A PSA on PSA – An Update

In my post of January 10, 2016, I spoke of issues relating to my elevated PSA (“prostate specific antigen“).  Past tests have been negative.  But the PSA numbers continued to remain high.  My urologist at the University of Chicago suggested a brand new test (developed in the last year or two) – called the “4K” test.  Instead of measuring PSA which is helpful but not determinative (and often unreliable), the 4K test measures four “kallikreins” (metrics which can more readily identify prostate cancer).  He also recommended an MRI with a contrast dye this time.  This too is readily new – and provides “highlights” of trouble areas.  

I had the 4K test and the MRI with contrast dye.   The 4K results are  reported in percentages:  “less then 10% chance of having a significant cancer (Gleason score more than 7).”  The MRI was even more optimistic (translation:  less than 5% chance of malignancy).   The two tests together were highly optimistic.  

Some men have a genetic propensity to higher PSA.  Prostate size can affect PSA and the aging process (lot of that going around) can elevate PSA.  And then there’s cancer. . . .     

It’s not fun to hear about medical issues (or non-issues).  But I believe it is important to my brethren  (and the brethren of my sisthren) to know about these two new means for detecting prostate cancer.  

Prior to 1988, prostate cancer was diagnosed by palpitation of lumps or hard nodules.  Then a biopsy.  Or – a man would develop chronic back pain (and then be diagnosed).  In 1990, the PSA test became widely used.  But elevated PSA often resulted in unnecessary biopsies – or surgery.   It is only in the last couple years that new diagnostic tools have been developed:  4K and contrast dye MRI’s.  Thank heaven for modern medicine. . . . .    

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A PSA on PSA

Here’s a PSA (“public service announcement“) on PSA (“prostate specific antigen“). 

My PSA has been stable – hovering around 2.0 for years.  Under 4.0 is considered “normal” — though “velocity” (short term upward change) is sometimes a sign of prostate cancer.   A few years ago, my PSA went to 4.0 then 6.0 within about 18 months.  I saw a great doc at the University of Chicago who recommended a biopsy.     The biopsy took 16 “cores.”   It came back negative.   Within a year my PSA number went from 6.0 to 8.0 to 10+.  Ouch. . . .   I then had an MRI of the prostate – combined with another biopsy.    The MRI with biopsy is supposedly 98%+ accurate.  It all came back negative.  Pfew (so far). . . .

The doc then advised that I go on a regimen of Advil (6/day for 3 weeks).  If the rise in PSA was due to inflammation (which is a possibility), this protocol would reduce the PSA level.    I did – and PSA went down to 8.0 where it has remained.

The doc says it may be chronic inflammation.   There are no other symptoms (no bumps, nodes or enlargement).   A rise (even dramatic) in PSA does not necessarily mean prostate cancer.  In fact, PSA testing has been recently discussed and – in some cases – discouraged. 

For men who live to be 80 – something like 80% will have cancer cells in the prostate.    Yet fewer than 10% will die of prostate cancer (which in many cases is slow-growing).  But NEVER play doctor.  Always see your urologist if your PSA inches upward . . . . .

There was a great article from the Wall Street Journal which relates to aspirin therapy in prostate cancer situations.  Regular aspirin use may lower risk of advanced prostate cancer.  Check out — http://www.wsj.com/articles/regular-use-of-aspirin-may-lower-mens-risk-of-advanced-prostate-cancer-1451946945