A PSA About PSAs

Posted on Sep 19, 2011 | 0 comments

Frank delaRama R.N., M.S., Oncology Clinical Nurse Specialist & Prostate Cancer Nurse Navigator at the Palo Alto Medical Foundation

Ignorance = Not Bliss

A huge majority of the men I meet with newly diagnosed prostate cancer have almost no other medical problems. “I eat right, exercise regularly. I feel so healthy…but now I have cancer?!” In fact, most men who are proactive about their health are most likely to have their PSA blood test and Digital Rectal Exam (DRE) completed on time, starting as early as age 40 (see my previous post 40-45-50 for the full guidelines). So, it’s the healthy men who catch the prostate cancer very early, and at the same time, are the most frustrated with “being sick” for the first time in their lives.

The good news is that finding prostate cancer so early using PSA & DRE allows us to talk about curing prostate cancer, and sometimes an option is even safely postponing treatment, to avoid side effects.

For men who have completed treatment, it’s nice to have a blood test to measure success. After surgery, we expect the PSA to basically be zero. After radiation to localized prostate cancer, we want the PSA to go down, maybe not all the way to zero, but to stabilize and not increase over time.

There is no real absolute normal level for PSA, as opposed to other labs like cholesterol and blood counts, so we focus upon trends. Stable or decreasing PSA is usually a good thing, while rising PSA is a concern. If a man has a PSA of 5.0 for many years, I’m less worried about him, versus a man with a PSA that jumps from 0.2 to 0.4, doubling within a short span of time (several months).

Getting the Correct Number

There are some things to consider before getting the blood test, to ensure that we are getting a correct number, and not a falsely elevated PSA:

• Best to avoid ejaculation for at least 48-72 hours prior
• If prostate DRE was recently performed, need to wait at least 6 weeks before checking PSA
• Any extended rigorous physical activity, particularly involving the prostate (e.g. bicycle riding)
  * There are some studies that even associate elevated PSA with other types of exercise not directly affecting the prostate; best advice would be to allow for at least 48 hours after any rigorous activity lasting at least 15 minutes.
• Other causes of elevated PSA may not bee associated with prostate cancer, such as prostatitis/infection.

September is Prostate Cancer Awareness Month. Learn more about the PSA Test:

Prostate-Specific Antigen (PSA) Test

About the PSA Test

Elevated False PSA Levels from Exercise

This blog post contributed by Frank delaRama R.N., M.S., AOCNS, an Oncology Clinical Nurse Specialist at the Palo Alto Medical Foundation and prostate cancer nurse navigator – a role he created at PAMF in 2004.  Frank was also instrumental in creating PAMF’s Prostate Cancer Buddy Program. He  is the chair of PAMF’s Cancer Patient Advisory Council, and has helped many men and their families along the cancer care journey, from diagnosis, through treatment, and into survivorship. You can follow Frank on Twitter at @fdelarama.