Steve Winkle Had Never Heard of “Free” PSA Until Six Years Ago

Prostate cancer has a way of rearing its ugly head when you least expect it. Steve Winkle had been having annual PSA tests since he was 50, and his test results were always within normal ranges that put him in the clear—or so he thought. 

“My PSA was below 4, my primary care PA had never indicated there was a problem,” he says.

When Steve applied for some life insurance, a nurse came to his home to take a blood sample.

“A couple of weeks later I got a rejection letter,” he says. “The reason for my rejection was a low percentage of “free” PSA. I thought, ‘hmm…I never heard of such a thing.’”

Steve wasn’t alone. Many men are not aware of their free PSA level. What is free PSA?
PSA is a protein produced by prostate gland cells. It circulates through the body in two ways: either bound to other proteins or on its own. PSA traveling alone is called free PSA.

While prostate cancer can raise PSA levels, so can other conditions such as an enlarged prostate, prostatitis, even the natural aging process. In fact, studies show that about 75 percent of men with an elevated PSA do not have prostate cancer. Only a biopsy can confirm the presence of cancer. And while a biopsy isn’t as involved as surgery, it can cause a bit of discomfort.

Rather than subject every man with an elevated PSA to a biopsy, urologists often measure free PSA in patients with a total PSA level between 4 ng/ml and 10 ng/ml. Men with a total PSA in this range and free PSA greater than 25 percent are more likely to have a benign condition than to cancer—making a biopsy unnecessary. But men with a total PSA between 4 ng/ml and 10 ng/ml and a free PSA level below 10 percent are candidates for a biopsy.

Along with the red flag presented by his free PSA level, Steve’s family history also put him at greater risk for the disease.

“My brother is nine years younger than I am, and was diagnosed with prostate cancer when he was 48,” says Steve. “I also had a paternal uncle who died of prostate cancer, so I knew I’d better do something and get this checked.”

Steve had seen an ad about USMD Prostate Cancer Center and made an appointment with Dr. Richard Bevan-Thomas, the facility’s medical director.

“He did an exam and recommended that I have a biopsy,” he remembers. “When the results came back, I learned eight of the 16 cores were positive for prostate cancer.”

Steve’s cancer was classified as Stage 2 with a Gleason score of 7.

“Given my family history, I was mentally prepared for him to tell me that the biopsy came back positive, but I was never really scared about the diagnosis,” he says. “I’d done a lot of research and knew that prostate cancer was relatively slow growing. I knew that if it was caught in time that it had a pretty good cure record.”

With his cancer classified as an intermediate-risk cancer, Steve opted for a robot-assisted prostatectomy—one of the two treatment options recommended by the National Comprehensive Cancer Network for men with more than 10 years of life expectancy.

“I went through the recommended steps of talking to the radiation oncologist, but for me even instantaneous gratification takes too long,” he admits. “Getting it taken care of, getting my prostate out, getting it over with, and getting on with my life that was something that appealed to me. I had pretty much decided since my brother had undergone a prostatectomy—and he had an open procedure before robotic surgery was available—that I wanted to go with the robotic-assisted surgery.”

On September 24, 2010, 65-year-old Steve underwent his robotic prostatectomy with Dr. Bevan-Thomas.

“I was comfortable with Dr. BT’s experience. I had a high degree of confidence in that he knew what he was doing and how to do it. I couldn’t have been any more pleased with him. He’s a great guy—very friendly, very open. It’s obvious that he believes in what he does and has a passion for it. I was very inspired by his attitude and his credentials.”

Steve’s surgery went well.

“It was absolutely no sweat. Twenty-four hours later, I was out of the hospital. A week later I had the catheter removed. Since then all of my PSA tests since then have been undetectable,” he says.

Now 71 and cancer-free for six years now, Steve feels good and rides his bike about nine miles a day.

“The biggest problem I have today is convincing my mind it’s no longer housed in a 20- or 30-year-old body,” he laughs, thankful that his prostate cancer was caught in time. Now he encourages men to be proactive about their health.

“I am absolutely an advocate for PSA screening,” he says. “I know there’s been a lot of publicity about how it’s not really an essential test, but I couldn’t disagree any more strongly. A PSA test doesn’t diagnose cancer, but it gives you an indication that something’s going on—that something might require further evaluation.”

He also encourages men to stay on top of their PSA levels and any changes in their levels.

“After I was diagnosed, I told my primary care provider and he was very apologetic,” Steve says. “He looked at my past results, and it turns out that the year before my PSA level had changed by more than 0.75—the threshold that is a red flag for prostate cancer. But he didn’t notice it, and I wasn’t tracking the numbers. I was just taking his word for it. Since my PSA was below 4, I didn’t think there was a problem. Had I known about the rate of change in conjunction with my family history, I would have investigated things sooner than I did. But I didn’t, and that’s history and that’s how things go sometimes.”

And for men who are diagnosed with prostate cancer, Steve offers this perspective:

“There are a lot of factors that need to be discussed with your urologist. Stage, Gleason score, your preferences, your lifestyle—all of those factors play a role in the decision you and your family are going to make. But the one thing that I’d say is just because you’ve been diagnosed with prostate cancer doesn’t mean that you’re going to die. It just means that you have a disease that needs to be addressed. And how you choose to address it will be the result of an informed decision. Talk it over with your family and your doctor, arrive at your decision and go with it.”

If you’ve been diagnosed with prostate cancer and would like to know more about your treatment options, the compassionate and experienced physicians at USMD Prostate Cancer are here to help. Reach out to us online or at 1-888-PROSTATE (1-888-776-7828).

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