The PSA Test...Still Controversial?

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Regular Member

Date Joined May 2007
Total Posts : 133
   Posted 12/6/2007 12:42 PM (GMT -6)   
No major scientific or medical groups (including The American Cancer Society) recommend routine testing for prostate cancer at this time. These groups (too many to list here) have concluded that studies completed so far do not provide enough evidence to know whether the benefits for testing for early prostate cancer outweigh the possible risks. (ACS: Can Prostate Cancer be Found Early?)
Many frequent Forum readers and contributors are familiar with the above statement. It is not new. Still, it angers many, including me. The American Cancer Society and other organizations recommend "that health care professionals offer the option for testing for early detection of prostate cancer to all men who are at least 50 years old (or younger if at high risk)." Simply put, the PSA test is not included in any of the standard blood tests. It is not considered all that reliable. There is no "magic" number, such as 4.0, that is guaranteed to detect prostate cancer. And it is not recommended before the age of 50.
In a July, 2003 issue, The New England Journal of Medicine goes on to say, "If the threshold PSA value for undergoing biopsy were set at 4.1, 82 percent of cancers in younger men and 65 percent of cancers in older men would be missed. Dr. Peter Scardino in his Prostate Book goes on to say" 70 to 80 percent of cases, an elevated PSA that triggers a biopsy uncovers no evidence of cancer...20 percent of existing prostate cancers would be missed if doctors relied on PSA results alone."
Now it is easy to cherry-pick quotes knocking the PSA test. But what is the answer? Dr. Scardino continues: "The PSA test properly used remains the best indicator of a cancer's presence." Doctors have to learn how to interput the test. Dr.Scardino goes on to talk about PSA velocity, (the rate or speed of PSA rise or doubling time). "If a PSA level increases more than 0.75 nanograms per milleter per year, there's an increased risk of finding cancer.
This is practical, but how about the man with a low PSA taking his first PSA test? What number do we use to measure against?
Dr. H. Ballentine Carter MD and Professor of Urology at Johns Hopkins Brady Urilogical Institute says the key is to look beyond the cutoff numbers and establish a baseline at a younger age. "Test when the other confounding benign conditions (like BPH which cause PSA to rise) do not exist...about 35 to 40 years of age. This will provide a baseline upon which other measurements of PSA can be compared for the rest of the patient's life. Change for PSA over time is the most valuable tool we have for interperting the PSA.
This year, 234,460 men in the United States will be diagnosed with prostate cancer. about 30,000 will die of it. Source: American Cancer Society
So why should anyone still want a PSA test? Well Dr. Patrick Walsh in his book, Guide To Surviving Prostate Cancer, may have the strongest and most compelling quote of all, "Because it is saving lives." I know it saved my life. How about yours?
Best Wishes,
Age: 55
Diag: 12/03/05, Biopsy, Gleason 10
Hormone Therapy: 12/15/05
PSA: 5.7
Surgery: 02/14/06
EBRT: May thru July '06
Current PSA .03, 09/21/07
Diag: T3b Seminal Visicle Involvement, Gleason 9 both lobes

Post Edited (veteran1) : 12/6/2007 2:40:29 PM (GMT-7)

Veteran Member

Date Joined Oct 2006
Total Posts : 1211
   Posted 12/6/2007 1:35 PM (GMT -6)   
Thanks for your interesting and informative posting. about all I can say for sure about it is that PSA testing has, without a shadow of a doubt, saved my life. When my PSA was tested late in 2006, it was found to be above 'normal'. This prompted action for a biopsy which reviled the presents of my cancer. The consequent open prostatectomy allowed me to return to a near normal life. Thank God for PSA tests!
I can only hope that PSA testing for all men will soon be included in standard blood tests.
Best wishes for a continuous and completed recovery for you.

