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,
Andrew
Andrew's View of the Week 
Hi Andrew, really pleased that you are on a positive trend with the PSA. I’m just into my eleventh month following Bracytherapy and recently, a fortnight ago, had a meet with my consultant.Although I don’t get stressed when the appointments are set, sitting outside the consultation room can jack up the blood pressure a little. For me it was, once again, good news. My PSA was up at just over 13 prior to seed implantation and is now just over 1. Smiles all round. My consultant has stated that he wants to see me two more times and, assuming the PSA trend is still down or at least static, will sign me back to my GP. I assume that the GP will still continue with the six monthly bloods, but I forgot to ask. So you are a bit further down the road than me. Blazing the trail that I am only to pleased to follow. Keep the faith Andrew, its looking good.
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For me, it starts at the blood lab when the draw the blood until they email me the result. That’s a great PSA drop. Good sign they got it all. My radiation doctor only did one PSA test and then referred me to the monitoring team which forwards all the reports to my GP.
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I have a relative who is in roughly your position, but for breast cancer which is, of course, also very curable. Nevertheless she goes through intense anxiety as these checks fall due, so I can empathise, at least, with what you go through. I’m glad all sounds as if it will be well for you: keep punching!
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The anxiety is great, but over time it does ease a little. For now, it looks like I am on a good path.
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you have my thoughts and prayer
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Thank you.
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You have a very good attitude which I think is key to your recovery. My best wishes are with you.
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Thanks.
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Here’s hoping that box sits on the shelf for a long time, like forever. 🙂 Take care.
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I hoping it will start collecting dust soon.
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Continued prayers for you, Andrew. Now and always.
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Thank you and peace to you and yours.
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Ah, man. What stress to live with. I’m glad you only have the PSAs twice a year. Here’s to a fifth year cancer-free!
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I am hopeful for year 5. I’d hate to do this more that twice a year.
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Congrats, Andrew. I know exactly how frightening and stressful this is from living through it with my daughter. Her issues started when she was 4. No more problems.
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Glad your daughter is past the problems. It is scary.
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Thanks for being open about this subject, Andrew. I lost my father to Prostate cancer and I can relate to having that fear out there, hanging in the distance. My numbers are good for now and I have learned that if caught early, it can be successfully treated.
Ω
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Caught early, it is very treatable with a high chance of a cure. Keep watching that PSA.
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Here’s hoping the numbers continue down and the time comes when this is all a distant memory for you.
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Some, it will all just be a bad memory.
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Andrew,
I wish you the very best for a complete recovery from this dreaded disease. It should be a law of nature that good and nice people cannot be susceptible to cancer in any form…
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That would be a great law.
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A couple of years back I had a bladder infection, caused, I thought, by my hip replacement operation, which had necessitated the use of a catheter for a day or so. The precautionary PSA test result was too high and I had to then wait a month for a retest, which was eventually OK. A pretty scary month though. I didn’t think or indeed, talk, about much else. If you can put that fear into a box on the shelf, then well done!
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That sounds like a difficult month. Having a catheter is no fun. Good that it got better.
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Congrats!
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Thanks.
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So glad to hear your PSA remains low. I’m sure those emails do indeed come with a dose of dread. Though PSA can have its problems with false positives as you listed, it’s nice to have it as a tool for monitoring treatment progress, isn’t it? Here’s hoping you reach that five year mark with nothing but nadir levels.
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The nice thing about PSA post treatment is that I don’t go in for scans and other procedures for monitoring. Compared to friends with other types of cancers, I’ve got it easy there – simple blood test and I’m done. Just two more tests to get to five years at nadir.
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That’s great news. I can certainly understand the fear never completely leaving, but at four years out, you’ve got to be feeling a lot less anxious than a couple of years ago. Congratulations on reaching another milestone!
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Thanks. The fear gets less with each, but a little is always there.
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