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It all started with my PSA numbers

January 1, 2017

Prostate problems are usually diagnosed based on increasing PSA numbers (Prostate Specific Antigen). The PSA, a protein, is an antigenic enzyme released by the prostate and found in abnormally high concentrations in the blood of men with prostate cancer. An antigen is any substance that causes an immune system to produce antibodies against it. Usually the response is very specific which can idetify the source, in this case, the prostate. A simple blood test can determine the PSA. Any amount could imply a problem, but a low number can often go untreated for a long time. Thus, one approach to a rising PSA number is called watchful waiting. In many cases, some response is eventually needed. Responding too soon or two aggresively may not comprise medical necessity.

Blood test(s)
For years I had blood tests that produced lovely full-color brochures filled with graphs and comparisons. Typically, there was a comparison that would say the ideal range and where my numbers fit (or didn't). Here are the results from a blood test I took on January 12, 2015.

Magnesium was 2.1. The ideal range is 1.6-2.6. No problem.
Homocysteine, a marker of oxidative stress should be less than 11.4 but mine, at 17.5 was circled and noted as "high." The doctor suggested taking 1,500mg daily of methyl folate. I liked the fact that he turned to supplements rather than pharmaceuticals.
The inflammatory marker L--PLA2 at 138.77 was well below the target of being under 200, with a hand written comment "good."

So what about PSA? That was on the third page, the last item. The acceptable range is 0.00-4.00 ng/ml. (nanograms of PSA per milliliter). A nanogram is one billionth of a gram. Rremember there are 28.3495grams in an ounce. Likewise, there are 28,349,500,000 nanograms in an ounce. We're talking microscopic here.

I would say 4.00 ng/ml is rather high. Many urologists start to get concerned when the number gets above 2.0. A second imdicator is how fast the number increases. The faster the more likely there is cancer. My value for that test was 6.46, with the determination of "high." The number was circled, but as far as I can remember, nothing was ever said about it. There was no referral to a urologist. The previous blood test, in February of 2013 (I can't locate one for 2014), had a value of 3.15. My PSA number had doubled. That should have been a red flag. It's odd, because I liked that doctor and felt he was very thorough. I have no idea how he missed this.

My records show that six months later, in July, 2015, the value was still 6.40, essentially unchanged. Although rather high for watchful waiting, apparently the decision was made to do nothing. I'm very proactive about my health; so it seems to me had there been a problem raised, I would have wanted to address it. I remember nothing of the kind. However, in writing this blog, I looked in my file and found another blood test that I had not previously noted. It was taken on March 18, 2015, barely two months later. There, my cholesterol was 256 (bad), glucose 91 (getting high), and PSA 8.13 with a note indicating the previous value was 6.46. That's rather confusing because four months later it was 6.40. Perhaps we were hoping that it would continue to go down. Such was not the case.

In 2016 I changed health plans, thus networks, thus doctors. In January I had another blood test, for which the PSA came in at 12.3. It doubled again, in six months. In this case, the doctor responded with concern. There can be some activities that raise the PSA level temporarily, like a lot of bicycle riding, but a more likely possibility is inflammation. Prostatitis. So, I took a series of antibiotics. We checked again in May, and the PSA was 16.0. Not inflammation. Likely, cancer. I was referred to a urologist, leading to the events which are described in my book. It was indeed cancer.

The key issue is whether or not the cancer has extracapsular expression, which is to say, gone beyond the capsule (border) of the prostate. By all indications, given the high numbers and rapid increase, that should have been the case. The biopsy showed seven of twelve cores malignant, six of them on the left side (see diagram). However, both an advanced form of MRI and a full bone scan showed no spread of the cancer. It could, however, still be there, in microscopic proportions. My urologist, like most urologists, recommended surgery. The surgeon, in turn, recommended we "go wide," taking the nerve bundles, the seminal vesicles (a pair of tubular glands which produce 70% of the semen), and the lymph nodes. Ultimately, during my proton therapy, they did treat a perimeter margin and the seminal vesicles and lymphnodes. Unlike surgery, however, my treatment was painless, non-invasive, and 98% likely to have no recurrence.

I did a number of things to address my cancer, including refining my diet, praying, and looking for the inner, metaphysical reasons why I might have gotten cancer. I go into this at some length in the book. My proton therapy started in September. In August, I had one last PSA test, which came out at 14.6. It actually went down by 10%. That could be a statistical fluke, but I like to believe it was the result of my efforts, and is one of the reasons why the cancer hadn't metastasized.

PSA tests are criticised as causing people to worry needlessly or agreeing to surgery or other treatments when they aren't needed. There are several other types of tests being investigated, but that goes beyond the scope of my comments here. After my extensive research I chose proton beam therapy, also called proton therapy. (If you are being treated with protons, they will be in an organized beam, hence that term is a bit redundant.) It all started with my PSA numbers.

And what now? In February, 2017, I had my first post-treatment PSA test. I was told to ignore the numbers for at least a year, but I was still curious. The result was 1.42. Or possibly 1.2. (The letter I received and my online records don't match.) I'm heartened by the low number, but the key will be that they keep going down. Any consistent rise in PSA after treatment can indicated problems. I don't expect that. We'll see. It's a numbers game.

Meanwhile, you may want to check out our two other related websites:
This is dedicated to Robert Ferre's book Best Prostate Cancer Treatment: Proton Beam Therapy. It has updates and additional information, photos, and more.
This site has an up-to-date list of proton therapy centers in operation in the United States, as well as a number planned or under construction.

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