Well, I jumped the gun by a couple of weeks and had my latest PSA test done this past Tuesday. I was originally going to wait until the week before Christmas, but with all that’s going on, I decided to go a little early.
Let’s just say I received an early Christmas gift—my PSA dropped from 0.14 ng/ml to 0.13 ng/ml. I can’t explain it, but I’ll take it. It also bumps my PSA doubling time out to 67.7 months. I’ll take that, too.
My appointment with the doctor is on 5 January 2021, and I suspect that, just like the last one, it will be a telephone call rather than an in-person visit given all that’s going on with the pandemic. That’s fine by me. I suspect the conversation will go something like, “There’s no need for action. Let’s retest in another 6 months.”
I’ll have to admit that I psychologically prepared myself for a higher number—perhaps as high as 0.2 ng/ml—and I was a bit taken aback when I saw the results. In a good way, of course. It took a few seconds to reconcile the change in thinking.
All the best to everyone through the holidays and into the New Year! Steer clear of the ‘rona and stay well!
My appointment with the doctor is scheduled for tomorrow afternoon, but after dinner this evening, my phone rang. It was the doctor calling about my appointment.
In a nutshell, VA Medical Center San Diego is trying to reduce the number of in-person visits during COVID-19, so he was wondering if I would be okay chatting with him about my results over the phone. Of course, I was.
He let me know that my PSA dropped from 0.16 to 0.14 ng/ml and that things were pretty “stable” and having a “low PSA” was a good thing. He mentioned that at some point in the future, we may need to discuss radiation, but that point wasn’t now. “For you, that could be years from now.” I’ll take that.
I shared with him my desire to do imaging before zapping if possible. I also brought up the trial at the VA Los Angeles, and he wasn’t aware of it. So I pulled it up and shared the trial number with him for his education / reference.
Bottom line: We agreed to retest in January and go from there.
Now all I have to do is make it through six months of COVID insanity…
On a related note, the VA healthcare system has gotten a bad rap over the years for a variety of things. It seems to be location-dependent, and some of the criticism is well-deserved.
I’ve been going to the VA Medical Center San Diego and its satellite clinics for about 8 years now, and I’ve had nothing but a positive experience, and tonight’s unsolicited call from the doctor just reinforced that for me.
As we used to say in the Navy: Bravo Zulu! (Well done!)
Apparently, getting my blood drawn in mid-afternoon adds one day to getting my results. Needless to say, I’m pleased with the 0.14 ng/ml reading. It’s down 0.02 from the last two times (excluding that oddball 0.08 reading in February).
My work schedule forced a little change in plan for getting my PSA test done. I was planning on going first thing tomorrow morning, but a 9:00 a.m. scheduled meeting was a little too close for comfort, and I wasn’t sure that I could make it back to the office in time, so I left work a little early to have the blood drawn.
The clinic did do a COVID-19 screening of me before I could even enter the building, including taking my temperature. Surprisingly, there was no one in line for the lab, so I was in and out in under 10 minutes. I may make going later in the afternoon my new routine going forward. In the mornings, everyone wants to be the first one there, so you can wait for about an hour to get the test done.
If COVID isn’t affecting lab processing and reporting times, I should be able to access my results online after 10 p.m. PST Wednesday.
Wow. I just may get this post out on time this month! I tell you, this pandemic thing has really thrown me for a loop when it comes to maintaining some sort of routine. Fortunately (or perhaps unfortunately), I’ve returned to working from the office every day for the last three weeks, and that’s brought some structure back to my life.
It’s hard to believe, but four months have passed since my last PSA test, and I’ll be heading off to the clinic on Tuesday morning. I hope. I haven’t actually confirmed that they’ve reopened for routine things like blood tests. If they are open and they do take the sample, I should have the results late Thursday night or Friday. My appointment to go over the results is on 2 July.
Just as a reminder, here’s my PSA roller coaster:
I’m at the point where I don’t get too worked up about these tests anymore, even with the upward trend. It is what it is and I’ll deal with the number when I get it.
Imaging Trial for Veterans in Los Angeles
The VA Greater Los Angeles Healthcare System is conducting a phase II trial “to determine whether a positron emission tomography (PET)/computed tomography (CT) scan using 18F-DCFPyL affects the clinical management plan in Veterans.” Some are saying that 18F-DCFPyL may prove to be even better than a Ga-68 scan.
For patients with biochemical recurrence, they want your PSA to be at least 0.2 in a post-radical prostatectomy situation, so unless my PSA jumps up again next week, I’m not eligible. (No, I’m not wanting it to jump up.) The cost is free to veterans and only veterans are eligible. You can learn more about the trial here:
I met with the urologist this afternoon—a new one to my case—and he was personable but very direct.
We talked about the goofy PSA reading and he wasn’t all that concerned about it. It appeared to be lab error and dismissed it as pretty much meaningless. But what followed caught me a little off-guard. “The one thing you absolutely do not want to do is start treatment.” He was quite emphatic. His reasoning was several-fold.
First, he talked about over-treatment given my numbers and pathology. He was looking at how long it took for the PSA to return post-surgery (nearly five years) and how slowly it’s been increasing (PSA doubling time / velocity). Those were positive indicators to him. Treatments like radiation and hormone therapy have side effects that impact quality of life and can be avoided with minimal risk for now.
Second, he expressed concern that if we started treatment too soon, specifically hormone therapy, it would be less effective when we may need it the most.
Third, he mentioned the absolute value of my PSA and how imaging wouldn’t be able to detect where any cancer may be at that level. That’s nothing new to me. We talked about the Ga-68 PSMA trial up at UCLA, and he confirmed that at my PSA level, the chances of finding something meaningful were small (<30%).
