What to do if your PSA test is abnormal | Peter Attia & Ted Schaeffer
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This clip is from episode #273 ‒ Prostate health: common problems, cancer prevention, screening, treatment, and more
In this episode, Peter is joined by Ted Schaeffer, M.D., Ph.D., an internationally recognized urologist who specializes in prostate cancer.
In this clip, we discuss:
- What is PSA
- Why PSA in the blood is problematic
- The importance of PSA screening
- Why patients should take ownership of their own health
- And more
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About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 70 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
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As a practicing MD for over 30 years, I have little confidence in the PSA test. I have had MULTIPLE patients with a PSA < 1.o and had cancer; I have had others that were over 8 and no cancer. It is an imperfect test, at best. I have picked up more cancers based on the trend for a patient than I have with a single read. We need something better.
Yes, it's PART of the evaluation for prostate CA along with the digital rectal exam, etc. There are many pts. who have "normal" chest radiographs who are harboring CA that will become lethal, normal abd. CT who later die of pancreatic CA, malignancies missed on colonoscopy, etc. Perhaps 30% of men with significant CAD are missed by exercise ECGs alone (therefore nuclear imaging is added). The perfect must not be allowed to become the enemy of the good. Yes, I know "good" is relative.
I’ve had a PSA 5.0 and greater I was diagnosed with Gleason 7 and started a naturepath Ionic calcium routine I’ve have 3 3T MRI’s and no cancer has been detected.
Even the guy that invented the test says that it is very unreliable for prostate cancer detection
I’m 68 and I recently had a psa reading of 11.2. The doctor told me they would except a psa around 4 for my age.
So today I had a mri scan. Got to wait and see a consultant now.
What I don’t understand is the negative comments about the psa. It’s got me a mri scan so surely the psa test is worth doing.
My PSA 6 year has history has been over 4. I had a Gleason 7 and went to a natural path, and started Ionic Calcium supplements. After three months there was no cancer found on my 3T MRI. Praise the Lord. My PSA is still high and 2 more MRIs haven’t detected it. I’ll keep checking every 6mo.
Thank you for this information. It seems like the urology community is all over the map in regards to PSA and other prostate discussions. I can't imagine undergoing radical surgery with so many question marks hanging out there.
Actually I haven't heard any significant variation among experts. Some discussions are more complete than others.
I’m dealing with an enlarged prostate and my PSA levels are up and down hearing this news is somewhat comforting. I am very appreciative of the content and the manner in which its presented.
Careful, DRE can inflate your PSA.
@@SUNofNY what is DRE ?
@@indrakusu Digital Rectal Exam. If Dr does DRE first then draws blood for PSA your PSA may jump a significant amount. Mine went up 50% and I almost died when I read the results. Then I found study after study that show this is well known result. DRE will raise your PSA for a day or two.
@@SUNofNYDRE is an advanced test for PSA? what did you feel when reach 50 ?
Mine 14 based on blood test, and doctor advised me to have biopsy. I'm so worried.
@@indrakusu DRE is the finger in the butt test. The DRE will raise your PSA a bit.
PSA of 14 is more than just a bit from DRE. Move forward with a good Dr. and learn as much as you can along the way.
My dad had prostate cancer (PC), he got treated and is fine now. PC is common and usually treatable. Early is better than later.
Gift to hear such expert dialogue.
I’m 77, PSA spiked from 5.7 to 7.5. Scheduled an MRI for next week.Free PSA 15%, ratio 1.2.
Not worried.
Take Zinc supplements...Dr.Berg showed normal prostate with 745mcg Zinc, enlarged prostate with 440-484 mcg and cancerous prostate with only 250 mcg.
Of course your decision we are same age and I will do further psa testing.
Any news on mri ?
In a for profit private healthcare system there’s no incentive to actually heal your pool of “clients”. UR right that patients should take responsibility
My P.SA was a 10 my urologist wanted to do a biopsy I sad no because I had a recent UTI infection so I wanted to get a retest my P.S.A.blood work.
This podcast is timely. I’m 58 years old. A lifetime athlete. Bloodwork this past week revealed that my PSA increased significantly, from 1.2 to 4.6. I’ll be having follow up bloodwork in two weeks. Thanks.
