By Pete Williams
“It can be a sign of prostate cancer.”
That’s what my urologist told me two weeks ago, right in the middle of National Prostate Cancer Awareness Month, when he phoned with the results of my PSA test.
Then again, that’s what I thought in January when I underwent anesthesia three times to remove a 1 cm kidney stone. Since then, I’ve dialed in my nutrition further, becoming a borderline vegan. I’ve dropped to what I weighed at college graduation 20 years ago.
The numbers were scary, though. PSA (prostate-specific antigen) is present in small quantities in the serum of men with healthy prostates but often elevated in the presence of prostate cancer.
My PSA was 1.7 – not dangerous in and of itself, though high for a guy my age (almost 42). The problem was my PSA “velocity,” the rise in PSA from year to year.
Many guys my age haven’t had a PSA test. It’s recommended for men over 40, especially those with a family history (which I don’t have), and highly recommended for guys 50 and over.
I probably wouldn’t have had a PSA test at all at this point. But in July of 2009, the Tampa Bay Rays held a free prostate cancer screening at Tropicana Field. As someone with self-employed health insurance, I jump at any free medical services. Plus, there were free Rays tickets involved.
So I had the PSA, which is a blood test, and it came back at a modest 0.9, well in the safe range. I also had the dreaded digital rectal exam and, um, poked fun at the experience in a blog. A year later, in August 2010, my PSA actually decreased to 0.8. I blogged about that too.
I wasn’t planning to get a PSA done this year. The guidelines suggest waiting until you’re 45 if you’ve had favorable results at 40. The Rays offered another free screening in early September, offering a pair of tickets to late-September games.
Yeah, right. As if the Rays would be playing meaningful baseball at the end of the month.
During a kidney stone follow-up visit to my urologist on August 11, he suggested some routine bloodwork. While we were at it, we could do a PSA test. No problem, I said, though I declined the digital rectal exam. My doc and I have been through a lot this year, and I didn’t want to stress our tenuous relationship.
The PSA results didn’t come back until Sept. 12. When your PSA jumps more than 0.35 from year to year, that’s cause for concern. Mine had gone from 0.8 to 1.7.
“We might want to do a biopsy,” the doc said.
Urologists like to say biopsies are routine. That is, if you view the insertion of the equivalent of a sewing machine needle up your backdoor to take a dozen rapid-fire shots at your prostate as routine. You’ll piss blood for a few days. You’ll see it elsewhere for weeks.
“There must be something else we can do,” I said.
The doc offered to prescribe an antibiotic for a week. It was unlikely, but perhaps I had some prostate inflammation. This could knock it out and we could do another test.
“What else can I do differently?”
He mentioned that vigorous exercise within 48 hours can skew a PSA test. “I don’t imagine you know what you did the two days before your appointment.”
“Are you kidding?” I’m a journalist, triathlete, and an all-around anal guy. I called up my training logs.
Tuesday, August 9 – 5:45 a.m. — 55-minute spin class, 45 minutes of core conditioning
Wednesday, August 10 – 6: 15 a.m. — Dry land Paddle Fit workout. (Water too rough to get on the paddleboard.)
Thursday, August 11 – 6 a.m. — 60 minutes of core conditioning. (Urologist appointment followed at 10:50 a.m.)
“That might be the case,” the doctor said. “But a more telling sign would be if you ejaculated within 48 hours of the PSA test, especially 24 hours before. Do you keep records of that?”
“I’m pretty sure I’m guilty there, too, Doc.”
We set up another PSA test for a week. I felt nauseous as I hung up the phone. Prostate cancer is one of the most treatable forms of cancer, though impotence and incontinence are common side effects. Other than that, there’s nothing to worry about.
I wanted a second opinion. And a third and fourth. I wanted to know everything about the prostate. Let’s face it. What guy gives his prostate much thought until it’s threatened?
I called Dr. James Borin, a urologist at the University of Maryland medical center in Baltimore who had provided so much insight during my kidney stone saga.
“The PSA is not a great test, but it’s the best test we have,” he said. “The holy grail of urology right now is finding a better diagnostic tool for prostate cancer.”
Borin reiterated the need to avoid ejaculating and vigorous exercise for up to 48 hours before my next test. I felt relieved after talking with Dr. Borin.
Dr. Aaron Katz, however, initially scared the hell out of me. I saw him interviewed by Don Imus, who has dealt with prostate cancer for three years. Katz stressed that the side effects from prostate removal and radiation are very real. The impotence percentages are scary.
But what I came to realize is that Katz, who appeared on my Fitness Buff radio show earlier this week and is the author of the new book The Definitive Guide to Prostate Cancer: Everything You Need to Know about Conventional and Integrative Therapies, is a strong advocate of taking a holistic, wait-and-see approach to prostate cancer.
Imus, 71, has not undergone radiation or prostate removal, preferring to undergo a strict diet, along with a regimen of supplements and exercise in order to avoid surgery or radiation.
“Not all men need to be treated,” Katz told me. “It’s not like pancreatic cancer or leukemia where you need urgent treatment. Because of PSA screening, many of these prostate cancers are caught early and many patients go their entire lives without needing radiation or surgery, which has side effects such as impotence and incontinence. There are some patients that do need to go those routes for treatment, but for others a change in diet, combined with herbal compounds and monitoring the cancer for years – even a lifetime – is a better course of action.”
Katz calls the PSA test the “Patient Stimulated Anxiety” test since the results often cause a patient to unnecessarily panic.
“We do more than a million prostate biopsies a year in this country and many are just a knee-jerk response to a high PSA,” says Katz, who is a New York urologist and director of the Center for Holistic Urology at Columbia University. “There are other things we should do first. Take a re-test, especially if you’ve had recent sexual activity. We can do a urine test to make sure bacteria isn’t at work. We can do a free-and-total PSA test and even a prostate ultrasound to calculate its size and density. Some men have a bigger prostate from genetics or a fatty diet. All of which will bump up the PSA and not necessarily be a sign of cancer.”
Katz mentioned that taking a spin class as I did within 48 hours of my first PSA exam wasn’t a good idea. That kind of up-and-down on the bike seat can affect the prostate and thus a PSA reading.
I liked Katz’ philosophy and his diet-and-exercise prescriptions. But if I had prostate cancer, what good would that do? I can’t eat much healthier and exercise much more than I already do.
Last Thursday, I went in for second PSA test. I refrained from vigorous activity of all sorts, including sex, for 72 hours, just to be sure. I finished the antibiotics. I prayed a lot.
This time we did a free-and-total PSA test, which is more in-depth than the regular one.
My “free PSA” was 33 percent. That didn’t sound good until I learned that the highest a guy my age can register is between 35 and 40 percent. As for my regular PSA number?
Back to 0.9, consistent with 2009-2010 and well in the normal range.
We’ll still monitor my PSA, revisiting in another three months. I’ll remember to refrain from vigorous physical activity, especially sex, for at least 48 hours beforehand.
Speaking of sex, what about the theory that lots of it is good for the prostate? Use it or lose it, right?
Katz says he often has men ask him to prescribe a program of sex three to four times a week to present to their wives.
“I see a lot of men at a time in their lives where they don’t ejaculate as much,” he says. “The fluid can build up into the prostate-causing calcium deposits that can cause inflammation that can lead to rising PSA or pain in the prostate. There have been studies suggesting a role in the chronic link in inflammation of the prostate and prostate cancer. So in that regard sexual activity has great benefits ranging from reducing stress to perhaps reducing your rate of prostate cancer.”