This is a disturbing and interesting topic. Remember there is no such thing as a normal PSA score or test result! With that said, one should ask, “If there is no such thing as normal, then how can I have an abnormal test result?” It really seems contradictory…because it is!
What is really at work here is the Prostate Industry looking for a symptom to focus on to find a disease. Or better stated, the Prostate Industry is looking for a way to monetize the PSA test. It is hard to believe anyone who has a motto of “First, do no harm” would looking to monetize my or your health issue. Just do not ever lose focus on the fact that medicine is both a science and a very big business!
The companies and the physicians who work with them are in business to create profit. They do not spend billions on research and development just to give away the results of their efforts. They want to sell the products or tests that result from their efforts, and they want to sell those products to as many of us as they can.
Enough of the commentary and back to the topic! So, you have an Annual checkup with your Primary Care Physician, and she does a PSA panel on your standard blood test, probably without ever asking if it is OK with you. Instead, he says it is just part of the normal Annual checkup, even though most professional medical organizations say a PSA test should only be done after a consultation with the Doctor and the patient’s consent. Of course, as a skeptic, I assume most doctors skip this discussion and just do the test as a part of the Annual checkup…unless the patient objects and says do not do a PSA test on me!!
So, you have done the Annual checkup, and the doctor did a PSA test as a “service” for you, even though you did not consent to have a test done. About a week later you get a call from your physician, and he says, “we need to discuss the results of your PSA test” to which you probably reply, “My what?” Too late my friend, the horse is already out of the barn, and you have now stepped onto the Hamster Wheel, so start running.
The doctor replies that your PSA is abnormally high. It registers 4.2ng/mL and that is a major concern as it should be below 4.0 ng/mL. To put this in context, 3 years ago your PCP would immediately refer you to a Urologist, take the referral fee and move on to the next victim, sorry, I mean patient. But now the protocol has suddenly changed, and they tell you they need to retake your blood test to recheck your PSA in 4 weeks. Having no options in sight, you agree, and he transfers your call to the scheduling person in his office.
You come back to his office 4 weeks later to do the follow up test, and since nobody told you anything about what to avoid before you do a PSA test, you follow your normal schedule in the week before the second PSA test. Since you’ve been a bit nervous about this whole thing you add an extra hard workout the day before the test so you can relax (or maybe you ride an extra 3 miles on your bike the day before). If you did, it would be strikes 2 and 3 and you are out.
Why in the heck did you not subscribe to that cool web site, Prostatesupports.org? If you would have subscribed then you would have known that in the 3 days before you do a PSA test, abstain from any sex, do not ride a bike and avoid hard physical workouts. Wonder why the doctor never tells you this important advice that may help you avoid the Hamster Wheel. Does he even know about this important advice? At least for the next test you will know now!
So, you do the second PSA test and hope all is back to normal. But since you had that hard workout yesterday, all is not normal. A week later your doctor calls again and says he needs to refer you to a Urologist because your PSA has now jumped up to a 4.3 ng/mL reading. Now you are scared as your life flashes before your eyes, and you see all of the mistakes you have made in life, but it is too late to change any of the choices you made. What is that Urologist’s name and number. The doctor tells you not to worry as his office will call the Urologist’s office and get you entered into their system as a referral patient (which comes with a referral fee and probably a gold star in his file from the medical system that now owns his practice and probably the Urologist’s practice too).
You next get a call from the Urologist’s scheduler, and she needs to set up an appointment immediately for you to have a consultation with the Urologist. You are over a month into this odyssey by now, so you are starting to freak out a bit. Hoping to never let them see you sweat, you try to stay cool and act like it is no big deal, right Fonzie? But it is a big deal because the thought of Cancer has entered your mind for the first time.
You meet with the Urologist for the consultation as scheduled and you are still trying to be cool on the outside while you cry and scream hysterically inside! He is a very nice guy and very matter of factly discusses with you what could be happening. Since you are 55 or 45 or 42 or 62, this is probably just an exercise in caution (unless you are the guy that is over 60 and then you probably have cancer of the Prostate but that will never be said at this early point). The Urologist says we need to do a complete exam which includes a DRE (short for get your fat finger out of my butt). He also wants to do a third PSA test to see what has changed. We can do that follow up in 2 weeks, which is Wednesday at 10AM.
In 2 weeks on Wednesday, you come in at 10, get a DRE and a blood draw. The doctor finds the DRE “unremarkable” getting your hopes up again that this is all just a very bad dream. On Friday the Urologist calls you back and says we need to talk. Your PSA has now skyrocketed to 5.1 ng/mL, and we are now very concerned that you may have Prostate cancer. He is going to refer you to an Imaging Center to get you an MRI to try and see what is going on. He tells you to stop crying and if the MRI cooperates and there are no suspicious areas in the Prostate you can go back to normal and forget this mess. He is kind enough to remind you there is no such thing as a normal PSA reading and that is why we need to do this Pelvic MRI with contrast to see exactly what is going on inside of you.
You get the appointment with the Imaging Center, and it is by far the easiest part of this whole odyssey as all you have to do is just get an IV to insert the dye and lay perfectly still for an hour. At least it would be the easiest part of the process if you did not feel like you were going to puke the whole time you are lying there worrying about how fast you will die with Prostate cancer. You are also trying to bargain with God by now to get his help getting you out of this mess. Miracles occur every day remember, just not to you!
Several days later your Urologist calls and says he now has the results of your MRI. Now you are sweating bullets as you are about to learn your fate. This discussion is about to go rapidly in one of 2 ways. The best-case scenario is he says he does not see anything remarkable about your MRI and so he does not think you have anything to worry about. You can breathe again and try to get your life back to normal.
On the other hand, he says there are some alarming images on your MRI of the Prostate. Based on that it makes sense to progress to a biopsy so “we” can determine exactly if you do or do not have Prostate cancer and if so, how extensive is it? By now logically you have totally zoned out of the conversation and would prefer to just go snuggle up to a nice bottle of Tito’s to forget that you even exist! But no such luck as it is time to meet and discuss your next step…the biopsy!
In my last post I was misleading. I said in this post we would discuss an abnormal PSA test and progress to the biopsy and discuss what a Gleason score is and how it affects you. However, I realize that is way too much information to digest in one post. Thus, I am calling an audible and making my next post about the biopsy process. Then in the following post we will discuss the Gleason Score and what that means to you.
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