I haven’t been visiting the site much lately and haven’t posted for ages. I’ve had something else taking all my attention.
In 2018 I had a PSA test. I was 61. It was very low; so low that my GP said “you don’t need another test for 5 years.” Well, 5 years later I was having a cardiac ablation to fix atrial fibrillation. I forgot about the PSA test. This year I asked about one (the GP never suggested it). I had no symptoms at all. It came back high. The repeat came back high. The MRI showed “probable tumors.” Then came the biopsy. Grade 3 cancer and it has escaped from the prostate. Then a PET scan…it is now in my lymph nodes.
So now I’m on the standard 18 months of androgen deprivation and 39 (!) sessions of radiotherapy. I’ve tired myself out reading papers on adjuvant therapies to try to add.
I’m not writing this for sympathy. I’m writing this to remind every guy here: make sure you get a PSA test done EVERY YEAR. No exceptions. I just wish someone had reminded me.
Oddly enough, if you read papers about prostate cancers, one of the main drivers is the PI3K/Akt/mTOR pathway. And we know that rapamycin inhibits that. But in my case, it didn’t seem to matter.
Highly suggest people listen to this podcast about the way to properly screen for prostate cancer. It’s very much available, provided that screenings happen regularly.
In this episode, Peter takes a deep dive into prostate cancer screening, explaining why advanced and metastatic diagnoses continue to rise despite the availability of screening tools, and what can be done to reverse this trend.He breaks down what PSA actually measures and why it is far more informative when tracked over time rather than interpreted as a single value
So interestingly, I ran the question by a group of Urologists some time ago (2-3 years). I have been below 1 for 3 or 4 years and they said, yep - there is a decent amount of population data that says I am quite unlikely to every have an issue. The trend over time is fairly significant and low values at 50 or so are a good long term predictor. I’m 56.
The arguments against screening are avoiding cost, stress and procedures that may not be helpful.
My 60yo BIL has had MRIs, biopsy and all benign. Doesn’t mean he is free and clear for life but he went through a lot and none of it changed his prognosis.
Hi DrT, I’m sorry to hear about your diagnosis and offer strong moral support - I wish you the very best.
As you say, rapamycin should have been helpful, it’s unfortunate that it doesn’t seem to have worked. It’s a good reminder that whenever there is a bell curve, someone has to be at the extreme end, and sometimes it’s you. That’s why population studies have their limits as to personal applicability. Not to pile on that point, but there’s this study which for a long time shaped my expectations:
Influence of blood prostate specific antigen levels at age 60 on benefits and harms of prostate cancer screening: population based cohort study
The bottom line, the study concluded that a single PSA reading at age 60 was a strong indicator of PC mortality risk. For those who had a reading of lower or equal to 1.00, odds were overwhelming that they would not experience metastatic PC or die of PC in the next 15 years, and the recommendation was for no further screening based on harm/benefit.
As you said, you had a reading below 1.00 at 61 - this would’ve put you in the low risk “no further screening recommended” group.
However, before anyone assumes they’re safe at or below a PSA reading of 1.00 at 60 y/o, there is an important qualification - which is why I changed my thinking (I was at 1.00 at 60).
This qualification is the following: if you are on medications which lower your PSA reading, this does not apply. Statins lower the PSA reading - so if my reading while on statins is at 1.00, it means my number is above 1.00 without the statin and so out of the “safety” range. Actually, my situation was even worse - I was on a whole gaggle of supplements which had the potential of artificially suppressing my PSA reading. Meanwhile, according to my genetic risk assessment, my risk of PC is 40% above average. This lead me to conclude that I cannot take any comfort in the Swedish study and I continued to request a PSA test yearly. Interestingly, last year my PSA (at age 67) was elevated above the “magical” 1.00 (it was 1.34) which has me somewhat worried. As a side note, there are of course factors which might elevate the PSA reading (recent ejaculation, long bike ride etc.) - and absurd as it may seem, digital prostate examination (where the doctor sticks his finger up your behind), if you then go off to have a blood test (including PSA) shortly after the doc visit. I have always tried to be careful not to get a distorted reading, and it’s something I try to be cognizant of.
The point of all this is to say that you are an individual and personalized medicine is the goal. All the population studies in the world only indicate statistical odds at population levels - you might be that minority, and at the extreme - minority of one.
I have seen this over and over again in my case and in the case of my wife. I read all those diet and lifestyle studies regarding LDL levels and despite truly epic levels of diet adjustments (as an example: over 100g of fiber daily etc.) and extreme measures my LDL remained stupidly high. So much for that. I then got on triple LLT drugs and my LDL barely budged - while studies indicated my LDL should’ve been hammered into the ground based on population studies. Exactly the same situation with my A1c - massive exercise and dietary measures - and stubbornly stuck at prediabetic levels. And so on for a lot of other “gee, I had zero risk factors” or “but, but, but all the studies said”. At this point I read the studies and dutifully follow recommendations, but have no expectations that they’ll necessarily apply to me.
I therefore strongly agree with you regarding getting tested for PSA - never mind what population derived recommendations may say. It’s your very individual body and it’s your life. Get tested. I would broaden this to many other screenings (colonoscopy even if older than 75 - where it’s no longer recommended!), get the CAC (even if many cardiologists don’t think it useful) and so on. Yes, false positives and over treatment and incidentalomas happen - but that’s where discernment is required - sticking your head in the sand is a childish reaction to complexity - sorry, life isn’t simple and you will need to step up, not hide and pretend.
Meanwhile, please take care of yourself and my thoughts are with you. Remember, you can always count on moral support from the community here. All the best, and good luck!