Born Sept., 1936
PSA 7.9
Stage T1C
Gleason's Score 3+4=7
Open RP 28 Nov 06
by Dr. Goodman in Chilliwack, B.C., Canada
Catheter out 15 Dec 06
Dry since 11 Feb 07
1st PSA result on 15 March 07 = 0
2nd PSA result on 15 June 07 = 0
3rd PSA result on 12 September 07 = 0

Regular Member

Date Joined Sep 2007
Total Posts : 293
   Posted 12/6/2007 2:56 PM (GMT -6)   
My PCP let my PSA go from 4 in 1988 to 10 in 2007, and still did not send me for a biopsy, becouse he could not feel anything with the finger wave. Yet when I could not get a Insurance Company to issue a new life policy due to the hight PSA reading, I refered myself for the biopsy. End result, my prostste was 65% full of cancer, and only due to a miricle, it had not spread. The PSA test may not be 100% accurate, it sure saved my life!
PSA 10 June 2007
Biopsy July 2, 16 of 16 samples positive
Di Venci 10/09/07, four hours on table, 3 in recovery
Total time in Hospital: 29 hours
Record for Dr. Lance, 65% of prostate had cancer, but NO spread, clean margins
Clean nodes,
First PSA at 5 weeks, UNDETECTABLE!
Catheter out at seven days, dry from hour one!
The Lord has truly Blessed me.

Tim G
Veteran Member

Date Joined Jul 2006
Total Posts : 2361
   Posted 12/6/2007 4:39 PM (GMT -6)   
Good information, Veteran!  Thanks for the reminder about  the PSA testing controversy.  In my own case, I have had annual PSAs.  The result quadrupled(from 0.6 to 2.5) in one year, which suggested to my primary care physician that something was awry, despite the negative digital rectal exam. 
We retested 3 months later in case it was a transient rise, then I was sent to a urologist for a consult.  The urologist recommended biopsy, but said it was only a 10% to 20% that it was cancer.  He said, "If it isn't, fine; if it is, we've caught it early and can 'cure' it.
Bingo!  One of 12 biopsy samples was positive.  The slides were sent to Dr Epstein  at Johns Hopkins for a second opinion and I began my prostate cancer journey with the best possible scenario for a cure.  
I personally do not understand why the AMA does not promote annual PSA testing for men.  I'm glad my physician included the test as part of my annual physical examination. 
I think that PSA velocity,rather than absolute numbers, are more predictive of cancer, especially in the lower ranges.  My PSA at the time of diagnosis was still within the normal PSA range.  Go figure!

Age 59 PSA 2.6 (Quadrupled in one year) Gleason 5
Bilateral nerve-sparing RRP 6/21/06
Cancer confined to prostate, post-op PSA's non-detectable

Regular Member

Date Joined Oct 2007
Total Posts : 94
   Posted 12/6/2007 6:03 PM (GMT -6)   

Thanks Veteran for your comments.

There  are many misunderstandings about the usefulness of both psa  and  testing  with psa.  For the most authoritive explanation of these misunderstandings, I recommend a booklet called HORMONE BALANCE  FOR MEN, by John R Lee M.D.  Dr. Lee does a remarkable job of clarifying what men  need to know about prostate cancer and PSA, and he backs it up with ample references to scientific studies. In a nutshell, what Dr. Lee explains are the two biggest fallacies in mainstream medical thinking regarding prostate cancer, which are 1) that it is beneficial to lower the PSA count as an integral aspect of treatment,and 2) that blocking testosterone will inhibit the growth of prostate cancer. One  of the most important concepts you will learn from Dr. Lee"s booklet, that even your doctor may not understand, is that when normal healthy cells of the prostate gland produce PSA it is simply in response to crowding ( or pressure). For instance, an infection on any type of inflamation in the prostate gland generally cause a rise in a man's PSA production because the swelling causes pressure or crowding of the normal cells. Even manually massaging the prostate gland will often cause a rise in PSA producton for the same reason. This PSA rise is the body's way to try to reduce this infection or inflamation, and indeed it has now been proven that the PSA itself is "ANTI-ANGIOGENIC" ,which is a process that  inhibits the growth of new blood vessels to the tumor. So with this understanding,---it is clear that a man with prostate cancer would NOT WANT to artificially lower his PSA production through the use of hormone blocking drugs. Remember , if you have cancer anti-angiogenesis is always A GOOD THING.

