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When should my son get a PSA

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Posted 8/31/2013 4:15 PM (GMT -5)
My son will be 35 in mid-October. His birthday present from me will be a certificate to pay for his first PSA...I THINK!

His father (me) and his grandfather (my father) both have/had PC. Additionally, his maternal grandfather died of PC. Seems to me that in itself puts him at a very high risk.

I asked one of the Umich doctors and he said age 40. But from reading plenty of posts here, it seems age 35 to get a baseline might be a good idea. I will also ask at the PC Conference that I am attending next weekend. Any thoughts?

Mel

Posted 8/31/2013 4:17 PM (GMT -5)
i'd say 40 if it were my son.
Posted 8/31/2013 4:47 PM (GMT -5)
Given his family history, I'd send the certificate now.

All the best,
Andrew
Posted 8/31/2013 4:52 PM (GMT -5)
I think it is a very considerate birthday present and that there is more benefit than harm in getting a baseline test at 35, given the family history.  
Posted 8/31/2013 5:03 PM (GMT -5)
Mel: A tough call for sure! He is your son and I think that a baseline number is the prudent thing to do NOW.

I have the same issue with my nephew who is 38 now. My maternal granfather died relatively young (mid 60's of PCa) and both his dad and his grandfather had serious PCa in their 60's. And I (his maternal) uncle had PCa at age 58. He is just getting remarried and I certainly don't want to bring this up at this point in his life now with the worry of potential side effectgs. I say to myself, that it is none of my business and have said nothing to my sister or brother-in law. But it does bother me to not say anything about what I perceive as a very high herediatry risk . My PSA at age 50 was 1.7 and it kept going up every year. I am quite sure (based on that number) that I had PCa in my 40's! Lucky for me, I was informed and watched it closely.

Bill K. from NJ
Posted 8/31/2013 5:04 PM (GMT -5)
I'm hopping by the time my son needs to worry about PCa it will be a thing of the past, he'll be 40 in 2036. That being said if he were close to 40 now, I would encourage him to get a baseline done.
Posted 8/31/2013 5:17 PM (GMT -5)
...day after tomorrow. wink

Seriously, maybe 38. That's a bit of a head start. I will counsel my own boy once he's married somewhere around 2040 to line up life insurance first and then get bi-annual PSA's. He'll be 40 in 2042. I might be gone by then, but I'll leave the info with the old lady.

btw, Mel, I was happy to read a bit ago about about your success on HT. No boobs is good news... and as long as the old PSA continues to drop toward zero, you're looking good. I'm happy for you. Hope your knees and back improve in the same way. Cheers.
Posted 8/31/2013 5:38 PM (GMT -5)
When he decides it's right for him.

Tony
Posted 8/31/2013 5:48 PM (GMT -5)
Mel,
I'd recommend a baseline at age 40. In the interim, give him a gift certificate for a new set of tires or a deposit on a medium size sedan with side curtain airbags.
I hope that you are doing well and that the lupron is doing its job without too many side effects. Are you still teaching?
Bill
Posted 8/31/2013 6:26 PM (GMT -5)
Now.

When I was 38 my PSA was 2.4

I was G6 organ confined at 42 with a PSA of 2.76
Posted 8/31/2013 8:36 PM (GMT -5)
I was diagnosed at age 41. My doc (Dr. Ash Tewari) said that my sons should get PSA test and prostate MRI at age 30 as a baseline for comparison as their health is tracked through their adult years.

-Gedman
Posted 8/31/2013 8:57 PM (GMT -5)

compiler said...
My son will be 35 in mid-October. His birthday present from me will be a certificate to pay for his first PSA...I THINK!
His father (me) and his grandfather (my father) both have/had PC. Additionally, his maternal grandfather died of PC. Seems to me that in itself puts him at a very high risk.

I asked one of the Umich doctors and he said age 40. But from reading plenty of posts here, it seems age 35 to get a baseline might be a good idea. I will also ask at the PC Conference that I am attending next weekend. Any thoughts?

Mel

Good thinking, Mel. It's only a simple blood test that can be included in a standard blood test for a general annual physical. So it would not hurt for him to begin building that PSA history NOW.

