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Monday, December 15, 2014

Urologist Visit

Today I had an appointment with a PA urologist, Susan Palmer, to followup on my recent high PSA reading of 10.5.  She was very competent, knowledgeable and informative.  I have to admit that having my deepest internal anatomy probed by a beautiful 30-something woman was, well...different.  I don't know what else to say about that.

Anyway, there is no surface indication of a tumor, although one lobe is larger than the other, which is not unusual.  The interesting thing about prostate cancer is that there are no reliable non-invasive tests.  The PSA test is only an indicator of possible problems, as is the physical examination.  The only way to know is to do a biopsy, which is an uncomfortable procedure and is not without the risk of infection (3%).

As is my wont, I had done a some research in recent years about the efficacy of doing the PSA test.  Many physicians and organizations advise against it for a variety of reasons, including false positives and negatives, the slow growth rate of prostate cancer, and the potential debilitating side effects of treatment.  Since I have no family history of prostate cancer, I suspended taking the PSA test after 2009, when my number was about 2.0.  As I mentioned in a previous post, I only opted to revisit this test because of the potential risk of secondary cancers associated with my MM chemo treatments.

I had a very good discussion with Susan about my options, one of which would be "See ya later".  I don't have any unusual symptoms and have no trouble urinating.  Also, I have not noticed any recent changes that might be cause for suspicion.  Therefore, I opted to have another PSA test done in a couple of months.  At that time, we can see if my elevated test result was an anomaly, whether it is stable, or is increasing.  If it goes any higher, I think I would opt to have a biopsy done.  Otherwise, I would probably just continue to monitor it.  If I do end up having a biopsy and the results were to be positive, that would bring up a whole new set of decision options to consider. 

Susan made an interesting point.  If one's life expectancy is less than 10 years, they generally do not recommend drastic treatment options for newly-diagnosed prostate cancer, because it is slow-growing and usually takes ten years or more to metastasize into a life-threatening situation.  Now I am a real optimist.  I personally expect to be here to continue to amaze, amuse, and confound everyone around me ten years from now.  But statistically, that would make me an outlier. 

So!  Here's the bottom line.  I'm not going to do anything drastic.  I will await my next test results in February and take it from there.  In the meantime, I don't plan to worry my pretty little head about it.  There is life to be lived, and that's what I'm going to do.


  1. Bill, read with interest your blog re: PSA etc. Sounds as if you are getting good advice and taking a cautious approach to the situation. The PSA level is not as important as whether it goes up in a short period. I always had a relatively high level which was attributed to an enlarged prostate but when it started to rise I had a biopsy, nothing found. A year later another biopsy, nothing found. Skipped a year and then another biopsy and there it was. I explored all the options but chose robotic surgery because my PSA was then up to 29. Biopsy procedures have improved so was not a problem even 12 years ago. I just wanted it out of there, 12 years later PSA is less than 0.1, have a check each 6 months. I highly recommend Dr. Patrick Walsh's book, he is with John Hopkins.
    Trust you and Gretchen have a trouble free move to your new home and a blessed 2015. Steve and Sue

    1. Thanks for your comments and support, Uncle Steve. I appreciate your advice about taking a cautious approach at this time. As you point out, the key question is how fast is the PSA level rising, so I should get some clarification on that after my next visit in February. I will look into the book by Walsh that you recommended. Happy New Year to you and Sue.

  2. My grandpa thinks that he is having some prostate issues. He used to be a doctor, so he says that all of his symptoms point to a prostate problem. He is going to talk to a urologist at the hospital he used to work at. Hopefully he can get help for his prostate.

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