If you have read some of my other posts, you know that prostate cancer runs in my family, so I had been carefully monitoring my PSA over the years.

PSA Chart showing rise and fall to zero after prostate surgery

PSA Chart

As you can see from the chart above, my PSA was rising slowly at a more or less “regular” rate (tied to aging) until about 2010. Then it shot up quickly to the 5 range and then just as quickly to the 7 range.

What happened? When I saw the results, I immediately called the PSA testing lab and told them that they must have made a mistake – I need a re-test. The girl on the other end of the line sounded confused, to say the least.

So I repeated the test, and this time my PSA score CAME OUT EVEN HIGHER than before.

What to do now? I called my urologist, and he recommended a biopsy, which I was able to get done pretty quickly. Then I nervously waited for the results.

Great news! My biopsy came back clean – negative – no problem – no cancer.  I felt like I had dodged a bullet.

As it turns out – NO, NOT REALLY. I am pretty sure that I had prostate cancer right then and there.

How do I know this? Because about three years later when my second biopsy revealed cancer, and I decided to have surgery, my FINAL PATHOLOGY REPORT showed extensive cancer on both sides of the gland. In other words, the “volume” or amount of cancer observed in my gland after it was removed and analyzed in a lab was far more than what one would have expected from my second biopsy report – which showed only one “hit” out of 12 on the left side only.

So I’m pretty sure my case of prostate cancer did not develop overnight.

I probably had the beginnings of prostate cancer when my PSA level rose abruptly to the 5 – 7 range, but because a biopsy is only A SAMPLING TEST, you can have cancer and still not detect it with a biopsy. The needle could just miss the area(s) affected by the cancer cells.

I don’t mean to sound alarming, but I believe that I had prostate cancer that my first biopsy did not detect – which gave me a false sense of security. This applies to me and my case only. Every case of prostate cancer is different.

This is not a knock on doctors, because they’re using state of the art, ultrasound-guided needle biopsies that are way better than anything that was been available before. It’s simply the best test anyone can perform given the fact that your prostate gland is buried deep inside your body.

Doctors use a grid-like pattern to take needle samples from all over the gland, but it is still a “sampling” process, not a 100% test. By some estimates, less than 1% of all the cells in your prostate gland are actually removed and examined under a microscope during a biopsy.

I am fortunate, because even though I waited 3 years to remove my prostate gland, I am still OK, since all of my PSA test results after surgery have been zero or undetectable. Latest update –>  PSA is still zero as of January 3, 2019.

Is my case unusual? Probably not, as I believe it’s fairly common to test negative on the first biopsy and then test positive on a subsequent test.