Have you changed anything since the last test?
@@NYGuy2000
No, I’m a very regimented person. No dietary changes or other lifestyle changes.
@raymondwade2433 Good luck with the follow-up test. Please let us know the result. Perhaps a lab flaw.
Is your intake of red meat and dairy super high? Those tend to be culprits regarding prostate issues. Also, the spike protein from Covid vac and infections contributes to elevated PSA. Did you go through those recently?
Did you listen to the entire episode ? Peter has a link to the full length episode , just below the video where are the infos. It's 3 hours long but worth every minute.
@@Lolipop59 about to give it a listen 🎧
Peter makes the most sense.
One thing I found out was you have to drink plenty of water prior to the test. It changed my reading from 8 to 3.4.
Seriously? That’s pretty significant
How much water did you drink?
Did you start drinking it the day before or just the same day as the blood test???
I am not familiar with the water, but I have read a man should not masturbate or have an orgasm two days before PSA tests.
I've found that too. When I'm dehydrated my PSA is high. When I'm well hydrated,. it's low.
Great information. I’m 60. In very good health. But 2 years ago my PSA was 4 for first time ever. I got my bloodwork today. It’s 5.2. Yikes. I have my annual physical in 2 weeks. We will address.
For what it may be worth to you, I’ve bounced around between 4.2 and 5.75 for the past 10 years. I go up, then down again. I doubt that I have an aggressive form of prostate cancer, but who the heck knows. You might want to try an ExoDX urine test, sometimes referred to as a liquid biopsy.
Thanks. My doctor said it might be prostatitis and put me on an antibiotic. I get my PSA checked again in two weeks.
Thanks Peter! Excellent comparison with CGM , if we were able to CONTINUOUSLY monitor PSA levels we would be able to prevent 99% of prostate cancer!
At 65 My Psa Was 6 And I Had A MRI ,Then A BI OPSY Which Showed I Had Gleason 6,7,8 Prostate Cancer Confined To The Prostate Gland .
Hey Charles, hope all is good. I had the same thing, then end up getting a prostatectomy 16 months ago. my current PSA is 0.05
I'm 60 and my PSA goes between 2.7 / 4.33, highest was 4.77 two years ago, I'm do a test on my own and taking 3 tablespoons of Costco Tomato Paste each day until my next test in July. I'll keep you posted if it lowers....read it's high in Lycopene which is an carotenoid antioxidant found in many plants, especially tomatoes. GLTA and stay positive
I've heard the same about tomato paste
For years, PSA testing was discouraged because it led to "unnecessary" treatments. I had to repeatedly request PSA tests to be included with my annual physicals. Well guess what? Elevated PSA, confirmed on follow up in two weeks. Then MRI, then biopsy and now Active Surveillance. If the test isn't offered, ask. If told it isn't necessary, demand. If still unsuccessful, find a new doc. It's your life.
That is VERY good advice. I'd add that an adult should only go to a board certified internist.
I’m 66 diagnosed with low grade cancer about two years ago. It’s so low the MRI did not pick up my cancer. Diagnosed from my second biopsy. My PSA in the last two years has been up and down between 4.5 to 5.0. Then it just to 8.44 down to 7,43. Just had my PSA it dropped to 5.43. Will be getting my third biopsy in May. My doctor i feel bis staying on top of it. And I do my homework and ask questions.
You need to stay on top of it yourself. Save your own life over 4, you need to remove it.
Is it safe to take a by biopsy of the prostate with a needle for cancer .my numbers are going up slowly
What is the highest psa reported and metastatic in bone reported and person survived with good life for more than 5 years.
OR as discussed at the end, men must be proactive in their own health. I started testing my own PSA at age 39 because I have a family history of prostate cancer. Now its a basic PSA, but it costs $40 labcorp and cheaper than going to my primary care doctor.
It was a timely video since I asked my doctor to include PSA in my annual exam, and my result was 0.2. Since I am in my late 40s, I will continue to include this test every year.
Good move. Wonder why you had to ask. Maybe you should ask him/her. Stool for occult blood? Colonoscopy?
