...And The Song Comes Back (Initial Reactions To A Rise In PSA)

Since receiving my 44th and final proton therapy session for prostate cancer in 2020, I have had mostly nothing but positive news to report. I’ve never experienced any substantial side effects. Erectile dysfunction and incontinence have never occurred. The mild urinary symptoms which I experienced prior to treatment were virtually gone. I did have some mild annoyances, but nothing problematic, and definitely nothing quality-of-life altering.

Proton therapy had delivered for me on every promise. For the next 4 years, proof of the kept promises rolled in regularly, as my PSA continually dropped.

That is, until September 2024.

A sudden rise in my PSA

Prior to then, my PSA had dropped from a high of 7.6 all the way down to 0.52. Though not in a completely straight line, the decrease was very predictable. But the September results were not predicted. My PSA was now 0.88.

Immediately I tried to reassure myself: “That’s not too bad at all, it’s a rise of only 0.36.”

But as if preprogrammed, my worries were automatic and uncontrollable.

“But it is up almost 70%.”

That kicked off an internal back-and-forth between reassuring myself and fearing the worst.

Starting to worry

I tried to calm myself: “You are still under 1.0, so that is great. Fluctuations are normal; that’s probably all this is.”

“But I have already had some fluctuations, and none have ever been this big," I thought. "Not only that, I know I was very careful to abstain from activity known to increase PSA for 5 days prior to this test.”

Having previously learned about the "PSA doubling time" metric, another thought crossed my mind: “if it goes up another .16, my PSA will have doubled.”

“Has the doctor said anything about this?” the reassuring part of me asked.

“No, but if it goes up twice in a row, or doubles that quickly, there is a pretty good chance that he will. Then what?”

Trying not to fear the worst

Uncontrolled again, my focus suddenly turned to my next PSA, 4 long months away, and almost on cue, a “then what” actually happened. A song started playing.

“Every day you get one more yard.”

Tom Petty in his song, "The Waiting," though thinking about a girl at the time, aptly recognized how difficult waiting for anything can be. I started wondering about my next yards.

“You take it on faith, you take it to the heart.”

I thought to myself: what else can I do now but realize that I am probably making something out of nothing? There is no reason to worry. Don’t jump to conclusions. Don’t automatically fear the worst. You are wasting valuable energy. Focus your energy. Stay positive! Count your blessings! How often have you told patients awaiting a prostate biopsy that they don’t have cancer until it is confirmed, so you can’t just assume that you have it? Well, how about following your own advice this time?

Waiting is the hardest part

“The waiting is the hardest part.”

Maybe, I thought, I should get a PSA in the next month or two, since it is easy to order those on my own these days. But it will be done at a different lab… maybe using a different process… so the results may not really be comparable. Especially when you are talking about tenths of a point.

Wait a minute, I thought, it's just a few tenths of a point! What am I getting exercised about; that’s not much at all! Take a breath, stop all the worry, do something fun, and simply focus forward. Look how far you have come!

So I do my best to shake my back-and-forth.

And then the song comes back…..