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Running and PSA levels (Read 126 times)


Latent Runner

    Hey Gang,

     

    I'm writing this kind of a "Head's Up!" for us guys, especially those of us over 50, heading into our annual physical.  I had my physical done in late January this year, and a week prior I dropped by a local lab for blood and urine work.  Come the day of my physical, my doctor said, "Everything looks good except your PSA (Prostate-Specific Antigen) has more than doubled since your last physical; you went from a relatively normal 1.85 to a 3.8, just shy of 4.0 which triggers various alarm bells."  He went on to say that any other 56 year old with consistent 3.8(ish) readings wouldn't concern him terribly, but for mine to have more than doubled in 18 months was, to him at least, cause for concern.

     

    Just to be on the safe side he sent me to a urologist; a visit I made about a month ago.  As with my Primary Care doctor, the urologist was more concerned about the 18 month delta than the actual number.  I explained to him that I am a runner and while I don't remember exactly how many miles I'd run in the days preceding my blood test, I was quite sure it was at least 20 (I just checked, the actual number was 24 miles).  He told me that "exercise induced high PSA levels" was a fallacy for all forms of exercise except sex and bicycling.  With that in mind, he asked me to get retested.

     

    On the morning of Sunday 30-March I jogged 3 miles to warm up for a 2-mile race, ran said race, drank the beer at the end, and hung my running shoes up for a couple of days.  During the afternoon of Wednesday 3-April I had my blood drawn again, and then went out for a nice easy 7 mile run.  Smile

     

    Today I got the results of that second blood test; my PSA had dropped from 3.8 to 1.79.  So much for "exercise induced high PSA levels" being a fallacy.

     

    So, I told y'all the above to tell you this; if you're going to have blood work done for your annual physical, no sex, no cycling, and no running for at least 48 hours.

    Fat old man PRs:

    • 1-mile (point to point, gravity assist): 5:50
    • 2-mile: 13:49
    • 5K (gravity assist last mile): 21:31
    • 5-Mile: 37:24
    • 10K (first 10K of my Half Marathon): 48:16
    • 10-Mile (first 10 miles of my Half Marathon): 1:17:40
    • Half Marathon: 1:42:13
    cookiemonster


    Connoisseur of Cookies

      There have been some conflicting results (apparently) but it seems there's something to consider with vigorous exercise prior to your bloodwork and/or PSA test.

       

      Now, the validity of the PSA test is another discussion altogether.

      ***************************************************************************************

       

      "C" is for cookie.  That's good enough for me.


      Feeling the growl again

        Your physician was right to be more concerned with the rate of change of PSA than the absolute number.  But once there is concern about the rate of change, it needs to be confirmed by repeating the test to make sure that the change is real.

         

        As you experienced, sometimes a re-test will reveal that a former test was not entirely accurate.  But I would not conclude from a single case study that running, sex, or any other single factor was responsible for the difference between two test results.

         

        Regarding the link shared about the validity of PSA testing, I would also caution the wisdom of firmly applying population-based data to individual cases.  It says when looking at death from any cause there was not a significant difference between PSA test and no PSA test.  But that's a red herring, because PSA testing is NOT meant to address death from any cause, only one cause.  So this metric will work to dilute any benefit of PSA testing.

         

        It also says people with PSA are often elderly, prostate cancer is often slow-growing, etc etc.  Well, those are not absolutes.  Someone dear to me, who was not that old, had a high rate of PSA increase several years ago.  They got re-tested, and it only confirmed the increase.  Their urologist was an idiot who attempted to railroad them into experimental therapy from which the urologist would financially benefit, so I got them into a real cancer center to consider options.  The biopsy did NOT reveal a slow-growing cancer that would smolder for decades until they died of something else, but a moderately aggressive cancer that would kill them in a handful of years if left untreated.  So this individual chose radiation and years later has a PSA which is effectively zero....the test caught a serious issue early and they have been cured.

         

        If you have a high PSA and are diagnosed with prostate cancer, don't rely on a urologist to manage your care.  While I am sure there are good ones they have a habit of recommending care which they can provide, which does NOT include the standards-of-care for early-stage prostate cancer -- radiation or surgery.  In the case described above, which is not atypical in my experience, the urologist heavily leaned on the patient to get cryotherapy, an unproven technique not considered standard-of-care but which would allow the urologist to keep the patient and continue to treat (and bill) them.  One is best to consult a university-based cancer center or system where the physician will not directly benefit from the course therapy the patient opts to pursue.  In the described case, I got the patient into a respected university-based cancer center for a consult and they were provided with all the pros/cons of standard-of-care options (surgery or radiation) by several physicians and then allowed to choose what was right for them with no bias.