@@wholeNwon Recently Had a Stool/Breath test. Colonoscopy last week. The stool test showed low elastase, very low secretory IgA, and occult blood. The colonoscopy results are all good. We will do the stool test again, and if the occult blood is still present, we may need an endoscopy. Adding digestive enzymes was very helpful. The doctor suspects occult blood could be because of ulcers in the small intestines or stomach.
My doctor was making all kinds of alarmist sounds because my PSA was high. He then sent me to a specialist, who said, "Or course, you're not supposed to have any sexual activity within 24 hours of your test, because it can totally throw off the test results" ... something my family medicine doctor had never mentioned. So I retested, this time taking a break from sex first.... and my results were fine. Turns out that even having sexual thoughts on the day of the test can throw off your results.
Partner in 70s had PSA 40 after bactrim because there was blood in urine. Waiting a couple weeks to retake blood work as we saw recent antibiotics can mess with PSA test. Does it seem a psa of 40 is likely cancer?
Diagnosed with stage 4 when I was 42. Am 52 now and in remission. Agree with Attia that we should be doing PSA more commonly and at lower age. Especially since the disease is impacting more young people than it used to.
Did u get your prostate removed?
Very young. What were your symptoms?
@@EZ8E couldn't pre.
@@EZ8E been ten years and I'm the healthiest looking cancer patient you ever saw. Really focused on diet and exercise and lifting. In remission again but it'll keep coming back.
@@ChalrieD Glad you are doing so well! Keep up the fight. Ive been having symptoms on and off for years. Im 50 now and considering taking a test. Couldnt pee at all huh? Yeah that would get me there. lol
At 65 years old my PSA when from 1.2 to 1.5. But I still want him to give me an ultrasound so I'm getting one because two years ago I was diagnosed with a medium large prostate. I take supe rbeta prostate I mean everyone should try whatever works for them and you don't know it has helped me to go to the bathroom I don't wake up as much at night like I used to now it's just maybe just one time at night
No excuse not to get frequent screenings at an early age except patient temperament. Also, never mentioned by drs is that you can get the psa along with regular blood draws done annually, so no additional appointment and blood draw is needed, for many this is a big consideration. Also, drs never mention what might throw a psa off (sex, bike, etc), this should be discussed so the patient can make the most of the test.
My physician mentions all of that.
I am 59 y.o. and my total PSA level now is 0,68 and my free PSA level is 0,08. If I understood correctly from this video, the percentage of free PSA in my case does not mean anything, because my total PSA is very low, so there is nothing to worry about?
Is there a correlation of the PSA score and heavy bike cycle riding? Spending lots of time on a bike seat would seem to have consequences.
When you talk about the ratio psa/prostate volume ,you refer to the volume or to the weight of the gland? Because you said "a volume of 40 grams"
Thank you !
The wt. is inferred from the volume measurements.
With a PSA of 17.7 and prostate 7 times normal size, I thought that my health issues were down to that, subsequently I have been told that the prostate was held within a capsule and the capsule had not been perforated. Eventually found that I am suffering from a kidney tumour, due to be removed in three months, seems a long time.
The ExoDX urine test is a good option for those who are concerned about an elevated PSA but don’t want to go straight to a biopsy.
It’s amazing how the PCP system works that your PCP only register than 76-yr old man has elevated PSA (over 5) and do not order freePSA & PSA density test. While the patient had already TURP treatment of his enlarged prostate 5 yr ago?
I am a 58 yo man with ischemic cardiopathy and undergo annual tests, including blood work, a stress test, and an echo-doppler cardiogram. One of the tests my cardiologist has requested is the PSA and the percentage of free PSA. Does anyone know why? I mean, what does it have to do with my underlying illness?
fully covered in the video.
My PSA when tested first in the end of march 2024 was 64.3
After seven days it came down to 50.67
Doctor s suspected prostate cancer ..
Then after MRI and biopsy cancer confirmed it's at early stage ..
After biopsy my oncologist advised to do psma pet scan .. .. On the day of pet scan at a gap of one month .. PSA came down to 22.07
All these days I was under zero carb zero sugar diet and three days water fast in every week ..
Again on 24.4.2024 I again tested for PSA .. It was 12.7 ..
