PSA screening was on the minds of two men, who recently contacted me by phone for prostate cancer health coaching. One man was a dentist and the other was a clergyman. Both were in their mid- to late fifties.
These two gentlemen contacted me because they felt I could help them deal with their fears about their first-time ever PSA screening results. They were both extremely anxious and in slight shock because their PSA scores were high. At a time when they felt perfectly healthy, they were alarmed because they thought the next step would be a biopsy and the possibility of cancer.
It should be noted that both individuals were superbly qualified in their respective fields. Yet neither could comprehend why despite being physically fit, they could still have PSA scores of 4.8 or 5.6 ng/dl, which are in fact relatively high for men their age.
After hearing these men out, I asked each one a few key questions on a strictly confidential basis. First I inquired whether they had sexual intercourse with their respective spouses within 48 hours before their prostate cancer screening. For reasons I can’t explain, both were rather emphatic when they said, Definitely, no!”
Then I asked whether either rode a bicycle from time to time. As it happens, both answered that they ride bikes all the time for exercise, especially when the weather gets warm as is the case during these hot summer days.
Curious, I asked if the men’s physicians, respectively a family doctor and a urologist, had told them not to have sex or ride a bicycle during the two days before a PSA test. They again replied, “No!!" As I then pointed out, it's not all that uncommon for doctors to omit this information before sending their patients to get PSA lab work.
I explained that it was unfortunate that neither doc mentioned how bike riding, let alone sex, could affect a man’s PSA score. “Frankly,” I stated, “Whether you ride a bike or a horse shortly before your lab work, chafing “down there” is bound to raise your PSA test score!”
From there I asked each man what his doctor had recommended after seeing their PSA reports with their high scores. In both cases, their doctors properly recommended these patients wait another three months to confirm if the scores were still high.
One of the doctors, the family practitioner, also gave his patient an antibiotic. His explanation was quite accurate: He wanted to confirm if a possible infection, rather than a malignancy, might be the source of his patient’s relatively abnormal PSA. In this case “normal” might mean a score of about 3.5 to 4.0 or even less, had these men been in their early 50’s or in their 40’s.
My suggestion to the first of these patients was not to worry, until the follow-up PSA test that was scheduled three months later. However I told the other, whose doctor immediately put him on antibiotics, that he might want to let his doctor know he rode his bike to the lab. Of course I added that his doc would probably tell him to stick with his new meds to rule out any infection.
Most doctors worth their salt know they have to cover all the bases. Neither they nor their patients should jump to any conclusions that a high PSA score means they are destined to have cancer. Rather than get alarmed it’s far better to explore matters further to confirm if any other factors are at play.