PSA FFS

The "P" in "PSA" stands for "Pain in the ass"

On May 1st I made my biannual trek down to the Needle Place for a blood draw to measure my Prostate Specific Antigen. The result came back “undetectable,” which means the tumor marker is clear, which means, for me, the cancer hasn’t come back.

I shared the good news here on Substack and got some very gracious kudos (thanks guys). One person posted this comment:

I clearly don’t understand how PSA works - I have stage 4 PCa, in my lymphs and bones but similar PSA and no testosterone

Is PSA a measure of “cancer activity”???

This is a fair question, and my friend who asked this should not fault himself for wondering why my PSA result means “I don’t have the cancer.”

A tiny bit of background here is important. About 3.5 years ago¹, I had my prostate and its sizable tumor removed after a period of active surveillance. That was the treatment choice I made with my oncologist.

The surgical procedure involved severing the main tube coming out of my bladder, as well as some lymph tissues. The best possible outcome of the surgery is that every bit of cancer was physically removed from my body. And I mean every bit; there should not be one single goddamn CELL of cancer left inside me after surgery.

This is absolutely crucial: if even a few cancer cells (literally a few, count them on your fingers) get left behind, or were hiding from the surgeon, or hitched a ride on the scalpel and took up residence in some other tissue—even those few could cause trouble. Trouble, as in, “you have cancer again.”

Why? Because any cancer cells left behind will grow and multiply. When they do, the CANCER CELLS will start to make PSA and dump it in my bloodstream. The CANCER CELLS themselves will assume the duties of my no-longer-present prostate and start manufacturing PSA.

So twice a year I get my blood drawn to see if any PSA shows up. My prostate is gone. It’s in a dish in a freezer in Ann Arbor, Michigan, so the only possible way for PSA to appear in my blood is if remnant cancer cells fired up and started making it.

So in MY case, and for men who had a radical prostatectomy, then yes, PSA is a direct marker of cancer activity.

January 2028 will be my 5-year milestone. Once I reach that point, I can get a PSA test just once a year. I’m looking forward to that, since that means I will experience the will-the-lab-results-say-I-have-cancer super-anxiety-freakout just once a year.

Also, f*ck cancer.

1. Has it really been that long? Was it really that recently? Wow.