        "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand

         


        Latent Runner

          Thanks for the response guys; I appreciate it.

           

          The good news is that my urologist is part of a larger university based system, and had my retest come back he was planning on handing me off to a different group.

           

          The better news is my PSA dropped back to my "baseline" level (before I was doing lots of running); here's the chronology:

          • Sep 2012: 1.85 (little if any running immediately prior to the blood work)
          • Jan 2014: 3.80 (blood work followed 24 miles of running in the previous 48 hours)
          • Apr 2014: 1.79 (blood work done after abstaining from running for 72 hours)

           

          In addition to the helpful link posted by cookiemonster, I did some nosing around and came up with the following discussions on this topic:

          Fat old man PRs:

          • 1-mile (point to point, gravity assist): 5:50
          • 2-mile: 13:49
          • 5K (gravity assist last mile): 21:31
          • 5-Mile: 37:24
          • 10K (first 10K of my Half Marathon): 48:16
          • 10-Mile (first 10 miles of my Half Marathon): 1:17:40
          • Half Marathon: 1:42:13


          A Dance with Monkeys

            Okay. So let's go with this.


            There are two possible causes of an acute doubling of a PSA:

            - vigorous exercise, including running and sex

            - prostate cancer

             

            Who really gives a shit if exercise can double your PSA? If cancer is on the list, take the PSA doubling seriously.

             

            To the OP, I'm glad yours went down. But I don't know that your experience would reassure me one iota if my PSA doubled, and I am certain I would get it checked out.


            A Dance with Monkeys

              If you have a high PSA and are diagnosed with prostate cancer, don't rely on a urologist to manage your care.  

               

              TOTALLY depends on the urologist. Where I am, I would ONLY rely on the urologist, because they are experts in both operative and nonoperative management, including do-nothing observation.


              Latent Runner

                Okay. So let's go with this.


                There are two possible causes of an acute doubling of a PSA:

                - vigorous exercise, including running and sex

                - prostate cancer

                 

                Who really gives a shit if exercise can double your PSA? If cancer is on the list, take the PSA doubling seriously.

                 

                To the OP, I'm glad yours went down. But I don't know that your experience would reassure me one iota if my PSA doubled, and I am certain I would get it checked out.

                 

                I think your comments are a bit out of context.

                 

                When I was told about the doubling of my PSA level, my brain went into "what changed" mode (I'm an analyist and engineer by trade).  The only answer I could come up with was "running".  Had my third test come back confirming the high PSA level of the second test, I would certainly have been concerned; that it came back confirming my (relatively) low baseline of the first test is reassuring.

                Fat old man PRs:

                • 1-mile (point to point, gravity assist): 5:50
                • 2-mile: 13:49
                • 5K (gravity assist last mile): 21:31
                • 5-Mile: 37:24
                • 10K (first 10K of my Half Marathon): 48:16
                • 10-Mile (first 10 miles of my Half Marathon): 1:17:40
                • Half Marathon: 1:42:13


                A Dance with Monkeys

                  No, I'm fighting off others taking your comments out of context. As I said, it is good yours got better AND you took it all very seriously, including by getting excellent followup.

                   

                  What would suck is if somebody else saw this, took it out of context, and simply blew off their doubled PSA because they had just had a good romp with the wife. And then turned out to have a bad prostate cancer. That would suck.

                  cookiemonster


                  Connoisseur of Cookies

                     

                    I think your comments are a bit out of context.

                     

                    When I was told about the doubling of my PSA level, my brain went into "what changed" mode (I'm an analyist and engineer by trade).  The only answer I could come up with was "running".  Had my third test come back confirming the high PSA level of the second test, I would certainly have been concerned; that it came back confirming my (relatively) low baseline of the first test is reassuring.

                     

                    To be fair, in line with Trent's comments, your "what changed" thinking should also have considered prostate cancer.

                     

                    Yes.  You ran a bunch of miles before this test.  That is one thing that's changed.  It is something concrete and distinct that you can point to and say "here's something I did that I didn't do before or after".

                     

                    The other thing that could've changed is that you had cancer.  That's not change you could really know about without the testing.  Which is, presumably, why you got the test in the first place.

                     

                    Unless all of this thinking was done after the third test came back with a normal value.

