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A Different Perspective Regarding Prostate-Specific Antigen Testing

A Different Perspective Regarding Prostate-Specific Antigen Testing I wish to provide a different perspective regarding prostate-specific antigen (PSA) testing and prostate cancer to the one reported by Dr Bennet.1 I was diagnosed as having prostate cancer at a similar age to Dr Bennet (57 years) some 6 years ago. I had routinely checked my PSA on a yearly basis, and it was typically around 2.0 ng/mL (to convert to micrograms per liter, multiply by 1). When retested it went up to 3.3 ng/mL, an unusual increase compared with my previous values but still within what was considered the “normal range.” Despite that, I was concerned about the sudden increase. I had symptoms of benign prostatic hyperplasia, and my father had prostate cancer in his mid 70s. I decided to consult a urologist colleague. On examination, my prostate was slightly asymmetric but without nodules. My urologist told me it was very unlikely to have prostate cancer but recommended a biopsy because of my family history. One of 10 biopsy specimens was reported positive for prostate cancer, with a Gleason score of 6 (3 + 3). Deciding on options was difficult and gave me a greater appreciation for the difficulty that our patients face when confronted with these decisions. I opted for a total prostatectomy with a surgeon highly experienced in robotic surgery. I left the hospital the day after my surgery. The pathologic examination results showed the margins were clean, but the Gleason score was revised to 7 (3 + 4) and cancer was found in another lobe of the prostate. I had no complications from the surgery, my sexual function is excellent, and I do not have to use any pads for bladder leakage. I believe I made the correct decision to have a prostatectomy. I was not comfortable with the idea of “watchful waiting,” being in good health with good life expectancy. My PSA remains undetectable. I believe the PSA test helped save me from a possible late-life experience with metastatic prostate cancer. Dr Bennet's experience is unfortunate but, as my own case demonstrates, is not representative regarding prostate surgery. Prostrate-specify antigen testing certainly has limitations, but it may well be better than no testing for people like myself. Back to top Article Information Correspondence: Dr Casner, Department of Internal Medicine, Texas Tech Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905 (paul.casner@ttuhsc.edu). Financial Disclosure: None reported. References 1. Bennett CL. A 56-year-old physician who underwent a PSA test. Arch Intern Med. 2012;172(4):31122371918PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

A Different Perspective Regarding Prostate-Specific Antigen Testing

Archives of Internal Medicine , Volume 172 (14) – Jul 23, 2012

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Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2012.2038
Publisher site
See Article on Publisher Site

Abstract

I wish to provide a different perspective regarding prostate-specific antigen (PSA) testing and prostate cancer to the one reported by Dr Bennet.1 I was diagnosed as having prostate cancer at a similar age to Dr Bennet (57 years) some 6 years ago. I had routinely checked my PSA on a yearly basis, and it was typically around 2.0 ng/mL (to convert to micrograms per liter, multiply by 1). When retested it went up to 3.3 ng/mL, an unusual increase compared with my previous values but still within what was considered the “normal range.” Despite that, I was concerned about the sudden increase. I had symptoms of benign prostatic hyperplasia, and my father had prostate cancer in his mid 70s. I decided to consult a urologist colleague. On examination, my prostate was slightly asymmetric but without nodules. My urologist told me it was very unlikely to have prostate cancer but recommended a biopsy because of my family history. One of 10 biopsy specimens was reported positive for prostate cancer, with a Gleason score of 6 (3 + 3). Deciding on options was difficult and gave me a greater appreciation for the difficulty that our patients face when confronted with these decisions. I opted for a total prostatectomy with a surgeon highly experienced in robotic surgery. I left the hospital the day after my surgery. The pathologic examination results showed the margins were clean, but the Gleason score was revised to 7 (3 + 4) and cancer was found in another lobe of the prostate. I had no complications from the surgery, my sexual function is excellent, and I do not have to use any pads for bladder leakage. I believe I made the correct decision to have a prostatectomy. I was not comfortable with the idea of “watchful waiting,” being in good health with good life expectancy. My PSA remains undetectable. I believe the PSA test helped save me from a possible late-life experience with metastatic prostate cancer. Dr Bennet's experience is unfortunate but, as my own case demonstrates, is not representative regarding prostate surgery. Prostrate-specify antigen testing certainly has limitations, but it may well be better than no testing for people like myself. Back to top Article Information Correspondence: Dr Casner, Department of Internal Medicine, Texas Tech Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905 (paul.casner@ttuhsc.edu). Financial Disclosure: None reported. References 1. Bennett CL. A 56-year-old physician who underwent a PSA test. Arch Intern Med. 2012;172(4):31122371918PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 23, 2012

Keywords: prostate-specific antigen

References