I just got a question from my Primary Care Doctor about my wanting to get PSA testing.... He said that the research study staff sent him a message saying that because of family history I'm at higher risk of Prostate Cancer... My father had it, and I believe my maternal grandfather did, I don't believe it was the hormone related type...

I had a PSA test in 2022, and he said the level then was "undetectable". He said because I'm on E (no mention of being ) he thinks the risk is low, but wants to know if I want to still get PSA tests... (I looked in the SOC v8, which has no definite advice - best quote: "there is no evidence to guide how often to screen for hormone-related cancers with prostate exams, PSA measurements, mammograms, etc. ")

His concern is that the PSA test is known to produce false positives that then lead to invasive / excessive additional testing and treatment, etc.

I don't have the described symptoms of prostate problems, but given that I have to cath, many of them don't really apply...

I'm not opposed to testing, and don't see it as a necessarily bad thing, but he wants me to think about it before deciding...

Any thoughts on whether or not I ought to get tested?

WheelyFixed

PSA is no big deal. Just a blood test. Might as well do it. Prostate cancer can sneak up on you.

I sent Wheely's question to Prof. Richard Wassersug, an acknowledged expert on prostate cancer education. He's also included a reference to his book about life on ADT (which translates as "life without testosterone"). Here's his response:

Happy to see if I can answer Wheely's questions. But just to get to his core question... Wheely should get the PSA test. That is the simple, succinct answer.

However , if we take up each of his comments separately...

It is correct that his risk of prostate cancer is low on estrogen, but it still not inconsequential.. There is a ton of papers on this topic for the MtF population. I've listed below only about half of them from just the last year.

The PSA test does NOT produce "false positives" for prostate cancer since it is NOT a prostate cancer test. It is only a screening test. A rapid rise in PSA may suggest that a biopsy is appropriate. One needs a biopsy so a pathologist can look at the tissue and diagnose prostate cancer. The cancer can only be confirmed with biopsy. PSA alone is NOT a diagnostic test.

Once one has symptoms of prostate cancer the cancer is too often too advanced to be cured. So whether he has smptoms or not is not relevant.

Incurable prostate cancer typically invades the bones. That can be severely painful. And it can be fatal. In that situation, one doesn't simply die; too often it is a protracted and painful death..

I could go on. But in my view, Wheely should get the PSA test!

Note: I am NOT an MD. I happen to be a prostate cancer patient who has been on high dose estradiol for over twenty years to control prostate cancer.

Richard Wassersug, PhD

Honorary Professor

Faculty of Medicine

University of British Columbia

www.LifeOnAdt.com (http://www.LifeOnAdt.com)

Note: The third edition of the book Androgen Deprivation Therapy: An essential guide for prostate cancer patients and their loved ones is now out. See: https://www.springerpub.com/androgen-de ... 84023.html (https://www.springerpub.com/androgen-de ... 84023.html). The book was First Place Winner of American Journal of Nursing 2024 Book Award in Consumer Health.

Refs:

Tyagi S, Tyagi S. Incidence of Prostate Cancer in Transgender Women Undergoing Androgen Deprivation Therapy: A Review. Indian J Endocrinol Metab. 2023 Nov-Dec;27(6):476-479. doi: 10.4103/ijem.ijem_53_23. Epub 2024 Jan 11. PMID: 38371191; PMCID: PMC10871014.

Crowley, F., Mihalopoulos, M., Gaglani, S., Tewari, A. K., Tsao, C. K., Djordjevic, M., ... & Lundon, D. J. (2023). Prostate cancer in transgender women: considerations for screening, diagnosis and management. British Journal of Cancer, 128(2), 177-189.

Manfredi, C., Ditonno, F., Franco, A., Bologna, E., Licari, L. C., Arcaniolo, D., ... & Autorino, R. (2023). Prostate cancer in transgender women: epidemiology, clinical characteristics, and management challenges. Current Oncology Reports, 25(12), 1431-1443.

Kaplan-Marans, E., Zhang, T. R., Zhao, L. C., & Hu, J. C. (2023). Transgender women with prostate cancer are under-represented in national cancer registries. Nature Reviews Urology, 20(4), 195-196.

I'm with the rest in here. People AMAB (born male) should get a PSA test and prostate exams, assuming they still have a prostate. It's an ounce of prevention preventing a pound of cure, and for how simple it is to do (get it done with other blood work, let the doctor do the prostate exam), it's the preferred alternative to cancer and death, I'd think.

I did this test for years now because of an uncle that died of prostate cancer. Of course false positive could accours as in any lab test. For the PSA a rise from the normal value is a marker of prostate activities. This activity could be from cancer cells or normal prostate activity and here I named sexual activity. So before you blood test make sure that you are not masturbating, having intercourse or any kind of activity that would stimulate your prostate. You should refrain those activities 3 to 5 days before your blood test. I didn't known about that and once my urologist seing my hight PSA level asked me about some sexual activity which could have happened to be nearby my blood test. Now this was not easy to remember as my blood test was about a month before my visit. Facing possible uncertainty I had to go for a second blood test having in mind to keep calm a few days before.

Thanks to all, especially Jesus for forwarding the

JesusA (imported) wrote: Fri Mar 01, 2024 8:46 pm question to Prof. Richard Wassersug

and getting his detailed reasons about why I should get tested... I've forwarded a short version to my doctor saying I want the testing...

Ironically, I seem to have developed prostate problems of some sort the same night... For a while I've been intermittently noticing a little more resistance when inserting my intermittent catheter. It would sometimes feel like it was getting hung up just before going into the bladder, but with a little bit of extra push it would sort of 'pop' into place and go on in. I hadn't been terribly worried about it.

However last night I had MAJOR problems, it took me multiple attempts and about 20-30 minutes of trying different positions, wiggling around and struggling to get the catheter to finally make that last inch or so... During this I had a lot of leakage and discomfort... I felt it was enough of a problem that I called the 'on-call' doc at the hospital, and he advised me to go to the ER... They took a sample which they said was positive for a UTI (typical for me and most SCI patients...) and put in a Coude Foley cath, so I'm now rolling around w/ a leg-bag when I'm up and an overnight bag when in bed... I do have an appointment w/ Urology on March 13 - hopefully they figure out what's wrong and what to do about it...

WheelyFixed

Better tested than untested. And I think they're more looking for changes in the trend than specific results.