What all this is indicating ?.. Is my cancer tumor slowly going away?
ive heard insulin feeds cancer so intermittent fasting cutting carbs sugar should slow the growth. im trying this too.... hoping autopathy will eat the cancer
Peter i understand your need to push back but please allow the specialists to finish is explanations.
The internet has a lot of rubbish but when you see two medicos discussing topics such as this I feel it can arm you with some information that can assist when you visit your own doctor with questioning etc. If you are not satisfied with the doctor ask ask ask questions of that person and also if necessary, find another Doctor for a second or even third opinion.
If you test every year and it varies to much from year to year as you guest says doesn’t that almost invalidate the test.
Surprised he didnt mention the newest test which is supposed to be more accurate than 4k and that is the Iso PSA test.
Could not agree more that patient’s need to take responsibility for their health on this an other matters. I love love love my physician but there is no way that any doctor, in our modern system can address all your health concerns over the course of the brief visits they are forced to in order to sustain a practice. In my case those visits are 15-30 minutes every 3 mos, and that is probably high relative to general population. I appreciate this information as I had been believing (although skeptical) the guidance not to “overtest” as the false positives can lead to bad outcomes. Sounds like that is nonsense. Test frequently, but don’t freak out if you get a single high result.
You are correct: Obviously it is nonsense. It's your LIFE we're talking about.
I dont even go to the doctor anymore. I have an HDHP plan and regular office visits and blood test run over $2200 a visit. I go online and order blood test from labcorp for $200 and add PSA to it. I have a home blood pressure gauge. That is pretty much all the doctor does anyways. Thankfully I dont have any serious health issues. If you are of average intelligence without chronic diseases that require regular treatment, there is almost no point of going to the doctor unless you're having an acute problem.
What about high exsome min3 is 41.00
There is a cost in anxiety, lost production and benefit to risk ratio in terms of length and quality of life. Any Decisions are NOT simple to be based currently available numbers , just the final word.
Brief anxiety is a SMALL price to pay to save your life. I speak from a lot of experience having gone through tests to characterize possibly deadly tumors in my head. 3 MRI, 2 consultations, 1 urgent admission for biopsy, etc. Was the anxiety worth it? Of course it was. And mine began when the chief of neuroradiology at our 1000 bed med. center called me at home in the evening to tell me that it looked like I had one of 3 possible tumors, each worse than the other.
Interesting!!
I'm 66. My psa is 2.5 and my psa density is 56 cc. Which puts me at 0.04
Low risk.
But my MRI states, according to the radiologist, 3 lesions at pi-rads 4/5, 4/5 & 5/5🤔
One lesion at 1.6 cm, and the other two smaller.
Should i be concerned.
I feel great. In great health, as far as i know. Metabolically sound.
P.s.
And of course, urologist wants to do a biopsy😕
Thx👍
So, have it. It takes 10 minutes, It'll hurt when they poke your rectum for the first two jabs, after that, it won't. Then, your butt and your penis will bleed a little for two days, you'll need to put something in your pants. I just used paper towels. There's no pain or discomfort after the procedure.
Any results from biopsies
How the hell you got that MRi ? Clinically you shouldn’t have it but now u did so u need to follow through
It looks like your density is .04, the volume is 56 cc, right?
Don't hesitate, if PSA is elevated, get additional testing (MRI, Biopsy, Scan. etc...)
ABSOLUTELY
My PSA was 5.6 for decades. 30 years ago a doctor recommended an ultra sound. After that he said the results were inconclusive and scheduled a biopsy. After the biopsy my PSA elevated to 19.8 where it has remained for 30 years. I have never had cancer but after the biopsy I now suffer from BPH do not trust PSA tests.
Wow, no talk of prevention by this urologist, very disappointing it’s not age or drugs or tests it’s diet and lifestyle that can improve healthy ie. prostate health. I watched my PSA creep up over my 40’s (horrible diet) topping out at 6.35 at 52 years young. I went to 2 different urologists they both screamed at me there is no way to lower PSA and that I needed a biopsy! I started KETO, low carb, intermittent fasting, and longer fasts FF 2 years my PSA dropped to 3.0! Last year at 57 years young it was 2.9! Do not listen to these medical ghouls and heal thyself!
