Axiom Home Page Forums General Discussion The Water Cooler A PSA on PSA's

Hi! It's Bob again, your medical conscience.

There has been a lot of news coverage lately about PSA tests (prostate-specific antigen) and their value. This is not a new debate, as media would have us believe. It has been going on for almost a couple of years now.

At the ages many of us (you) are at, you may be advised to screen for prostate cancer as a regular course of preventative care. It's usually around the 50 mark, Mark. A PSA is a simple blood test.

False positives have always been a problem and there's the rub, so to speak. Here's what is likely to happen to you if you get a positive result.

First, they will redo the blood test. If it turns out positive again, they will want to do a biopsy. That may or may not be conclusive. You may end up (sorry) facing a decision about what to do without the sort of complete information one should have to make that sort of decision.

Many men panic at the test results and opt to have surgery. We now know that many, many of them did not need it. In many cases, prostate cancer is a pretty slow mover. It may cause BPH (a bladder/urinary condition), or impotence, or nothing you notice at all. The problem with the surgery is that it does lead to impotence in more than 30% of men and about the same rate of permanent urinary problems.

What to do?

If your health care provider does not explain all of this to you when discussing whether or not to do a PSA, find another one. Good physiscans have been all over this for a while now and know the bugaboos involved. Just understand that having the test could lead to a biopsy (not THAT horrible) to confirm or deny; then quite possibly, another, bigger decision.

The jury is totally out. My Dr. gave me all the info, (well over a year ago) then asked if I wanted to do the PSA. I said, "yes," but it was a completely informed response. Now you have a little more info if ("when," scaredy pants, WHEN, not if) you have to make this decision.

If you find out your physician went ahead and screened for PSA w/o telling you beforehand, throw an absolute nutty (on YouTube, please).

If you get your prostate tickled every now and again, is that considered an acceptable test?

Thank you, Bob.

Why would I throw a nutty if my physician screened my blood test for PSA? I mean, that part's not invasive, and I'm not sure anybody should be scared to have more information. It seems like the "what next?" part is where things get more interesting and accountable.

I do deeply appreciate the caution about the inconclusive nature of biopsies. That is terribly important.

AND, I've been getting checked, with normal results so far.

From Pints for Prostates



I remain grateful for how generously folks on this board share their knowledge.

The reason to be rightfully pissed is contained in your quote. You need to know all of that stuff BEFORE you agree to have the test done, nes pas?

Where the hell is the French Grammarbot?

Which one?

Professeur Vin?



his crusty sidekick, Garçon Pain?



Les Lunettes Turquoise?



or, last but not least, the bastardly Robot de Bâtard Français?

He's busy changing..."monkey" to "minkey".

It means "isn't it so?" However the correct spelling is n'est-ce pas.

In 4 quarters of college French, I swear I was taught that is was n'est pas, but that was nearly 40 years ago and I suspect the memory is JUST a tad clouded.

You can tell that the Bots are French because they wear berets. Must be a national requirement or something.

Ha! french grammar. I'm not an idiot, Tom. Next thing, you're gonna try to convince me that there are declensions and conjugations in Ebonics.

Now, now, Bob...

The old world languages leave English bound and gagged for grammar and pronunciation.

"That's one thoroughly tough bough!"

Bren R.

Before this thread spun out of control, I was thinking that the PSA test (as many times as needed) is MUCH preferable to the doctor's random (and RUDE) thumb.

My doctor and I both agreed that using any measurement, the thumb test is the least favorite for BOTH of us.

That, of course, makes me wonder why a smart person who goes through college (4 yrs), medical school (4 yrs) and the whole intern/residency thing (3yrs)and gets that much smarter and well-educated chooses the specialty of Proctology.

And please, there is NOT enough money to justify that.

It's not about the money, Ray. No med student chooses proctology, it chooses THEM!

Maybe you'd rather have a venture capitalist from Morgan Stanley do it? No, no, a hedgefund manager!

Bob, those Wall-Street types are the target, not the profession.

What I meant was that you want someone who's doing that to you not to be motivated by money (they don't make a lot, either), but by caring for your health, no matter how gross, er, I mean, delicate.

I'm not sure what you mean by this thread spinning out of control. It has been long established that BOTH the PSA test and a rectal exam is VITAL to detect any changes that may occur in the prostate after age 50 (for accuracy's sake it isn't done with the thumb). A PSA test certainly may be preferable to a 'rude' finger but it doesn't make it less important. The procedure isn't painful but it is uncomfortable, and lasts for less than 5 seconds. I've had it done by proctologists as well as family physicians. They know what the proper size and feel of the prostate should be based on age.

There's nothing fun about it, and I get the fact that some people want nothing to do with something as 'invasive' as a prostate exam. The importance of the exam however, cannot be underestimated when combined with a PSA number over time. How to proceed if things change when you get older is debatable (as well as other symptoms that may occur), but the exam's relevance in undeniable.

Spoiler, I think Ray was referring to the derailment where we left topic, because I started slandering (the fantasy of) french grammar.

That aside, I'm thrilled you are on top of you health. However, the # of deaths from prostate cancer in men who had a PSA and those who didn't differs by only 4%. In other words, it really doesn't save lives. I have 'em all the time, too, but I was informed more than a year ago about possibly ending up going through hoops of fire for a false positive. Just something good to know before one commits.

Ah ok, Bob. Ray, I misunderstood what you were referring to with my opening comment so, my apologies.

Bob I agree with you on the PSA numbers. Jumping to something as drastic as prostate removal or other treatments because of a false positive can lead to worse problems than leaving it alone.It's always good to be as informed as possible before making a decision. That's why if I ever get a high PSA number I certainly wouldn't go nuts and immediately start some sort of treatment.

Man, it's annoying getting older.

Apology accepted Spoiler. I am removing the latex glove from my right hand....

My father who is going to be 85 in August was diagnosed with prostate cancer about 8 years ago. He was having regular check-ups including PSA tests for years. The doctor had noticed an elevated level in the PSA test which resulted in a round of radiation treatments (36 total). Fortunately he is a very healthy individual and hasn't had any further issues. I have had PSA tests done in the past however my doctor just recently stated that he doesn't think that it is necessary to carry on with the PSA testing.

Don't throw out the baby with the bath water, Ray.

Where were you 33 years ago, Bob? If you were juxtaposed to my folks house, I would've ended up on your backyard.

Cam, that's so not true. Your parents didn't want you gone until they got to know you better.