Fallacy number two is that blocking testosterone will inhibit the growth  of prostate cancer.  In HORMONE BALANCE FOR MEN, Dr Lee goes into detail about how this medical fallacy got started, and also presents ample scientific evidence that proves this idea is   indeed a fallacy. Common sense points out the fact that prostate cancer is almost non-existant  in younger men,---AT A POINT WHERE THEIR TESTOSTERONE IS THE HIGHEST. You would think  that if testosterone does indeed feed the prostate cancer, then we would have always seen the highest rates of this type of cancer in younger men.

As I said earlier, PSA has anti-angiogenic properties,so a man really doesn't want his PSA production reduced.  Moreover, testosterone  has the ability to oppose estrogen in the body.  Men's bodies make estrogen too, though not as much as women's bodies.  When a man's testosterone level is artificially reduced through the use  of testosterone blocking drugs,---THAT ALLOWS A DANGEROUS SHIFT IN HORMONE BALANCE TO OCCUR,---a shift Dr Lee calls "estrogen dominance" Men can feel and see this shift take place when they take Lupron, Casodex, or other testosterone blockingdrugs,-as they experience enlarged or tender breasts and other syptoms of estrogen dominance.  THIS IS A VERYDANGEROUS SHIFT TO ALLOW TO HAPPEN BECAUSE ESTROGEN DOMINANCE IS LIKELY TO PROMOTE THE GROWTH OF CANCER IN THE BODY.

In a nutshell, conventional doctors THINK they are reducig prostate cancer growth by blocking testosterone and artificially lowering PSA count.  But what they are really doing by employing testosterone -blocking drugs is simply reducing the production of PSA in a cancer patient whose body is producing PSA as a defense agaist the cancer.  This way  of reducing the PSA has no correlation to a reduction in the man's cancer, and the resulting  ESTROGEN DOMINANCE that occurs when testosterone is blocked COULD ACTUALLY PROMOTE THE GROWTH OF CANCER.  Thus the use of testosterone blocking drug for prostate cancer is an extremely dangerous practice,---because it may PROMOTE the cancer growth  in two ways, 1) BY REDUCING THE BODY'S ABILITY  TO PRODUCE PSA THAT IS ANTI-ANGIOGENIC, and  2) BY PROMOTING ESTROGEN DOMINANCE.



age 68, T1c gleason 3+3=6, prostate 66cc, 3 positive out of 13

Scheduling surgery Feb 2008



Veteran Member

Date Joined Apr 2007
Total Posts : 823
   Posted 12/6/2007 8:55 PM (GMT -6)   
I had a physical last January which included a psa test which I have been getting since I told my Dr. I did not want to die from cancer. He has found skin cancer and I have had colon tests to make sure I didn't have colon cancer. When my PSA was 6.3 he called me and we did it again and it came down to 4.3. He still left the decision about a biposy up to me. I again told him I did not want to die of cancer so refer me to a urologist. He found cancer in my prostate. I have had a total of 6 doctors examine me and found nothing with a DRE so I am a beliver in the PSA. It saved my life!!!!


FLHW(David E)
Regular Member

Date Joined Nov 2007
Total Posts : 201
   Posted 12/6/2007 10:23 PM (GMT -6)   
The question is, what else is there? I believe there is a urinary test under development but I am not sure it is approved, widely available or mot importantly approved by insurance companies.
Dx'd 2/18/05
PSA 219, bone mets, lymph node involvement
Gleason Score: 7
Current (11-17-07)
PSA: 23
Lupron, Keto, Avodart

Regular Member

Date Joined May 2007
Total Posts : 133
   Posted 12/6/2007 11:17 PM (GMT -6)   


Thanks for reading FLHW. I am not implying that there is better test. You are right. It is the best we have and it worked for me.

Thank you for your kind comment.


Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 12/7/2007 12:02 AM (GMT -6)   
Good post Vet...
You are preaching to the choir with me. Have a look at my stats and age. The only logical explaination is that the ACS and the insurance companies don't want the added expense. That's my rant.

Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology was poor: Gleason 4+3=7, 4 positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
My PSA did drop out after surgery to undetectable.  It has not returned and I will continue HT until January '08.
My Life is supported very well by family and friends like you all.

Tim G
Veteran Member

Date Joined Jul 2006
Total Posts : 2361
   Posted 12/7/2007 12:03 AM (GMT -6)   
Selmer said...
Tim, you said:
"The result quadrupled(from 0.6 to 2.5) in one year, which suggested to my primary care physician that something was awry, despite the negative digital rectal exam.
We retested 3 months later in case it was a transient rise, then I was sent to a urologist for a consult."

So I take it the retest was 2.6 instead of 2.5 in the initial test.
Did your general doctor or the urologist ever suggest any antibiotic or anything else during those 3 months or prior to biopsy?
Your situation presents a case, age and some numbers similar to my own. In my own case since I did no testing for 5 years after an initial .8 and then got a 2.9 My doctor wrote "good results" on my copy of the results but he couldn't have known whether the jump took place gradually or all in one year like your case.
Then again perhaps I was lucky he didn't because my next test was 1.6. I think I may have had a slight undiagnosed prostititis inflammation. Some of them are non-bacterial and largely asymptomatic yet very real in regards to affecting a PSA. There are several studies on such.
Now the real question I have, for my own thinking, is whether there is a 4,5 or 6 Gleason sample somewhere in my prostate. I'd actually guess there is a 4 or 5 somewhere if looked in enough spots.
BTW did your post operation pathology report give any change in your Gleason 5?
Also did they find any other areas or percents of the prostate involved?

Glad you took care of yourself. I'm curious about what my Friday PSA will show. I'd be happy for anything close to my last test of 1.6. If it pops back up above 2.0, it will probably cause me needless concern for another 6 months.


Selmer--Yes, the PSA retest was 2.6 ng/mL (statistically the same as the 2.5)  The further follow-up and biopsy was triggered by the PSA velocity. My urologist did mention that it could be due to a prostatic infection. I was not given antibiotics, although that probably would have been suggested if the biopsy were negative.  Alas, it was not.
The biopsy core that was positive was a Gleason 6 (3,3) but the pathology report on the prostate following its removal reduced it to a Gleason 5.  The cancer was only in one area about the size of a pea.  But that's like being a little pregnant.  It was only a matter of time (months, years) before it would spread elsewhere inside, then outside, the prostate.
I wish you well on your own situation.  Take care and hang in there...Tim

Age 59 PSA 2.6 (Quadrupled in one year) Gleason 5
Bilateral nerve-sparing RRP 6/21/06
Cancer confined to prostate, post-op PSA's non-detectable

Veteran Member

Date Joined Apr 2006
Total Posts : 1732
   Posted 12/7/2007 12:08 AM (GMT -6)   

So, how would Lee's theory play out with a man who is lean, has a PSA of 20, a testosterone level of say, 600, prostate size of 25gms and an estradiol of 12?
Thems scarey stats when looking at that PSA.

Be well, Swim

Regular Member

Date Joined Oct 2007
Total Posts : 94
   Posted 12/7/2007 3:29 PM (GMT -6)   

Hello swim,

I dont know how that works out.  It looks to me that  the estradiol is in ratio with testosterone at 12, but there could be a progesterone imbalance.With a PSA of 20, there is much cause to worry. I found the Dr Lee books enlightening, because of his position as a leading expert in hormone replacement, who did pioneering work with progesterone. Look up some of the articles by Dr Lee. See what you think. and get back with me,---thanks.


age 68

Psa 4.9--up from2.9  in one year

Tc1, gleason 3+3=6, prostate 66cc, 13 biopsies 3pos.-------I will be having the DaVinci procedure in February 2008

Veteran Member

Date Joined Apr 2006
Total Posts : 1732
   Posted 12/7/2007 5:12 PM (GMT -6)   

Dr Lee has been dead for years. His research was not only incomplete, it may not actually be water tight. While I do believe whole heartedly in hormone harmony, studies say normal testosterone levels in the presence of lymph positive cancer (untreated) may cause a rapid progression for some patients. I'm sticking with the reliability of the PSA until something better comes along. The free PSA is one of our promising early indicators and the serum PSA is absolutely our best post treatment test available. Keeping belly fat down is health wise, cancer or no cancer.

PSSS: Paul did indeed use 2 mgs / day of progesterone cream for quite some time. His cancer / PSA did not progress from diagnosis to treatment. Of course he had a very low testosterone level at the time too. I'm not opposed. I'm simply concerned progesterone is going to do harm to some. DIM or Indole Carbinol 3 / DIM might be the better choice. Who knows? Good luck with surgery soon by the way :>)


Regular Member

Date Joined May 2007
Total Posts : 133
   Posted 12/7/2007 5:55 PM (GMT -6)   
Vickie and Siberian,

I am on Hormone Therapy because most docs agree that prostate cancer "feeds" off testosterone. Estrogen Dominance is an interesting theory, but I can find no research to back it up. However, it is always good for me to read something new, whether i agree with it or not. That is what this Forum is for.



Regular Member

Date Joined Oct 2007
Total Posts : 94
   Posted 12/8/2007 6:03 AM (GMT -6)   

veteran and swimmon

The reports that i read were studies done at Sloan-Kettering. and Baylor University Hospital.  I also read them in a JAMA report. There was another study out of Johns hopkins, also.  Dr Lee has been dead 3 years, but he was a preeminent doctor in Hormone replacement, and a pioneer in the use of progesterone. The  Johns-Hopkins report was  on web page Other information was from the National Cancer Institute. I am only putting this information in the forum, for everyone to view, as additional  background on the different opinions held by the leading prostate cancer researchers.  While I myself have not made up my mind onwhat I would believe to be correct,----I am paying close attention to studies out there that believe there should be a balance in the body of the major hormones,such as insulin, progesterone, estrogen, and testosterone,---and that when this balance is disturbed,--THAT YOU MAY HAVE THE PROMOTION OF PROSTATE CANCER.


Regular Member

Date Joined May 2007
Total Posts : 133
   Posted 12/8/2007 7:15 AM (GMT -6)   


The post concerns PSA testing and the many controversies it generates regarding accuracy and other factors such as age and how to interpert test results. PSA testing is still not part of a standard blood work-up. At what age should testing begin. Does PSA velocity make the test more or less accurate? Does PSA testing save lives?



Post Edited (veteran1) : 12/8/2007 5:21:08 AM (GMT-7)

Veteran Member

Date Joined Apr 2006
Total Posts : 1732
   Posted 12/8/2007 6:28 PM (GMT -6)   
PSA saves in my opionion Vet. Until there is a better way, it's gonna stay the PSA!!!!

1. The PSA is most useful as a post treatment tool..especially following surgery.
2. Velosity is important...marks a trend.
3. PSA testing should begin at 40, earlier with a history.
4. Yeah, why isn't the PSA standard blood work in adults anyway?
5. Free PSA is a useful tool during investigational phase (when a man's PSA is found elevated).


Veteran Member

Date Joined Aug 2007
Total Posts : 1015
   Posted 12/9/2007 12:20 AM (GMT -6)   
Great discussion! :-)
My PSA jumped from 1.2 in October 2006 to 4.3 in April 2007 and with no clinical reason for it to jump other than a possible cancer... thus I had the biopsy and cancer was present. 
My family has no history of prostate cancer and I had no other physical evidence of cancer... no well-defined lumps or bumps.   The biopsy told the story and the PSA is what led to choosing a biopsy.  Without the PSA, the cancer would still be growing inside of me.
It is true the PSA is not perfect and causes false alarms.  The mammogram is not perfect either.  I would not give up either test until we get something much better.
Thank you, Vet, for starting this discussion.
Kind regards,

"Idaho" ~ Barry


Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

1st PSA 0.04 (undetectable) 9/11/2007

My web site:

Veteran Member

Date Joined Feb 2007
Total Posts : 1219
   Posted 12/9/2007 11:05 PM (GMT -6)   
Hi Vet,

Good post. From my point of view, if my husband had gotten his taken yearly, as he should have, he might not in the situation he's now in. So, it is what it is...not perfect but it can be a life saver.