Finally, he was very much aware that continued monitoring is needed to make sure that this doesn’t get away from us, and he was content with PSA tests every six months considering how slowly the PSA was increasing. I wasn’t quite comfortable with that, so my next PSA test will be in late June with an appointment on 2 July 2020.
I did mention to him the issues I’ve been having with my back and sciatica, and that I had an MRI last night to have that checked out. I’m 99.5% certain that the problem is related to a back injury that happened in 1986, but that other 0.5% of me was wondering if there was metastasis to the spine. He pretty much dismissed that possibility out of hand given where my PSA level is at. (Hey, my mind wanders into some pretty dark corners sometimes, but given that one of the first place prostate cancer likes to metastasize is the spine, it’s not too far-fetched an idea.)
Again, I was a little taken aback by how emphatic he was concerning not pursuing any treatment at this moment. I got the sense that he really values trying to balance avoiding over-treatment versus quality of life versus knowing when to step in and act. For now, I’m comfortable with continued monitoring with another PSA test in four months.
So, I’ll leave you with a little urology “humor” that has men cringing everywhere.
As I was sitting in the exam room waiting for the doctor, I looked over on the desk and saw the tools of the trade—some lubricating jelly and toilet tissue—at the ready for the dreaded DRE. (The rubber gloves were in dispensers hanging on the wall.)
Then I reminded myself that it was a DRE during a routine physical that discovered the mass on my prostate and started this adventure. Thirty seconds of discomfort can save a life.
My last PSA test on 4 February showed a 50% drop in my value compared to the previous test in September 2019, which is a major, unexplained swing considering that I haven’t been doing treatments of any type to lower my PSA. It just didn’t sit right with me, so I asked for a retest.
I went in on 20 February for the retest, and the PSA came back at 0.16 ng/ml, exactly where it was in September 2019. (At least that’s the silver lining in the cloud: it didn’t go even higher.)
We’ll probably never get a good explanation for the dip in my PSA earlier this month, and I guess that’s just part of dealing with this beast. I’m going to leave the errant data point on my chart just to show how wacky this can be at times.
The one thing that this has done, though, is drive my PSA Doubling Time down to 39.7 months according to the Memorial Sloan-Kettering PSADT Calculator (excluding the 0.08 reading). That’s still a very good number, but it’s downward trend over time is becoming more concerning.
I’m really glad that I was able to get the retest done before my appointment with the doctor on Tuesday. It certainly will make for an interesting discussion.
Excited that my PSA value went from 0.16 ng/ml in September to 0.08 ng/ml last week, but completely thrown for a loop as to how and why a 50% decrease happened (without any treatment or other intervention). The last time I was at 0.08 ng/ml was nearly three years ago in April 2017.
I follow the same routine for a week before each PSA blood test to avoid activities that may influence the outcome. The only difference time was that I had a cold/flu the days before the test (Monday afternoon-Thursday evening; blood draw on Friday morning), but I can’t imagine that having any influence on a PSA number. I’ll ask when I talk to the doctor on 25 February 2020.
I tried updating my PSA Doubling Time using the MSKCC PSADT calculator, and this bumped my PSADT from 43 months to 123 months. There is a caveat, though. The online calculator accepts only PSA values of 0.10 or more, so I rounded up my 0.08 to 0.10 to run the calculation.
I get that there can be lab errors or accuracy concerns as well, but I would be hard-pressed to attribute a 50% shift to a lab issue. Still, when you look at the last four data points on my chart, there is pretty significant fluctuation between each and its previous data point when compared to the quite consistent series of data points prior to that. It makes you go, “Hmm…”
Don’t get me wrong. I’m not complaining about where the PSA is at. I will say, however, that these kinds of wild swings make it challenging to wrap your head around what’s happening in order to prepare for what’s next. I was mentally gearing up for calls to imaging centers and radiation oncologists because I was expecting the result to be in the 0.16 to 0.18 range this time around.
So that’s it. A short post with unexpected, somewhat bizarre results. We’ll see what the doctor says on the 25th.
Years ago when I was in my late 40s, I was on one of my infamous road trips through the U.S. Deep South—Mississippi, specifically. I stopped for lunch at a fast food joint, placed my order, and was surprised by how cheap it was. When I got to my seat, I looked at my receipt and it showed “Senior Discount.” I was in my 40s, for crying out loud! I know I didn’t look that old.
Now, about 15 years later, I’m seeking out senior discounts. Or at least one in particular.
In the United States, when you turn 62 years old—as I did last week—you can purchase a lifetime pass that gives you access to all of our national parks for a one-time fee of a mere $80. Within a few hours of turning 62, I was in possession of my lifetime pass. Sweet! Now, I just have to make the time to use it.
My sister came out from Chicago to celebrate my birthday, and it was good to be able to spend some quality time with her, showing her some of the more popular sites in sunny San Diego. She, of course, enjoyed escaping the Chicago winter, even if it was just for a long weekend.
So there are some perks to making one more trip around the sun each year as we grow older. It doesn’t always seem that way on days when joints ache and memory slips a tad (now where are those keys again??), but it certainly beats the alternative.
I’ll be back to reality with my next PSA test in early February. Until then, you may find me in a national park someplace. (Yes, even Death Valley. It’s on my bucket list and now is the time of year to go.)
I’ve been a bit remiss in following my regular posting schedule the last two months. I’ll work to get back on track, posting on the 11th of each month. (Unless I happen to be in a national park.)