A low or normal PSA and still have prostate cancer? You bet!

"Some of us think holding on makes us strong; but sometimes it is letting go."- Hermen Hesse

 The article below is one of the few times I have actually seen written the concept of a low PSA and prostate cancer. Why is it important?

Because often times men will have a physical exam by their family doctor and everything is checked but the prostate by rectal exam. (Remember the article that stated that 70% of men have never had a rectal exam.)

How does this happen and why? Well men don’t like a rectal exam. The family doctor gets a PSA with his normal blood work along with the chemistries, CBC, etc and it comes back normal. The patient is told that the PSA is normal and it ends there. Everybody is happy, the doctor did not have to do the rectal exam (doctors don’t especially like doing the exam either…that’s why there is a specialty called Urology) the patient did not have to have the exam, and the patient got good news, the doctor “checked for prostate cancer” and nothing is done for the next year.

What is the chance that the above situation would miss a cancer? Well…not very often. But…it is a tragic situation when a relatively young man religiously goes for his annual exam since age 40, never has the rectal exam but does get the yearly “normal” PSA and then at age 48 the PSA does go up or he has voiding symptoms and a rectal is done, is abnormal, prompts a prostate biopsy and viola…he has inoperable prostate cancer just like Frank Zappa and Bill Bixby had.

Have I seen this happen? Yes. Often?…No. But I have been in the room with the family of the unfortunate man and the wife asks, ” How can it be that he has gone for all the check-ups he was told to go to over all these years and you are telling me he has inoperable prostate cancer?”

Then the explanation that prostate cancer can be tricky and that some very aggressive forms don’t produce PSA the way the normal glands or less aggressive glands do. My explanation offers little condolence.

One other thing…really bad cancers lose all of the characteristics of normal cells. They can become so bizzare the pathologist has trouble determining what cell type or organ it came from. Often times the only way they know it’s a prostate cancer is that they know that the tissue came from the prostate. When a prostate cancer is bad…it can be very bad, i.e. high Gleason’s Score.

So what to do…do the rectal with the PSA and everyone should be diligent about it. How? Through knowledge of the disease and its variations.

Ps…Just did surgery on a man named Dillinger. How about that?

Who was “The lady in Red?”


Do men with higher PSA levels have a better prognosis than men with lower PSA levels?

August 29th, 2011 Posted in prostate cancer diagnosis The PSA level helps determine how likely it is that the cancer has spread (metastasized). It also helps determine how likely the cancer will be cured with treatment such as radiation or surgery. Generally, the higher your PSA level and the faster the rate at which it increases, the more prostate cancer cells you have in your body.

In some cases, the PSA level may not be elevated, despite the presence of prostate cancer. In such cases, the cancer cells often have more genetic mutations than other prostate cancer cells do, and they don’t have the ability to make PSA. This type of prostate cancer is usually more aggressive and doesn’t respond well to treatment. Some scientists believe that the genetic mutations in these cancer cells may allow such cancers to grow and spread more quickly.

3 Replies to “A low or normal PSA and still have prostate cancer? You bet!”

  1. My husband went thru Hodgkins lymphoma in 2009/2010 and this year earlier had a PSA of 12.8 – had 38 biopsy’s taken that came back normal but has no erections, has a constant cough and back ache? I am so worried about him!


  2. Hello everyone/anyone my husband saw his doctor a week ago and his PSA came down to 10.8 from 12.8. His doctor was happy about this and said since he has had 54 biopsies in the last 2 years he doesn’t feel he needs to do any in the near future. I was so happy to hear that his PSA came down I didn’t let my husband know I’m still worried, he coughs and his tired most of the time? He is 63, white, a red head and had Hodgkins lymphoma in 2010 and now declared cancer free after he went thru chemo and radiation. He then asked the doctor about taking some testerone since he has no desire for sex. The doctor is checking his level first – we are waiting for the results to come back so he can begin to take medication. I also asked the doctor about a thickness in his bladder wall I read on one of his x-ray reports and he said that it happens. My question to anyone or a listening reading doctor is my husband out of danger? My husband is the sweetest man I know and I hate cancer, thanks for listening.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: