PSA screening is not a good idea if you’ve been on a bike during the 48 hours preceding your visit to get your blood drawn. Other activities to avoid before a prostate cancer screening are sexual intercourse and an infection such as prostatitis. These are comments I underscored a couple of days ago in the first of this two-part series on PSA screening and bicycles. But what else can cause an elevated PSA score?
Another possibility is that a man can get a “false positive” reading for no apparent reason at all. That’s because it's not possible to always be accurate in determining the amount of PSA or prostate-specific antigen (a protein) in a man’s bloodstream. Quite simply a given score can be a momentary“ snapshot” that could change the next time it’s measured. So why screen using the PSA test? Because it’s the only decent prostate cancer biomarker we have…for now.
The key point is that doctors need to tell their patients about these and other considerations that can cause an abnormal PSA reading, and if they forget to do so, it's your job to inquire. Knowing what factors might be at play is ultimately the patient's responsibility since it's your body! As such, men and their wives or partners don’t have to worry when they first learn their score is high, providing they explore such matters further with their doctors' guidance.
What if repeat testing in the first 6-12 months produces the same high score? That’s when you can start worrying if you’re prone to do so! Better yet, talk with your doctor to see if you should get a prostate biopsy to verify if you have a tumor or not. Even then you need not stress out, since at least 80% of men diagnosed with prostate cancer ought to know it's likely to be discovered at an early stage and is very slow-growing.
As with the two men I described in Part One of this post, sometimes we allow our emotions to run wild. Information can allay your anxieties, since knowledge is power, - providing you get good advice it from the right source. Frankly such guidance should come from your doctor, but sometimes you have to find answers elsewhere from other reputable healthcare sources such as this column.
The question remains: If you ride a bike and your PSA is high, can you always blame this on biking? Not always! For instance, during the past year a 40 year old police detective in Tempe, Arizona, told me that he discovered he had a high PSA reading. His doctor immediately biopsied him only to discover he had advanced cancer, - something that is quite rare during an initial diagnosis.
I asked the detective how he reacted to hearing he had a high PSA score, even before his doctor advised a biopsy and discovered the advanced malignancy. His response, like the two men I described earlier, was that he was truly surprised. After all, as he said, he was in great shape and had no complaints or symptoms with one exception: He felt occasional chafing between his legs after riding his bicycle everyday to work and to various appointments! In fact that’s why he went to the doctor in the first place!
Like the others he rode his bicycle everywhere, even when going to the lab where he got his PSA blood work. But in his case his PSA reading was high not due to bike riding, but because of the malignancy in his system.
The morale of the tale? Be aware that bike riding, while healthy for most people, can result in an artificially high PSA score which doesn’t require a more invasive, expensive biopsy. On the other hand, riding a bike and discovering your PSA is high, may be more than coincidental. In rare cases, at least, it can accurately indicate that you need a biopsy, which in turn verifies that you actually might have you have prostate cancer.
In my view, once you reach age 40 (and sometimes before), routine PSA screening can be quite useful. Every individual is different, but the stories I’ve related indicate the distinct possibility you may well need further testing to determine whether or not you have prostate cancer.
If you haven’t already done so, consider getting a routine, annual PSA screening from the time you are 40, as advocated by the American Urological Association.
Do so even though though other organizations like the American Cancer Society and the American Medical Association discourage such advice. During the past couple of years these organizations have stipulated that a simple PSA blood test is not advisable, given false positives, unneeded biopsies, and expensive, aggressive overtreatment in 47 of 48 men who are diagnosed.
Whether you’re in your 40’s, 50’s, 60’s or beyond, an annual PSA test is advisable. That’s true for most men after they consult with their doctors, whether they still ride their bikes or not!
A failure to take the proper action, even if based on some second-guessing, can result in a price few of us are prepared to pay.