One week from tomorrow is the date for my next PSA test. I know this because all my reminder systems—Alexa, Google Calendar, Microsoft Outlook, etc.—simultaneously started beeping at me today.
It’s time to prepare.
And prepare I must. For some men a PSA test is a simple blood test. For me, it is a week-long process requiring careful planning. It is more than a brief encounter with a lab tech, a needle, and a vein. It is a physical and psychological journey.
If you’re relatively new to the never-ending merry-go-round of PSA testing, you might not yet appreciate the momentous nature of this occasion and the need to manage it. With nearly eight years’ experience, I have learned exactly what should happen on each of the seven days preceding the test, as well as how to handle the time between the test and receiving the results. There is nothing haphazard about it.
You may be a PSA newbie, or perhaps you’re a PSA veteran with more experience than me. Regardless, I know of no one who has fully documented the correct approach to prepare for each test, so let’s fix that now. Here is a day-by-day checklist to manage this complex recurring event and relieve some of the stress associated with your next PSA test.
7 days prior (T-7)
At the outset, we must remind ourselves of the physical and mental challenges we’ll be facing.
Day “T-minus-seven” is kickoff day. At the outset, we must remind ourselves of the physical and mental challenges we’ll be facing. The more tests we’ve already endured, the easier this is. We remember each one as if it were only yesterday, and we know what awaits us.
Yet, despite similarities to previous PSA journeys, this trip will be unique. We are a little older, possibly a bit wiser, and have more experience to draw upon than ever before. We’ll spend day T-7 reliving our past PSA trips, mulling over them continuously throughout the day.
It is a day of introspection, but we cannot go it alone. Yes, on this day we must also rally the troops. It’s time to make sure our team is aware that it’s that time again. We need them to be ready to provide support and encouragement as our anxiety ebbs and flows.
We awaken our nearby friends and family to this need by taking every opportunity throughout the day to casually and cleverly insert a mention of the upcoming test into normal conversation. If you’re at coffee shop with a friend and the server asks what you’ll have, say “I’ll have anything that can lower my PSA! My test is just a week away, so make its strong!” Respond to any “hey, how’s it going” greeting with something like, “Not bad, but ugh, it’s PSA time again, and you know what that means!”
Of course, only those in our shoes really do know what that means, but that’s okay. An active cheerleading section is indispensable, even if they don’t personally know how it feels to play the game.
6 days prior (T-6)
On day T-6 we commence the daunting Discussion of Hypotheticals, or the DOH. This is a technical phrase for what can more simply be referred to as the “what if” game (a.k.a., the WIG). We never know what our PSA result will be—which, after all, is why we do the test. So we play game.
Our PSA may be higher, lower, or exactly the same as it was last time. We must anticipate our reaction to each result to avoid the last-minute stress …
Thankfully, the WIG has only three possible outcomes: Our PSA may be higher, lower, or exactly the same as it was last time. We must anticipate our reaction to each result to avoid the last-minute stress and frenzy of being caught unprepared.
On T-6 we begin the DOH by first considering how we’d react to the ostensibly easiest outcome: a lower PSA. Of course, this is what we all want, and we should be able to rejoice with this outcome. But upon further reflection we realize there’s lower, and then there’s loooooooower. It’s not necessarily as simple as it appears at first glance.
Nevertheless, down is always better than up, and we are justified to feel at least some relief, if not jubilation. A respectable drop is the best possible outcome. But defining “respectable” is simultaneously subjective and statistically determined. It’s part art, part science.
If we expected or needed our PSA to be lower, we might view a very slight dip as less than respectable—insufficient to engender confidence. Why didn’t it drop more? We might worry that it was within the margin of error, maybe not really lower at all, and possibly even a bit higher. I know some men who would immediately re-test.
Others would happily accept any dip at face value, and many would celebrate. The key is to know in advance how you would respond, and avoid being caught unprepared when the results are in.
5 days prior (T-5)
Next, we focus on outcome #2. How should we react if our PSA remains unchanged? If it’s been acceptably stable for some time we can just relax and move on. If our PSA is already wonderful, we can have a small celebration. Even if our PSA was not-so-hot, we can at least be glad it held steady.
For many of us, post-radiation PSA levels are a roller coaster ride of ups and downs. If you’re on that ride (as I am), an unchanged level means we must wait …
For many of us, post-radiation PSA levels are a roller coaster ride of ups and downs. If you’re on that ride (as I am), an unchanged level means we must wait another three, six, or twelve months to look for the next shift. It’s kicking the can down the road. It can be frustrating, but it’s better to look on the bright side and view it as a no-news-is-good-news reprieve.
In summary, if our PSA doesn’t change and we’re expecting a decline, we can be mildly disappointed but unworried. If we are fearful of a looming increase, we can be slightly relieved and postpone any further concern until next time. If our PSA graph has been relatively flat for quite a while, we probably expected more of the same and will be unphased.
It’s all about our pre-test expectations.
4 days prior (T-4)
This is the toughest day. There is always a chance we might have to face a higher PSA, and we better be prepared. Even though we’re aware of the benign reasons that can explain a jump, we’re not going to like it. Sure, it could be the result of prostatitis, of healthy prostate tissue producing PSA, or of prostate agitation before the test. It could also be little more than the infamous “PSA bounce” that sometimes follows any kind of radiation, which ironically might actually be a good sign.
There’s no denying that “up” always feels bad, but what does it really mean? Again, it depends. Will we be rushed into the ER for an emergency prostatectomy? Not likely. Will we need some additional testing—much improved in recent years—to see if the cancer’s back? Maybe, but not necessarily. It depends partly on prior PSA test results. Will we die tomorrow? Probably not, unless you’re a very poor driver.
About the only nearly guaranteed result of an elevated PSA is a lovely conversation with our friendly urologist and/or oncologist.
About the only nearly guaranteed result of an elevated PSA is a lovely conversation with our friendly urologist and/or oncologist. Mine are both nice guys who seem to genuinely care about me, so this is not too bad. Beyond that, who knows. Living with uncertainty is something we all need to become better at. It’s the nature of life. And even if our PSA goes up, we’ll probably live another day to wax philosophical.
3 days prior (T-3)
With only three days to go, we must turn our attention to the physical side of preparation. The crux of the matter is that any stimulation of the prostate can cause our PSA level to be higher. If our PSA were to go up, we don’t want to be left wondering if it was merely because of some inadvertent prostate agitation. We all want meaningful results.
What stimulates the prostate? Sexual activity is at the top of the list. So beginning on day T-3, no sex—neither mental nor physical, and neither solo nor with others. No looking at artistic magazines for men. No lustful looks at your wife, who must cooperate by wearing only the most unflattering outfits during these few days. She’s part of the team, and everyone plays a role.
For some of us, this particular issue is not a problem. At some age, for one reason or another, that ship may naturally have sailed. For others of us, hormone therapy may have knocked out the temptation, at least temporarily. But if you still ever think about sex even briefly, for these next few days—just don’t.
2 days prior (T-2)
On day T-2 we continue our physical preparation by avoiding anything that might vibrate near our mid-section. Steer clear of motorcycles, bikes, airport massage chairs, hotel vibrating beds, horses, tractors, riding mowers, F-350s, treadmills, trampolines, and row 30+ on any commercial aircraft.
It’s also wise to avoid using anything that might rattle other parts of your body because the vibration might travel through your skeletal system to the prostate area. Don’t use a chain saw, lawn mower, food blender, electric shaver, electric toothbrush, or shotgun. The list goes on, but you get the idea.
1 day prior (T-1)
With only one day to go, we have a single dominating concern: protect the prostate at all costs. Treat it like a thin glass vase. Make sure to sit only on the softest cushions, never on a hard surface. Always sit softly—don’t plunk down. If possible, stay in bed all day. If you have one, lock yourself in a padded room. We can’t be too careful.
we have a single dominating concern: protect the prostate at all costs. Treat it like a thin glass vase.
Don’t move at all unless absolutely necessary. Eat soft food to avoid the skeletal stress of chewing. Drink through a straw to avoid the strain of lifting a glass. Allow others on your support team to bring food and other essentials to you, rather than taking any movement-related risks. Leave nothing to chance.
Protect the prostate.
If possible, schedule your test for the early morning so you can quickly return to the business of life—mowing the lawn, walking the dog, and hugging loved ones. The pre-test physical regimen is rough, and the sooner it’s over, the better.
It’s also a good idea to drink lots of water before your test, as I am reminded each time by the lab tech. She smiles and asks me whether I’ve “plumped my veins” with plenty of water. I’ve learned to do that, and it generally seems to help her strike oil on the first try.
1 day after (T+1)
Actually, this begins as soon as the blood is drawn on PSA-day. Immediately after the test we can expect to feel an odd combination of relief and trepidation. We’ve made it through the blood draw, we protected the prostate, and we are ready for any possible outcome. Good. But there’s always an underlying fear of the unknown, fear of the future. And that’s okay, too.
Now we wait. What we need are distractions to stop our overactive imaginations. Movies, meals, family, friends, and maybe even Facebook are there to fill our time as we await the results. Use every diversion available and have some fun.
2 days after, and beyond
We made it. Another PSA test is done. Now what? We’ll get the results, and we already know how we’ll react. It’s back to the business of life.
Regardless of the test results, life goes on until it doesn’t. During the final years of his 101-year life, my mother’s fourth husband began each morning declaring, “I made it!” I’m now only 68, but I already feel the same way.
Cancer has a way of radically changing our perspective forever, at any age. If it isn’t cancer, there are plenty of other calamities in life …
Cancer has a way of radically changing our perspective forever, at any age. If it isn’t cancer, there are plenty of other calamities in life that can do the same. I had cancer, but I know many others who’ve had much worse. Being their friend helps me remain grounded and reminds me to appreciate each day.
Admittedly, some parts of this Official PSA Planner might be just a tad (shall we say) exaggerated, but that’s okay. I have found it helpful to mix a little humor into life’s challenges, and this is no exception. I hope you can benefit from that approach, too.
We’ll both be embarking on yet another PSA excursion soon enough. Maybe next time we can breeze through it a little more easily. In the grand scheme of things, a PSA test isn’t worth getting all worked up about.
Just do your best to wake up tomorrow with a smile, saying, “I made it!” Then hop onto your motorcycle, rev your chainsaw, swim some laps, or cut a cartwheel.
Get busy. Seize the day.
How do you get ready for a PSA test? Email me your tips. Thanks!