PSA Variation/issue solved

I've had regular screening for PSA for more than ten years with 'normal' results until 2015. In 2015 my PCP said my results are a little high and he suggested a retest along with a % Free PSA. With that retest my PSA dropped back to a 'normal' level for my age. In 2016 my PSA was up again and my PCP suggested seeing a Urologist. The Urologist did an exam and said my prostate felt normal and ordered another PSA check. That PSA test came down significantly (5.94 to 3.0) and my Urologist suggested that a biopsy might help explain the PSA variation. The biopsy showed a small amount of Gleason 6 in 3 of 12 samples. The Urologist said I had three options surgery, active surveillance or radiation. He said that although he was an excellent surgeon he did not have any significant knowledge about radiation and suggested I get the opinion of a Radiation Oncologist. Thanks to the information I gained from this forum I decided on SBRT treatment in June of 2017 at Cleveland Clinic . My first my first PSA following treatment dropped significantly and I was elated. My second PSA following treatment was actually higher than my first post treatment result and I began to worry. My third post treatment PSA was a duplicate of my first and I was feeling relieved again but I also felt there must be some explanation for the variation.

I was aware that PSA results could be effected by a lot of things including sex or bicycle riding etc. prior to blood draw. I also was aware that laboratory differences could also cause variation. Since I avoided sex and spinning classes I did check with our hospital lab. Although all of my blood draws were at our local hospital and all of the results were being posted on my hospital portal I found that our hospital was sending out some of my tests to be run at Quest Diagnostics. The difference in results between our hospital and Quest was significant. I do not believe either my PCP or Urologist was this was happening since both only talked about the actual result. When I asked our hospital lab why they sent some tests out they said whenever a script requested "% Free PSA" they had to send it out since they could run only total PSA. They also said that sometimes their equipment could be down or for cost reasons they sometimes sent out samples to be run at Quest. The clue that led me to solve the variation was that some of the PSA results were reported to two decimal places and others to only one (Quest).

I believe it's very important to double check that your PSA results are run by the same lab. Although the differences maybe small those differences may result in unnecessary testing, biopsies and worry. Here are the details.

Date PSA Result Lab. Action
10/19/10 1.48 Butler Hospital PCP/Nothing
12/02/11 1.49 Butler Hospital PCP/Nothing
11/14/12 1.98 Butler Hospital PCP/Nothing
11/21/13 1.95 Butler Hospital PCP/Nothing
09/04/14 1.92 Butler Hospital PCP/Nothing
09/29/15 3.28 Butler Hospital PCP/Recheck with % Free
12/30/15 2.1 Quest PCP/Nothing looks normal
10/03/16 5.94 Butler Hospital PCP/Time to see Urologist
01/20/17 3.0 Quest Urologist/Biopsy
June of 2017 SBRT Treatment CCF
09/19/17 1.1 Quest
12/05/17 1.24 Butler Hospital
02/22/18 1.1 Quest

BTW Cleveland Clinic is very happy with my drop in PSA no matter what laboratory ran them. They requested I have my future draws at Quest since they are able to transfer Quest data directly into the CCF data base. CCF also suggests being patient since it may take a couple of years to reach Nadir. The only side effect I've had is a reduction in ejaculate. Sex is still great and no urinary or rectal issues.