~ Ani Difranco
Over the past few weeks I’ve had a bit of a scare I’ve been dealing with. As a heart transplant patient, we are constantly monitored for all kinds of issues and illnesses. We have blood and urine tests, X-rays, EKG’s, echocardiograms, cardiac biopsies, heart caths, colonoscopies, dermatology screenings, etc. I know the ladies have to see their gynecologists and the men get PSA tests.
For me PSA has been an ongoing issue. It’s been “elevated” for a decade.
I want to talk about a few things here, so most of this is for the men …. or ladies if their “significant other” or a loved one is also on the elevated PSA journey. I’ll try not to get too graphic, but it is what it is ……..
PSA, Prostate Specific Antigen – Here’s the technical stuff
- The PSA test measures the blood level of PSA, a protein that is produced by the prostate gland. The higher a man’s PSA level, the more likely it is that he has prostate cancer. However, there are additional reasons for having an elevated PSA level, and some men who have prostate cancer do not have elevated PSA.
- The PSA test has been widely used to screen men for prostate cancer. It is also used to monitor men who have been diagnosed with prostate cancer to see if their cancer has recurred (come back) after initial treatment or is responding to therapy.
- Some advisory groups now recommend against the use of the PSA test to screen for prostate cancer because the benefits, if any, are small and the harms can be substantial. None recommend its use without a detailed discussion of the pros and cons of using the test.
In my case, my PSA has been above the”normal” range of 0 to 4 for over ten years. Over the past 10 years I’ve been seeing my urologist on a regular basis. Over time as the PSA levels have increased, I’ve under gone 3 different prostate biopsies of 10 to 12 specimens each time. All specimens have been NEGATIVE.
Recently, I had my typical labs completed and my PSA jumped up another 50% in 6 months. From around a stable”10″ to 15.6. As I went in for my office appointment, I found it a bit odd that they didn’t take me to one of the “normal” exam rooms. I thought that maybe they were busy, so we went into a larger lab area. I soon found out why ….. my urologist was more than a bit concerned. I could see the concern on her face and hear it in her voice. We talked about my numbers, my heart transplant, my anti-rejection medications, my history and she said she wanted me to have a new, high-tech test that is way better of detecting prostate cancer than the old PSA. The test is called a PCA3 and I knew about the test and had even spoken with her about it while it was still in clinical trials. My urologist wanted to do the test right then. Another note, I have read that the PCA3 test is $3800 …. hope insurance covers it!!
Here’s the technical stuff on PCA3 –
The Prostate CAncer gene 3 (PCA3) Assay is a gene-based test. It is not a replacement for prostate specific antigen (PSA). It is an additional tool to help decide if in men suspected of having prostate cancer (PCa), e.g. those with a PSAbetween 2.5 and 10 ng/mL, prostate biopsy is really needed to diagnose PCa. PCA3 is, unlike PSA, prostate cancer-specific. This means that it is only produced by PCa cells and not affected by prostate size. It discriminates better than PSA between PCa and benign/non-cancerous prostate diseases such as benign prostatic hyperplasia (BPH, i.e. prostate enlargement) or prostatitis (infection of the prostate). Therefore, PCA3 gives very useful information, in addition to PSA, in deciding if biopsy is really needed.
The PCA3 test was very easy …. had to have another “DRE” (digital rectal exam …. note to men, women doctors usually have smaller fingers …. just sayin’) …… then had to pee in a cup. Said cup was FEDEX’ed to a lab for gene analysis. I was done, with an order to get a “Free PSA” test, which is a bit more intense version of the regular PSA test and instructions to come back in 2 weeks.
Went and had the “Free PSA” test and stopped at the hospital a week later and got a copy of the results …. the PSA was back down to 10.1, but the”Free” part was a little high at 28%.
I knew the tie breaker would be the PCA3 results. Of course I worried a bit, fretted some and prayed a lot ….. and then I simply put my faith in God. Heck, I’ve already had a new heart installed, I can handle about anything thrown my way.
Well, almost ……
I went back to see my urologist for my follow-up appointment and detected nothing out of the ordinary. Back in a normal exam room, normal questions and follow-up with the nurse and she left and said the doctor would be in shortly. A few minutes later the doc came in, but with the nurse, which I mentally noted is NOT normal. I also noted the doctor was a bit fidgety as she looked at the screen on her iPad …. those few seconds seemed like eternity ….. suddenly, she blurted out, “You’re OK!!! The test came back NORMAL!!” …… I honestly wasn’t ready for that. We talked about the actual test numbers (Mine was 17 ….. anything under 35 is considered NEGATIVE). I think she was more relieved than I was, if that’s even possible … I was mostly shocked!! Her diagnosis was …. I’m just an enigma.
Then it was …. thank you, good-bye and see you in 6 months!
I will remain vigilant ….. I’m not saying I won’t ever get prostate cancer, but I can breathe easy …. until next time.
And I thank God every day for the good and not so good. It’s all part of life and I happen to enjoy living!!