Pesky PSA Monitoring

prostate_logo movember_logo One of the tests to check for the possibility of prostate cancer is a blood test to determine PSA level. PSA = Prostate Specific Antigen, a protein produced by one’s prostate gland. As I understand it, an increased level of PSA may indicate a larger prostate which may be due to prostate cancer but could alternatively be due to a so-called benign enlargement(Benign Prostatic Hyperplasia). It is the enlargement of the prostate which can lead to a reduced urine flow by narrowing the urethra. [Note: yet again, there are other possible causes, not just an enlarged prostate.]

My initial blood test about five years ago had revealed that my PSA level had been ~2.09 (the units, I think, are ng/ml). My consultant prescribed a regime of a sequence of three blood tests – two further ones to be carried out at 6-monthly intervals. Being a travelholic [Ed: I just coined that word.], having to ensure that we were chez nous for visits to nursey in April and October was a bit of a drag but, hey, this is my health we’re talking about; we worked around it. As near as I can remember, my second test produced a reading of ~1.1 and the third ~1.5.

Following blood test series, came a second fight with hospital parking for a second review with the urology consultant. The astute reader may have noticed that my second reading was considerably lower than my first. It seems that PSA levels can fluctuate by about 30% quite naturally – interesting stuff – so readings depend where within the fluctuation cycle blood is taken. His conclusion, based upon the fact that my PSA level had not screamed northwards, was that, whatever my condition,

… it is not due to a currently active cancer.

Very carefully chosen words, I suspect.

We still needed to keep an eye on my PSA level, though, so for the next three years or so, I continued having those pesky blood tests every six months with the occasional appointment back with the urology consultant. The earlier results hovered in the 2’s, eventually climbing to about 3.1. “Out of bounds” for PSA level, alarm bell status, was set by Mr. Consultant at 5.0. Over the last 18 months to April 2010 my readings went something like 3.5, 4.1, 5.1 – a steady climb, ultimately ringing the aforementioned alarm bell.

Time to return to the consultant. Not only was my PSA now deemed too high but another jolly delightful DRE (Digital Rectal Examination) revealed a less than normal prostate – it was now apparently firmer and somewhat larger. Not good news. Mr Consultant said we could go on monitoring but suggested a biopsy.

“I was going to ask for a biopsy, anyway”, I replied, “besides, we’ve been monitoring for five years already.”

Interestingly, in checking on the precise full name for which PSA stands, I discovered, on the website, the following “rough guide” as to what might be considered normal PSA levels at given ages:

  • 3 ng/ml or less is considered to be in the normal range for a man under 60 years old;
  • 4 ng/ml or less is normal for a man aged 60 to 69;
  • 5 ng/ml or less is normal if you are aged over 70.

According to these levels, my PSA level had been out of bounds for about three years. Now, according to these, my reading is “out of bounds” for a septuagenarian. Had I seen these previously, I may have been suggesting that I have a biopsy earlier.

I was now “looking forward to” a delightful transrectal biopsy of my prostate, more about which in a future post.


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