                     

                    In the end, all things being said, it was smart that you got the follow up and a good thing you saw a return to baseline.

                    ***************************************************************************************

                     

                    "C" is for cookie.  That's good enough for me.


                    Feeling the growl again

                       

                      TOTALLY depends on the urologist. Where I am, I would ONLY rely on the urologist, because they are experts in both operative and nonoperative management, including do-nothing observation.

                       

                      Could be.  No urologist accessible to the patient in question performed the surgery or did the radiation.  I'm not sure of the whole story on that part as I believe he was the one to remove a renal carcinoma from the same patient.  But I know he was going to be unable to do the surgery and learned he had a history of not telling people of options available to them through someone else.

                       

                      I am sure his behavior is not the norm, but he controls referrals for a wide geographic area and actively works to prevent patients from leaving his care (and pocketbook).  In fact the patient in question must now drive 2 hours for his checkups, because all offices closer are affiliated with this urologist and will no longer see him.  I had to call and recite HIPAA back to them and threaten legal action in order to get them to give up the patient's medical records to take them elsewhere for a second opinion.

                       

                      However I am also aware of large behavioral studies indicating that urologists, more than about any other medical specialty, tend to hang onto patients longer and apply more antiquated treatment strategies rather than to refer them on.  As a group.  This says nothing about yours.  Smile

                      "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand

                       


                      King of PhotoShop

                        Man, when I see that Spaniel has posted in response to any thread, I always read it because I'm assured of a well-thought-out quality answer. Thank you.

                         

                        On April 29th I will have a radical prostatectomy (laparoscopic robotic) and I'm having it done by the rock star of this procedure at UT Southwestern Medical Center in Dallas, TX, one of the top teaching hospitals in the U.S.  (For this type of cancer surgery, number one is Johns Hopkins.)

                         

                        My PSA went from 4 to 8 to 10 over the past three years, and my surgeon told me my PCP should have referred me to him sooner and "I'm going to send him an email and tell him so!" which you rarely ever hear of doctors doing.

                         

                        I am past the "active surveillance" stage of the cancer growth, as I am 67 and in great shape, so I have to have the prostate removed. Believe me, I have done all the research, including reading the wonderful book "How to Survive Prostate Cancer."  I also consulted with an oncologist about radiation, the seeds, all that stuff and I hope anyone doing their research will think carefully about going this route.

                         

                        My cancer is totally contained within the prostate, so my prognosis is very good.  I will post to this thread again if it's still active and let you all know how it's going.

                         

                        But I will tell all of you this. After 40, get after it, and don't take anything for granted.  Good luck to all of you. Spareribs


                        Feeling the growl again

                          Man, when I see that Spaniel has posted in response to any thread, I always read it because I'm assured of a well-thought-out quality answer. Thank you.

                           

                          On April 29th I will have a radical prostatectomy (laparoscopic robotic) and I'm having it done by the rock star of this procedure at UT Southwestern Medical Center in Dallas, TX, one of the top teaching hospitals in the U.S.  (For this type of cancer surgery, number one is Johns Hopkins.)

                           

                          My PSA went from 4 to 8 to 10 over the past three years, and my surgeon told me my PCP should have referred me to him sooner and "I'm going to send him an email and tell him so!" which you rarely ever hear of doctors doing.

                           

                          I am past the "active surveillance" stage of the cancer growth, as I am 67 and in great shape, so I have to have the prostate removed. Believe me, I have done all the research, including reading the wonderful book "How to Survive Prostate Cancer."  I also consulted with an oncologist about radiation, the seeds, all that stuff and I hope anyone doing their research will think carefully about going this route.

                           

                          My cancer is totally contained within the prostate, so my prognosis is very good.  I will post to this thread again if it's still active and let you all know how it's going.

                           

                          But I will tell all of you this. After 40, get after it, and don't take anything for granted.  Good luck to all of you. Spareribs

                          Thank you, perhaps I should put more thought behind my typical quick and barely-thought-out posts.  Smile

                           

                          I am happy you did your research; with any medical procedure or major decision it is good for people to inform themselves.  No good doctor...at least not one I would want as part of the treatment team for me or anyone I care about...will be offended when someone seeks out a second (or third) opinion if that makes the patient more comfortable with a decision.

                           

                          Best of luck with your surgery and eliminating the cancer.  Someone else I know had that procedure a number of years ago, the case I talked about previously ended with radiation.

                          "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand