Dr. Geo: 'My Own PSA Experience: A Lesson in Patient-Stimulated Anxiety'

Travel writer Rich Steves gets some great news

(Letter from the editor: Dr. Geo Espinosa, a naturopathic physician at NYU (Go Violets), is one of my favorite prostate experts. He’s upbeat, humorous, personable and knowledgeable. With his permission, I am sharing this column on his close encounter with PSA testing. Check out his website at DrGeo.com—Howard Wolinsky.)

By Dr. Geo Espinosa

I often tell patients: "Don’t get too high when your PSA is low, and don’t get too low when your PSA is high."

I say this because I’ve seen too many men stop living while still alive—paralyzed by PSA readings.

Recently, I completed my own wellness health workup, which included about 25 vials of blood work. Among the biomarkers tested? PSA.

(Dr. Geo)

When the results were ready, I logged into the portal, finger hovering over the “results” button. And to my surprise, I felt it—a low-level anxiety, a subtle knot in my throat, a moment of hesitation before clicking.

There’s a reason why some of us in medicine jokingly call PSA "Patient-Stimulated Anxiety." Holy crap, it’s real!

Despite the fact that my paternal grandfather died from prostate cancer and my father has had prostate issues since I was a child, this was the first time I personally experienced that visceral reaction to seeing a PSA result.

Turns out, my number is in a good range. But the real takeaway? For a brief moment, I felt exactly what my patients feel—the pounding heart, the uncertainty, the internal dialogue of "What if?"

So, my fellow readers, I understand you a little better now. I hope I don’t need a diagnosis to keep deepening that understanding.

How to Handle PSA Anxiety: What I’ve Learned from You

Over the years, my patients have taught me that dealing with PSA testing—whether before or after a prostate cancer diagnosis—is not just about the number. It’s about managing the fear and uncertainty that comes with it.

Here’s my best advice, much of which I’ve learned from you, my patients and readers:

• Acknowledge and even embrace the fear, but don’t stay stuck there. Anxiety is a normal response to uncertainty, but it shouldn’t take over your life.

• Move your body. Physical activity helps release stress and reminds you that you are alive and in some control of your health.

• Stay informed, but don’t obsess. Understanding your numbers is important, but one PSA test does not define your health or your future.

• Keep living. Many men let PSA anxiety overshadow everything else. Don’t let fear rob you of the present moment.

Ultimately, the key is self-health advocacy—being proactive, informed, and engaged in your well-being without being consumed by fear.

Here’s to thriving, not just surviving

Chicago area AS patients: Join us for lunch on March 20

Calling all Chicagoans on Active Surveillance for low-risk prostate cancer. I have had a flurry of emails from you after NOT hearing from you for years, My The ActiveSurveillor.com newsletter is organizing a lunch at 11:30 a.m. Central March 20. Contact me at howard.wolinsky@gmail.com, and I’ll share the deets.

Sorting out biomarkers: A Guide for Patient’s on Active Surveillance

By Howard Wolinsky

PSAs, MRIs and biopsies each tell part of the story on prostate cancer. But increasingly, biomarkers are playing a role in making decisions on Active Surveillance vs. treatment for men with prostate cancer.

Active Surveillance Patients International is presenting
“Sorting out biomarkers: A Guide for Patient’s on Active Surveillance” featuring Jonathan Tward, MD, PhD, an international authority on biomarkers.

The webinar will be held at noon to 1:30 p.m. Eastern on Saturday March 29, 2025.

To register, go to: https://zoom.us/meeting/register/wsESZAXeR8Shp7FU60FHvg

Please send questions in advance to: contactus@aspatients.org
Dr. Tward is recognized as a major authority and key-opinion leader in treating prostate, bladder, and penile cancers. He holds The Vincent P. and Janet Mancini Presidential Endowed Chair at Huntsman Cancer Institute in Genitourinary Malignancies.at the University of Utah.

Dr. Tward has served as the principal investigator for several of the critical studies funded by Prolaris to create and validate their treatment threshold recommendations. He served as a scientific advisor to Myriad,mand continue to consult for them. He has dedicated most ofhis career to developing better tools for men and have worked with Veracyte (Decipher), Artera AI, and others.

Prostate Cores newsletter

Check out my new Substack newsletter Prostate Cores, abstracts on research on PCa, biopsies, BPH, prostatitis. New edition out March 1. Sign up today.

TAS, the vid

Check out the YouTube video, Active Surveillance 2025: The Year in Review. Please fill out questionnaire: https://forms.gle/AqUUKt8TnXvDZnmL8

Travel writer Rick Steves is ‘cancer free’

By Howard Wolinsky

Famed travel writer Rick Steves, 69, announced in Facebook on Feb. 22 that he is “cancer free,” six months after his radical prostatectomy.

Steves said: “PSA 55 to PSA 0.09 to PSA <0.03 …Yes! If you know prostate cancer, you know the happy story of those numbers — and the relief of hearing my surgeon [the great Dr. Dan Lin, of Seattle’s Fred Hutchinson Cancer Research Center] say, “You can now consider yourself cancer-free.”

He added: “Life has been a whirlwind lately, with a new grandson, a New York Times bestselling book, and a president essentially declaring, “L'État, c'est moi” (“The state, it’s me”… in the spirit of Louis XIV.) But I’ve been on a deeply personal journey since last July, when I was diagnosed with prostate cancer. I promised I’d keep my traveling family posted — and I’m happy to now report that I’ve weathered the storm.”

Steves has been doing his audience a great service by sharing his latest journey, his prostate cancer journey. I wish some A-listers on Active Surveillance would follow his example.

He wrote: “For now, I’ve broken through the storm, and it’s smooth sailing ahead. But more storms are inevitable, and I’d be wise to keep in touch with the captain and take care of the ship. (This would be a nice place to segue into the value of continued government investment in medical and scientific research — but I’m trying my best to keep politics out of this post.)

”I decided from the start to share my cancer story with my Facebook friends as a public service. But I never dreamed it would be so newsworthy… from CNN to People Magazine to The New York Times. People care. And when you go public, people come out of the woodwork to share their own experiences with cancer and to help and support you.”

The message is important: I learned the hard way (almost the very hard way) about the importance of men being tuned into their bodies — especially older men like me, with a history of cancer in the family. I didn’t notice any symptoms and assumed my frequent trips to the WC were simply a consequence of my healthy determination to ‘stay hydrated.’ Only after my diagnosis did I learn that my uncle and his dad both had prostate cancer at my age. It was totally on me… and I was too busy simply living to get tested.”

Good message.

”Thankfully, I got a new primary care doctor who wanted to kick off our relationship with a blood test. And two days later, our shared mission shifted radically from wellness to survival. After carefully considering all the options, I decided to get a radical prostatectomy — which meant my entire prostate would be removed.

”Going into the surgery, the big concern was: Had it metastasized? If the cancer is contained in your prostate and they take your prostate out… you’re good to go. But if it turns out that it spread… your journey could be a very long one (or a very sad, short one). It’s all about the ‘margin’ between the cancer and the edge of your prostate, which can only be measured once it’s out. I envisioned my prostate as a good-looking little apple with a dark and rotten core (a good margin) or a windblown old dandelion with missing tufts (no margin plus spread). My doctor’s report after the surgery: “Not as good a margin as we had hoped… we can be guardedly optimistic… but we’ll need to wait for your PSA score in later blood tests.”

A PSA score is a number that measures how much “Prostate-Specific Antigen” is in your blood. A high score can indicate your body is battling invasive cancer cells — and my initial PSA of 55 was through the roof. Two months after my surgery, it was good news… down to 0.09. But as my doctor says, ‘A big flame or a tiny flame — either can start a destructive fire.; He’s greedy and wanted it all gone, so he would only say he liked the trajectory and “we’ll see how it looks down the road.” And finally, my latest blood test has brought home some very good news: A score of <0.03, which means less than the smallest number they can measure.”

Steves shared his close encounters with the twin plagues of radical prostatectomy: incontinence and erectile dysfunction. He didn’t mention penis shrinkage.

“And what about the sexual dysfunction you always hear follows prostate removal? It varies from no problem to no more erections forever and ever, depending on how much unavoidable nerve damage your surgeon did while taking out everything that could have been cancerous. (How’s my ED situation? Let’s just say I’ll be no fun at an orgy for six to 12 months.)”

ASPI video on Gleason 3+4 as future of AS is posted

The February ASPI webinar, “Is favorable intermediate-risk PCa the future of AS?,” featuring Dr. Kevin Ginsburg, MD, urologic oncologist at the Karmanos Cancer Institute/Wayne State University in Detroit is now available.

Go to:

Ginsburg, J. Edson Pontes, M.D., Distinguished Endowed Chair in Men’s Health at Wayne State and co-director of the MUSIC (Michigan Urological Surgery Improvement Collaborative ).

MUSIC has been one of the most successful U.S. programs for Active Surveillance. Over 90% of patients with low-risk prostate cancer in its program go on AS vs. 60% nationally. Likewise, MUSIC has been successful in offering AS to patients with favorable intermediate-risk prostate cancer at a rate of about 45% compared with 20% nationally. In 2023, ASPI presented MUSIC with its first ASPI AS ADVOCACY AWARD for its advances in researching and promoting Active Surveillance for lower-risk patients in place of aggressive treatments.

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