Did they also tell you that about 25% of men with prostate cancer have normal PSAs?
@@wholeNwon they’ll tell you anything to get you into an invasive expensive procedure. They didn’t tell me that biopsies will cause spread of relatively slow benign prostate cancers. They didn’t tell me there was any cancer. They didn’t tell me of possible incontinence from the procedure. They didn’t tell me that most “cancer cells” would have been fine just left alone. They don’t tell you a lot of things. What else did I miss, please comment…
@@andrewrivera4029 I was told but the risk/benefit analysis markedly favored biopsy.
@@wholeNwon for who? For a young healthy 21 year old with a .2 PSA? For a fat 43 year old with a PSA of 122? For an 81 year old metabolically impared male? Who is in their risk/reward calculus? Please forward me the study you’re lookin at.
@@andrewrivera4029 Or you could do what I do and ask your M.D.
The PSA indicator is right up there with Thalidomide and the lobotomy on the scale of medical failures. 3,000,000 men around the world been wrongly diagnosed and relieved of their prostates over the last 30 years, plunged into an immediate spiral of sorrow, thanks to the horrid PSA test.
Diet has a lot to do with this , lam not a doctor but the research l done on myself l noticed my physical shows this
ExpIain this like I didn't go to medical school......
His is 66 now was 45 PSA 10 years ago. Hes sick now
❤💪
Are you referring to my son's, which were normal. I can't possibly have a PSA.
Psa 3.9 Gleason 9 prostate cancer
😢
48yo. PSA 7.5 to 10.65 in six months. I am worried. In my country a basic PSA test is $35...or for me a week's groceries. Waiting 4 months for urology appointment at government hospital. Owning this, changing diet and acting pro-active in the event that it is cancer.
In the meantime your doc. can order an MRI of your prostate and have it ready for the urologist so you don't have to wait for him to order the study. That will speed things up for you.
You must be in Canada.
@@schmingusss South Africa
@@NeilSmit-pr9wy We have to pay out of pocket here as well.
So what to do if your psa level is abnormal. I didn’t get the answer.
Easy: See a good M.D.
You can do whatever you feel will help you but do add “butterfly aasana “ yoga exercise at least five hundred reps everyday. You can look up on TH-cam how to do that exercise. Your numbers should fall immediately. All the best,
PSA stands for Patients with Severe Anxiety. THAT's why they don't do it every year.
American Cancer Society recommends stop testing for psa at age 69 because even if the lab finds something, you'll die from something unrelated ( not prostate cancer).
so the resistance to yearly psa testing lies in the fear of over treatment. shouldn't be too hard of an obstacle to overcome...
I was disappointed the doctor would not endorse yearly PSA test for men over 40. It is a blood test that I purchase from labcorp for $40, so I assume it literally cost an hmo or hospital next to nothing to add it. I started at age 39 because like Dr. Attia said, I wanted to know my own baseline and track changes. I get a PSA every six months. It may be excessive, but as someone with a family history of prostate ca on both sides, it's a cheap price for important information.
@@_m_K_. yep. i was diagnosed 2016 at 51 years old, gleason 9. psa was only 2.3. though i had never had a psa test before. i also had blood in the urine. without the digital rectal exam indicating a lump the cancer likely would have been missed. however if there was a baseline to work from the 2.3 would have meant more, being it was the first and only test it was rather abstract. in the past year both my brothers have been also diagnosed with prostate cancer. nothing as far as cancer goes on my mother or father's side. i think its completely irresponsible for doctors or anyone to just blanketly recommend to stop or slow down on the psa tests. they did this in united states for a while, guess what, in a few years they had too many men presenting with advanced cancers. stuff that would have been caught. some don't understand a gleason 6 or 7 or whatever, it doesn't stay at those grades, it mutates and goes up in grades. gleason 6 which is 3 and a 3 will become a 3 and 4, which becomes 4 and 4, on and on it goes. I opted for a prostatectomy and there were positive margins, extension, invasion. It had to be treated again using radiation and hormone therapy. 4 years after its back again, though the psa number is very small it is rising. meats, fats, eggs, dairy simply put animal based products accelerate the prostate cancer and there is plenty of evidence to back it up. i feel bad for people going down the animal based keto diet pathways, as far as cancer and heart disease there is nothing to back it up as being a valid choice. anyhow.