When I told my uro a few years ago that my Dad had PC, he said this made my chances of getting it TWICE the norm. When I added that one of my Dad's brothers also had PC, he replied that this made me THRICE as likely to get it. Turns out that I did have it at that very time.

So there is NO reason at all to not begin testing now. We've had people in their 30s that developed PC even though it is pretty rare at that age. But a firmly established family PC history kind of alters those facts. He should begin testing now and hope that he doesn't get it (if he does) for many years -- at a time when there might be even better testing methods and, perhaps, even a more effective way to cure it.

Take care,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.
Posted 8/31/2013 9:55 PM (GMT -5)
I actually feel bad about answering the question. He should get it whenever he and his dad think he should get it. Folks here are right, it's not such a big deal, especially with a dad as knowledgeable about PCa as his father is.
Posted 8/31/2013 10:50 PM (GMT -5)
Mel,

I agree with Tony on this one; when they decide to. I did a great job of showing them the consequences of waiting too long and I feel bad they have to worry about the legacy. I will tell my sons that they need to get their baseline PSA whenever THEY want it. If the doc refuses for ANY reason, fire him, and find one that will support it.

Don
Posted 8/31/2013 11:07 PM (GMT -5)

A guy’s family history for pc is not just from his dad. 

 

The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2. Women who have inherited mutations in these genes face a much higher risk of developing breast cancer and ovarian cancer compared with the general population.   Men can have these mutated genes as well.

 

My husband's wife had the BRCA1 gene. She survived breast cancer, but passed away from ovarian cancer. Both of her sisters had breast cancer.

 

We were told that their sons should start PSA tests at 35 as the BRCA can increase the risk of PC in sons. Kind of a double whammy now that my husband has pc.

 

If you know any women with the BRCA 1 or 2 genes and they have sons, they should be aware of the connection and get tested starting at about age 35.

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722558/

 

Conclusion:

 

These results indicate that the BRCA2 founder mutation confers a 3-fold elevated risk of high-grade prostate cancer. Although BRCA1 mutations were not associated with prostate cancer, the BRCA1-185delAG was associated with high Gleason score tumors. These findings should be carefully considered in genetic counseling and/or evaluating therapeutic options.

 

http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA

 

1.What are BRCA1 and BRCA2?

 

BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. These proteins help repair damaged DNA and, therefore, play a role in ensuring the stability of the cell’s genetic material. When either of these genes is mutated, or altered, such that its protein product is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer.

 

Specific inherited mutations in BRCA1 and BRCA2 increase the risk of female breast and ovarian cancers, and they have been associated with increased risks of several additional types of cancer. Together, BRCA1 and BRCA2 mutations account for about 20 to 25 percent of hereditary breast cancers (1) and about 5 to 10 percent of all breast cancers (2). In addition, mutations in BRCA1 and BRCA2 account for around 15 percent of ovarian cancers overall (3). Breast cancers associated with BRCA1 and BRCA2 mutations tend to develop at younger ages than sporadic breast cancers.

 

A harmful BRCA1 or BRCA2 mutation can be inherited from a person’s mother or father. Each child of a parent who carries a mutation in one of these genes has a 50 percent chance of inheriting the mutation. The effects of mutations in BRCA1 and BRCA2 are seen even when a person’s second copy of the gene is normal.

 

3.What other cancers have been linked to mutations in BRCA1 and BRCA2?

 

Harmful BRCA1 mutations may increase a woman’s risk of developing fallopian tube cancer and peritoneal cancer (7, 8). Men with BRCA2 mutations, and to a lesser extent BRCA1 mutations, are also at increased risk of breast cancer (9). Men with harmful BRCA1 or BRCA2 mutations have a higher risk of prostate cancer (10). Men and women with BRCA1 or BRCA2 mutations may be at increased risk of pancreatic cancer (11).

 

Prostate cancer and genes:

 

http://www.cancer.gov/cancertopics/pdq/genetics/prostate/ HealthProfessional/page2

Posted 8/31/2013 11:12 PM (GMT -5)
azsunshine, thank you, that was very informative.
Posted 8/31/2013 11:52 PM (GMT -5)
Azsunshine,
Interesting angle of attack here. Currently there are no completed clinical trials on BRCA1 and 2 for men on PCa but that does not mean it should not be considered, At this time I would be very interested in any published data on survival through this method but there's a problem. There are not even enough men to enter a trial to date on this.

