One of the major issues for men who are being screened for prostate cancer is whether or not to undergo a prostate needle biopsy. Factors considered in the standard risk model include prostate-specific antigen (PSA) level, digital rectal examination result, age, family history of prostate cancer and history of any prior prostate biopsies. The rate of change in PSA levels with time, referred to as PSA velocity, has also been used as one criterion for determining the need for a prostate biopsy. Clinical recommendations from two organizations, the National Comprehensive Cancer Network (NCCN) and the American Urology Association (AUA), suggest that men with a PSA velocity that exceeds a certain threshold value (0.35 ng/ml per year) should consider having a needle biopsy, even if their overall PSA levels are below the standard cutoff for the procedure and they have a normal result on a digital rectal examination. However, a recent study published online February 24 in the Journal of the National Cancer Institute concluded that a rapid increase in prostate-specific antigen (PSA) levels is not grounds for automatically recommending a prostate biopsy. This study was also summarized in the March 8th, 2011 issue of the National Cancer Institute (NCI) Cancer Bulletin. Researchers looked at whether a PSA velocity above the 0.35 ng/ml per year threshold—when added to a standard risk model that includes age, PSA level, DRE result, family history of prostate cancer, and history of a prior prostate biopsy—improved the model’s predictive accuracy. The authors concluded that “in all cases, the addition of PSA velocity yielded only a slight difference in the risk model’s predictive accuracy. In fact, the analysis indicated that lowering the PSA threshold for a biopsy from 4.0 ng/ml to 2.5 ng/ml would be a more effective means of directing prostate biopsies.”
As always, the content of this website is intended for information use only. All personal medical decisions and actions should be made only after consultation with established medical professionals.
Monday, March 7th, 2011 was my day for my 4-month PSA test in preparation for my urologist appointment next week. In the past, the week leading up to the PSA test had been characterized by periods of mild depression and apprehension. But the intensity and frequency of these episodes had been on the decrease. In fact, as time goes on, I find myself getting more and more trusting and confident in God’s power to maintain my disease. It is a general rule that our trust levels increase in times of stress as opposed to times of tranquility. At the end of our March 6th Sunday church service, my pastor again anointed me with oil and prayed over me in accordance with James 5:14-15. My consistent prayer is that my prostate cancer either be healed completely or that I be kept in natural or medication-induced remission. But I am always being challenged that in addition to my prayer for healing, it should instead be like that of Christ’s prayer before His crucifixion, namely that “not my will but God’s be done.” In any event, as I entered the hospital parking lot on a beautiful sunny Florida Monday afternoon, I paused for a few minutes and meditated upon, prayed and claimed (where appropriate) God’s wonderful promises and wisdom listed in my website section entitled “Spiritual Medicines.” With a resulting sense of peace, tranquility and humble confidence, I entered the hospital and my blood was drawn. The result would be known in 24 hours.
Tuesday morning I awoke with a great deal of apprehension. Would I continue to be in “remission” or would the PSA result show that I had become resistant (refractory) to the hormone treatments? This would be disastrous as it would accelerate my downward disease progression. I could not shake the negative feelings. I have got to learn to counter these worst-case scenario “what if…” feelings. By noon, I could wait no longer and called my urologist who informed me that my PSA again was <0.02 ng/mL or basically undetectable. Halleluia!!! On the phone I exclaimed “praise the name of Jesus” in response to the congratulatory voices from my urologist’s office. God is so good!!!! I now await my next Lupron treatment or perhaps a “holiday”???? I will have been on hormonal therapy for five (5) years this coming July, 2011. My most troubling side effect has been a fifteen pound weight gain which I am attempting to lose by a strict diet and weight-bearing and aerobic exercise several times per week. My goal is to lose twelve (12) pounds. I’ll let you know if I succeed.