Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. PSA tests are used to observe the advancement of cancer over time.

When you’re diagnosed with metastatic castrate resistant prostate cancer, have undergone radical surgery, radiation, and then almost 2 years of a hormone therapy drug, everything in your life revolves around your PSA level. Literally, your life is at stake. Undetectable is good. It means the drug is winning the battle. Detectable is bad. That means the cancer has made a sneaky comeback.

Every 4 to 6 weeks, Tim drags himself to the Schar Cancer Institute, gets his blood drawn, and then to the 5th floor to meet with his oncologist. Between the time he leaves the lab and arrives on the 5th floor, his CBC and Comprehensive Metabolic Panel results are in. His PSA results come in later in the day. So we wait anxiously.

This year alone, Tim has had an aortic valve replacement (to replace a faulty one installed in 2019), two hernia repair surgeries, and 3 falls that resulted in a broken nose, a brain bleed, a broken wrist, and rib fractures. He had COVID and RSV. But his PSA remained undetectable.

Yesterday we had typical appointments from 8:30am until 12:30pm. His blood pressure was good, his blood levels looked good, and his oncologist was pleased. But the most important test didn’t come in until 3:30pm.

I try to be there when the PSA results come in, but I had been out running errands and was 5 minutes away when they did. The test popped up on MyChart and they were not good. They showed detectable levels of PSA.

I walked in the front door to find Tim in his chair. His stoic facade barely concealed is fear. Of course we Googled what this could mean. I found:

“A value of 0.1ng/mL would be considered essentially zero. PSA above 0.1 is usually an indication of cancer recurrence, and treatments for recurrence should begin before the PSA reaches 1.0ng/mL.”

We contacted his oncologist who responded:

Your PSA is slightly detectable this time. I’m cautiously optimistic that it will remain stable over several more readings, but sometimes, it can be indicative of emerging resistance to Zytiga. We should continue to keep an eye on it and plan for scans again if it continues to trend up. We keep the same treatment going until there is both overt progression of disease by PSA and on imaging studies.

Tonight we are going with our dear friends to Wolf Trap, a beautiful wooden structure with indoor seating and a lawn for picnicers, to see Taj Mahal play. Life will continue for us and we try hard to cherish and appreciate every moment of everyday.

If you get confused, listen to the music play. ~ Robert Hunter/Jerry Garcia