The Critical Role of the PSA Test
There are a variety of opinions on the usefulness of the prostate specific antigen test (PSA) for helping diagnose prostate cancer. The prostate is always producing this protein, so why test for something that is perfectly normal? To identify cancer, how accurate would such a test really be? Couldn’t there be false readings that just cause unnecessary anxiety? Why put yourself through all that when it could just be a waste of time and money?
There are plenty of valid questions concerning the appropriateness of PSA testing and the role it plays in the diagnosis of prostate cancer, but I have one definitive answer: the PSA test, by itself, might have saved my life.
Something was not good
By age 57, I had already been screening for prostate cancer for many years, due to family history. I had a physical exam every year, and during that exam both a digital rectal exam (DRE) was performed and blood was drawn for a PSA test. At no time before or after my cancer diagnosis did any DRE ever yield any positive findings. And it did not matter who performed the DRE. Family physicians and specialists alike were always in agreement that my prostate always "felt normal."
Furthermore, my PSA was always below 4.0, which is often considered the level at which one should begin to take notice. With a PSA under 4.0, and nothing on a DRE, all is good, right?
But something was not good. The only indication I had of a pending problem was "hidden" in my PSA results.
Fluctuating PSA levels
Additionally, there was one mild urinary symptom. I started to need “extra energy” to fully empty my bladder, but that was easily explained away. “Your prostate is probably just getting a little larger,” I heard, something not uncommon for a man my age. With many yearly prostate exams under my belt and no findings, it probably wasn’t anything significant.
But my PSA kept increasing. From 2015 to 2019, it had risen to 3.7 from 1.69, and it had been over 2.5 for four of those years. That should have been plenty of evidence, I later learned, to send me to a urologist, but I still didn’t get referred until the following year.
Then in 2020, my PSA actually went down to 3.1! “You need to go to a urologist!” But at that point I couldn’t understand the logic. I wanted to say, “Why didn’t you refer me last year when my PSA was 3.7?”, but I bit my lip. I later learned that my doctor had ordered a different, “more sensitive” PSA test that red-flagged at 2.5. All of my other PSA tests were the 4.0 version, but my value was never high enough to trigger that. Now that I had triggered my very first PSA test, it was off to the urologist.
Surprising information from my doctor
“You need a biopsy” was the last thing I expected to hear, but to my total amazement, two minutes into the consultation, that’s what I heard. But that should not have been a surprise, and the urologist explained why.
First, he noted that my “PSA velocity” was suspect. It had been steadily rising for the better part of 5 years. Secondly, he noted that my PSA had been above 2.5 for 4 straight years. “Neither of these things should be happening at your age,” he said, and he said that for men under 60, it is a better idea to focus on PSA values greater than 2.5 rather than 4.0.
That helped me realize that not only could there be a real problem, but that a problem actually could have been there for a while. I received positive biopsy results three weeks later.
PSA testing helped me catch cancer early
Deciding whether to get a PSA test can be a tricky decision, as some people still remain skeptical of the value that it offers. But for me, there is no skepticism whatsoever. My PSA tests were the only evidence I had of a possible issue.
Had I put off cancer screening completely, or decided to forego PSA testing and relied only on an annual DRE, it is quite possible that my cancer would still be undiagnosed as I write this. Had I agreed to a PSA test sporadically, my PSA velocity may not have been complete enough to suggest the need for biopsy.
Instead, I was able to catch, and treat, my prostate cancer very early. With early diagnosis, additional treatment options were available to me that may not have been available had the cancer progressed further before diagnosis. Early diagnosis is the key to longterm success with prostate cancer, and PSA testing, for me, was the critical key to my early diagnosis.
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