@@_m_K_. Yep. Should get a base line psa at 40 for all men. I'm baised because i got the prostate cancer at 51, it sucked and still sucks. It was the first psa test i had done so there was nothing to compare it to. In the past year both of my older brothers have been diagnosed with prostate cancer too. Some guys get it even before 40.
Put youtube down and see your doctor
If your PSA is beyond 4 ng/ml in Caucasian men and 2 ng/ml in black men you should see a urologist asap. Black men have a propensity for falling victim to prostate cancer. I have a great deal of experience with all this. Get a PSA test after age 50, or earlier if your father had it, like mine, who died from prostate cancer. The silly argument against having a PSA test has been that a high PSA would result in surgery to remove the prostate, taking a risk against cutting the nerves to preserve an erection. If that happens, patients can have an implant and it works better than ever. So the argument is invalid. My father died 60 years ago and the science about prostate cancer hasn’t advanced much in all that time.
My experience: all my high PSA test results were caused by Urinary Tract Infections, nothing else.
How high it was?
286, and after treating the UTI it was down into the 'normal' range (retest was 2 months later).
Thanks for you answer, nice to occasionally read something like that kind of better "news"
Read the book, Prostate Hoax. Then make a decision for yourself on PSA? By the way, the author invented the PSA.
Incorrect: The test is not free. My health care doesn’t cover it. Medicare doesn’t cover it. Therefore, my supplement doesn’t cover it. Or I wasn’t informed that 2-4 years is covered?
It sure covered my PSA tests and does so once a year. It also covered fractionation of PSA and I think it now covers Episwitch test.
@@wholeNwon Thanks for your reply. I was incorrect. I checked with Medicare this morning, and it is allowed once a year. If one goes to medicare.gov, logs into one's account, "open all options- check preventative services" it lists the next eligible date.
Ted is not able to talk, Peter is interrupting to much. WHAT A WASTE OF GOOD INTENTION
MINE CAME WAY DOWN !
Psa is 48
Same here. PSA 49 first test, 45 repeat test.
@@ygillham 4.9 or 49?
@@ygillhamwhat is your follow up care?
Radiotheraphy/Goldseeds/Hirmontabletts all is called Brachyd, Don't hesitate.
After several refusals to give me a psa test, my psa appeared to be 51. Within 3 months followed by a prostatectomy.
Mebendazole, Fenbendazole, Ivermectin. Ivermectin has been added to TNBC treatment by the City of Hope. Mebendazole has been added to Docetaxel by the University at Glasgow for PC.
The information here is ultimately designed to lead you towards invasive procedures/treatments and make money for the pharma industry/individual practitioners involved.
below 1? Seriously? The person who invented the PSA test says its BS.
source?
Best test is a pet scan for prostate cancer. It is best test to actually c if it outside and spreading.
@@rjcrjc8025 PSMA TEST
@@nvan78He wrote a book called the Postate Hoax
Blood for PSA should be drawn BEFORE a DRE, not after.
DRE sends PSA up an average of 0.7 for 24-48 hours.
Inflated results forcing patient through more stress and testing for nothing but.. profit?
DRE ?
@@albiniogonzalezgonzalez6374 digital rectal exam
Crack and re-submit.
Doctor: It turns out we gave you the wrong test results
Patient: Whose test results did you give me?
Doctor: Abby someone
Patient: Abby who?
Doctor: Abby Normal. Yes, I’m sure that was the name.
If your PSA is over 4 at age of 45+ you need a biopsy. It is you life. It is important to establish base line starting in mid thirties. PSA test every year your insurance covers it.
I wonder what causes physicians to become bald.
The stress of ripping people off.
@@dlindo8892 fluorescent lights, or maybe florescent childhood trauma.
Another doctor who has another tool for making $$
meaningless test causes more harm than benefit
Which 'harm' are you talking about PSA testing? Which is the risk to get PSA checked more often?
PSA meaningless?? My test led me to be checked further and cancer was found. Treatment at Sloan Kettering