our Medicare Advantage provider has been pretty good about all of this, I’m not sure that it can handle standing orders like those you describe, but we’ll give it a shot. Meanwhile, I don’t mind bugging the docs from time to time. I sort of like the challenge of finding that line that gets us what we need – without ticking ’em off. Let’s stay in touch. Seems that we’re not only on the same road, but also at right around the same mileage marker.

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