Bless you Vet,
Husband Diagnosed 11/17/05 Age: 63 No Symptoms
PSA: 7.96, Positive DRE
Biopsy Right: 6 of 6 Cores Positive Biopsy Left: 1 of 6 Cores Positive
Gleason: 4+3 = 7 Stage: T2B N0 MX
3 mo. PSA Post LRP Surgery: 11.8, 12.9, 13.9 Bone scan, CT scan, Endorectal MRI, Chest XR - neg.
09/06/06: 6 mo. PSA: 18.8 Distant lymph node involvement Start HT Lupron 3 mo. shots
12/06/06: PSA 0.8
03/07/07: PSA 0.3
06/06/07: PSA 0.1
09/05/07: PSA 0.1
11/27/07: PSA 0.1

Doting Daughter
Veteran Member

Date Joined Aug 2007
Total Posts : 1064
   Posted 12/10/2007 12:31 PM (GMT -6)   

In my father's case, the ONLY reason he had a biopsy done was because we knew that it was above a 4.  (Which after requesting a copy of his medical records for the past 10 years to see what his previous PSA results were, he should have been referred a lot sooner.) Our family is the reason he had a biopsy done.  His pcp never referred him to a urologist..which is another story.  (I am working on the anger/forgiveness but I still have a ways to go)

However, if it was not for the PSA test, he would have never had the biopsy.  Therefore, thank God for the test!!

My frustration with the PSA test is that tumor volume seems to have little to do with the actual PSA number.  Can anyone explain this?  For example, my father's PSA was less than 6 and according to the tables he had approx. a 10% chance of spread and sure enough it spread.  In addition, looking at the posts on this particular forum, there are many men who have higher PSAs that had negative margins and confined disease.  Don't get me wrong, I am thrilled for all of you.  I just wish my father's pathology yielded the same results. sad    (This is another area where I struggle.  I want to make sense of everything, but Cancer clearly doesn't follow a "guideline") 

Happy holidays and peace to you all,


Father's Information
DX July 15, 2007
Age 62 (now 63)
PSA 5.5
Original Gleason 3+4=7 
Post Surgery Gleason- 4+3=7
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin
One positive node
Bone Scan/CT Negative (Sept. 10, 2007)
T3a N1 M0
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
HT to being Nov 07
Radiation soon to follow

Regular Member

Date Joined Aug 2007
Total Posts : 120
   Posted 12/10/2007 11:44 PM (GMT -6)   
Great information here, thanks, 1 item not covered about PSA being lower one time than the one before.
My Uro asked me not to have intercourse for two days before a PSA test. He said that ejaculation would
cause a rise in PSA and could give a false reading. If you look at my stats you can see that it was PSA
tests that have saved my life for a while. I think most of us here agree that it is the best test we have
at this time and I for one am sure glad it was available. My biggest concern is, it is not made available to
those in their 30's and 40's because the family doctors or primary physicians are not aware of how much
it can help and I think a lot of them think that a PSA of 4.0 is OK. Thanks for all the good info. Uncle Dan
Age 67
No symptoms, DRE negative, 10 - 06 PSA 5.44, 01 - 07 PSA 6.47
5 - 07 CT and Bone scans negative, 05 - 07 Biopsies, 2 of 6 positive
Gleason Score (3+4) 7 Stage T1c
08 - 14 Dr. Dasari - Baptist Hospital, Nashville da Vinci RAP, five hours surgery
Some right nerve and all left nerve removed,
Hospital discharged 8 - 16
Pathology report Negative margins, Encapsulated, 50% left side
Lymph nodes 2 R & 1 L - Negative, R & L seminal vesicles - Negative
Gleason changed (4+3) 7 closer to 8 than 6
9 - 26 Great PSA 0.000, 9 - 27 Starting on meds for ED
10 15 Dry most of the time, occasional leak (dribble )
10-27 Received pump started use on 10-29 can see resulted, enlargement.
11-22 Viagra, Lavitra no help yet, Pump still not producing usable results either.
11-28 2nd PSA since surgery 00.00

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