Controversy over getting a PSA test caused him to pause screening for two years, but a change of heart in year three found prostate cancer.
Gary, from Colorado, had a routine going with his primary care physician: Every year they evaluated his prostate specific antigen (PSA) levels that can indicate possible prostate cancer. Every year the cancer screening showed that levels went up a bit.
“When all this came out about PSA not being effective and all that, my primary care physician (PCP) and I had a conversation about that two years in a row,” says Gary, who is 64 years old. “I had a PSA test every year up until then and we looked at the new evidence and said, Well let’s not do it. So for two years I didn’t have the PSA.”
The controversy about PSA cancer screening refers to the United States Preventive Services Task Force (USPSTF) issuing a recommendation in 2008 against PSA screening, despite objections from the urologic community. As a result, primary care providers, like Gary’s, have since offered fewer prostate cancer screening tests.
Urologists, including all of the physicians at Urology Associates, have been raising the alarm to continue PSA testing. And many primary care physicians, like Gary’s, also rethought it all.
“In the third year, my PCP had done enough research on his own, and he said, Let’s put the PSA back in. My PSA levels were at the threshold when things start to go on,” Gary recalls. “We could look back over the years and see a linear rise with my PSA. So he referred me to Urology Associates, and I went to see Dr. Edward Eigner.”
What followed was a digital rectal exam and an ultrasound-guided biopsy of Gary’s prostate, with Dr. Eigner removing 12 samples for laboratory examination. Four showed prostate cancer of intermediate aggressiveness. If you’re going to have prostate cancer, that’s pretty good news because it means they caught it early – thanks to the wise decision to resume PSA testing.
Good choice on prostate cancer screening & treatment
Next came the big decision of how to treat it, whether to treat it. Dr. Eigner told Gary that if he were 10 years older, they might do nothing.
“My wife and I had a pretty extensive discussion with Dr. Eigner at his office at Swedish Medical Center about all the options. He recommended that I look into two options, surgery or radiation therapy using the CyberKnife,” says Gary. “That discussion with Dr. Eigner was a big help.”
“I learned even more online and particularly via Urology Associates’ patient portal. I had several conversations with Dr. Eigner, and he was able to answer questions I had from my reading,” Gary says. “All of it worked quite well: I knew where I was going, what my options were, what the side effects were. I had really comprehensive information from the start.”
Gary decided to undergo CyberKnife treatment at Anova Cancer Care, which has a clinical partnership with Urology Associates.
“I went through CyberKnife and it was easy. It requires just five treatments instead of 40 with standard radiation,” says Gary. “That’s the route I chose.”
He finished the treatments in July 2015. Gary had a minor bladder issue in March that was easily treated.
CyberKnife turned out to be a good choice for Gary. “Since then, my PSA numbers are down,” he says. “Things are going pretty good.”
Gary to men: “Get your PSA tested”
Gary was wary of prostate cancer treatment at first, well aware of the problems that can arise from surgery and the side effects, such as incontinence, erectile dysfunction and others.
“One of the down sides I’d heard was why bother with a PSA test because of all the false negatives and positives. And the biopsy could be more damaging than the cancer itself sometimes,” Gary recalls.
“But that turned out not to be the case. It was really simple. It sounds unpleasant, and it’s not going to be on your top five things to do, but it was not bad,” he says. “I was fine in a couple of hours. With that ultrasound-guided biopsy technique, the doctor can see pretty well. And Dr. Eigner is a quite skilled, dedicated surgeon.”
Once he learned he had prostate cancer, Gary got in touch with his three brothers and advised them they should have a PSA test. All now monitor their PSA level through routine testing.
“It’s our genetic makeup,” says Gary. “I was having prostate issues years ago, and my urologist asked if prostate cancer ran in the family. I didn’t know, so I called my dad and asked, Have you had any prostate issues? He said, I don’t even have a prostate anymore. That’s how I learned it ran in our family.”
That’s one thing Gary says men should know: The medical history of prostate cancer in their families. That puts them at higher risk.
“I take my hat off to my primary care physician for deciding to go back to the PSA testing,” Gary says. “And sure enough we caught it. If not, in 10 years it would have been all over my body.
“Get the PSA test: It’s really cheap and really easy,” advises Gary. He adds that if men see the PSA number rising, they should have a good discussion with their urologist. The doctor will let them know if they need a biopsy.
He says to find a doctor like Dr. Eigner who does ultrasound-guided biopsies to determine if you have prostate cancer. “That’s the best thing a man can do.”
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