Every six months I get an email from the “Prostate Cancer Monitoring Team” telling me it’s time for my six month PSA test. The first few of these created a lot of anxiety. As life goes on these little emails get easier to handle, but there is always fear with each test.
The prostate specific antigen (PSA) blood test measures prostate activity in a man’s body. In a man without prostate cancer the test measures prostate activity and is a bit like an engine check light. A high reading means something isn’t right and you need to see a urologist. Any number of things can raise PSA including, an enlarged prostate, an infection, sex 48 hours before the test, bike riding, and in some cases cancer.
However, in a man with prostate cancer, PSA is everything, as prostate cancer cells kick out lots of PSA into the blood stream. That makes this simple blood test the ideal way to check the progress of treatment, or in cases like mine, to see if the cancer remains under control. The math is simple, a low PSA means the cancer is gone and a rising PSA means the treatment failed and is still active. Men who’ve had their prostates removed can expect to see near zero (<.01 ng/mL) while those of us who’ve had radiation therapies can expect the PSA to eventual reach a low number (typical under 1 ng/ml) called, nadir.
It can take a couple of years post radiation to reach nadir and the expectation is that once reached the patient will remain there for a very long time. If the cancer has been cured, the PSA will remain at nadir for the rest of a man’s life. In a failed treatment, or if the cancer has metastasized the PSA will rise and things will get bad.
The general rule is that the cancer is declared cured if there is no reoccurrence within five years of treatment. This isn’t a magic number, just a statistical waypoint. Some have reoccurrence after five years. The five-year line is simply the point where most reoccurrence stops happening.
This month I am at four years post treatment with a steadily failing PSA. I got my test results last Monday and I am at .3. The last test was the same so this is likely my nadir level. Reoccurrence is generally defined as nadir + 2. So as long as my tests come back below 2.3, I can relax and move on with life.
Still, the fear is there. The radiation likely did its job and am I am now left with just the side effects of treatment. If you think too much, which I sometimes do, there are plenty of other fears including the possibility of another cancer.
So today, I can put all that knowledge and fear in a box on the shelf, and wait for the next email from the monitoring team.
Till next week,