From the clinical trial s website:
clinicaltrials.gov/ct2/results/displayOpt?flds=a&flds=b&flds=d&submit_fld_opt=on&term=brca&cond=prostate&gndr=Male&show_flds=Y

Only a couple trials and they are not of any decent quality yet. I hope research gets us that 17 gene test that PCF is touting and I am hoping to hear more about it next week at the PCRI conference. I will go into the ASCO database tonight and do more fact finding on it as it can indeed open new doors that the PSA test leaves closed.

Peace

Tony
Posted 8/31/2013 11:59 PM (GMT -5)
I agree it is somewhat controversial, but better to be aware of the possibility and get tested than not. All three surgeons we spoke to recommended they get tested at 35.

Here is a link from Prostate Cancer UK with some interesting information too:
http://prostatecanceruk.org/news/brca-genes-myth-busters

 

Posted 9/1/2013 12:04 AM (GMT -5)
Does he get a regular physical exam? It might be a good idea for him to discuss this with his doctor, given his family history. If not now, baseline by age 40. Has he been checked for testicular cancer, or does he do regular self-exams, since this is the primary cancer for his age group?
Posted 9/1/2013 12:14 AM (GMT -5)
Excellent, AZ...

Here is the IMPACT trial information is someone would like to participate...

clinicaltrials.gov/ct2/show/NCT00261456?term=brca&cond=prostate&gndr=Male&rank=1&submit_fld_opt=

This trial completion is expected in 2017. The results probably a year out. But I would encourage participation in it if one knows that they have the BRCA1 or BRCA2 gene mutation. Unfortunately today a male may have to pay for this genetic test to make this determination.

Controversial may be the wrong term. Highly experimental probably more appropriate. Already in the ASCO database I have identified three poster boards and fifteen slides but no slide presentations dedicated to BRCA1 and BRCA2 gene mutation as associated with prostate cancer.

Here are some more InfoLink search information on the topic:
prostatecancerinfolink.net/?s=brca

Skip the Angelina Jolie stuff and the articles get interesting. But they are so short of the necessary criteria to make this a reasonable approach other than to say, participation in trials is needed and what better participants than those who have known extensive family history with PCa?

Again thank you for your thoughts here.

Tony
Posted 9/1/2013 4:09 AM (GMT -5)
Tony:

Will you be staying at the Marriott?

We will be getting there Friday evening and leaving Tuesday morning

Mel

Posted 9/1/2013 5:27 AM (GMT -5)
35 is not too young. Some men get this at that age. I think my Doctor started checking me in my early 40's. Around 2.2 till I hit 55. It jumped to 6.5 then. I was asymptomatic, felt great. 16 core biopsy showed 8.5 to 9.8 on the Gleason in every core. I had the advanced fast growing kind. Had the surgery in Aug. 2005., but it had already come out of the capsule. My Doc skipped the Psa test when I was 54, I probably had it then. Went stage 4 last year when it metatastized to my bones and lymph glands. Lupron made me crazy, radiation worked for about 6 months, Taxotere was working but had to quit after 3 rounds because the drug almost killed me. It took off again here and I just had my second treatment of Cabazitaxel on friday. So far I am tolerating it better. I have the kind that beats you, but oddly I've been very happy. I appreciate every day I'm here.
Posted 9/1/2013 6:34 AM (GMT -5)
My doc recommends 35.

I have taught my son many good things and I have passed on many good things to my son. PCa will not be one of the good things.
Posted 9/1/2013 9:10 AM (GMT -5)
Mel. My son has the same GP as I have and he had his first PSA test last year at age 35. With my family history my GP insisted he get one for a baseline. He told him the next one should be at age 40. BTW my son had a PSA of .75.

 

Terry
Posted 9/1/2013 10:09 AM (GMT -5)
Do the test....it certainly cant hurt....I mean it doesn't take a clinical study to do a common sense test such as a PSA test just for peace of mind....LOL.
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