Whew PSA Dropping!

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newtopc
Regular Member


Date Joined Dec 2009
Total Posts : 57
   Posted 8/13/2010 4:55 PM (GMT -6)   
I had my PSA rechecked after a jump from 3.95 - 6.18 after biopsy, results from yesterday 4.64. This drop in just 21 days. I know all the do nots prior to the test. The only thing that was different from other tests was I had my third twinrix shot 2 days before the blood draw. I googled twinrix and PSA and there is nothing on the internet relating to PSA and an effect from twinrix. I see the URO in two weeks, we will se what he has to say. I would expect at least one more PSA test before we shoot "ahem" for another biopsy. Have a great weekend friends, Greg
47 Year old male, smoker, healthy
Routine physical May 12, 2009, PSA 4.12
Follow up PSA October 27, 2009, PSA 4.61 / Free PSA 4% (Not good)
Referral to Urologist Feb 18, 2010
Follow up PSA January 7, 2010, PSA 3.95, Free PSA 4% (still not good)
Biopsy March 16th, 2010, 8 core samples taken, Results April 5, 2010
Results - very small prostate, DRE normal, all core samples negative
July 22, 2010, PSA 6.18

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24053
   Posted 8/13/2010 5:03 PM (GMT -6)   
Greg,

Just my untrained opinion, but from reading your case, I would want another biopsy at least within 6-9 months of that last one, and perhaps this time, despite your small prostate, more cores done next time, at least 12-14. Something is going on. Despite that, hope you never test positive.

David
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7/7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy, on Catheter #20

newtopc
Regular Member


Date Joined Dec 2009
Total Posts : 57
   Posted 8/13/2010 5:32 PM (GMT -6)   
I know David, I don't like my case either. The URO is not as concerned as I am. |He says he has hundreds of cases like mine and no cancer. He is one of the best here so I have to go with the specialist as I am the generalist. He told me he is going to be following me very closely. I will have to play the hand that is dealt in the end.
47 Year old male, smoker, healthy
Routine physical May 12, 2009, PSA 4.12
Follow up PSA October 27, 2009, PSA 4.61 / Free PSA 4% (Not good)
Referral to Urologist Feb 18, 2010
Follow up PSA January 7, 2010, PSA 3.95, Free PSA 4% (still not good)
Biopsy March 16th, 2010, 8 core samples taken, Results April 5, 2010
Results - very small prostate, DRE normal, all core samples negative
July 22, 2010, PSA 6.18

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 2285
   Posted 8/13/2010 6:59 PM (GMT -6)   
All I can add is my history..I went from "negative biopsy" to Gleason 9 in a little over a year..
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third 12 core biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 899
   Posted 8/13/2010 7:20 PM (GMT -6)   
Fairwind said...
All I can add is my history..I went from "negative biopsy" to Gleason 9 in a little over a year..


In actuality you were likely a Gleason 9 last year but a common 12 pin biopsy missed the tumor. That's not too unusual and why some people want better more accurate tools and procedures such as color dopler or 3D saturation biopsies. I'm much more familiar with the latter

You've been on this site for like 5 weeks and already have 100 postings. That's quite a bit I suggest you may want to read a little more here and educate yourself more before you become such a prolific poster. Please consider that constructive criticism. Your willingness to post and support others is admirable.

BTW The TUCC is not considered by all in this area as the final word on PCa. Some of their UROS are much better than some of the others there. I agree it's a beautiful building. I can't believe I'm still receiving certified letters from a TUCC urologist who I last saw in November 2007. Either he's really desperate for patients or the TUCC management staff refuses to believe someone may go elsewhere for more advanced less invasive treatments.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy
 
2/16/10 12 of 12 Negative Biopsy 

Post Edited (realziggy) : 8/13/2010 6:49:10 PM (GMT-6)


reachout
Veteran Member


Date Joined May 2009
Total Posts : 583
   Posted 8/13/2010 7:37 PM (GMT -6)   
Yours is an unusual case. My PSA also bounced around, and I had a low free PSA. My uro told me he didn't think I had cancer, but my biopsy showed Gleason 7. In your case you had a negative biopsy so maybe you are more typical than I was for those types of numbers. When I researched free PSA I found that tue studies are only valid for PSAs between 4 and 10, so with a PSA in the low 4s the free component may not be as meaningful. Difficult case but that's why we rely on uros. If I were you I would get another PSA in a few months.
PSA history:

May 2005 2.7

Mar 2006 3.2
10 May 2007 4.1
24 May 2007 2.9
20 Jun 2007 3.3
Sep 2007 2.6
Jul 2008 3.8
May 2009 5.6, followed by biopsy (age 64)

8 out of 12 cores positive Gleason 3+4=7 Stage T2a
Da Vinci Surgery 08/07/2009
PathologyuUpgrade to Gleason 4+3=7 Stage pT2c
Neg Margins and Nodes
Extracapsular extension noted but neg Extraprostatic Extention (??)
Dry immediately
Daily Cialis 5mg slow recovery
First PSA Nov 2009 <0.1
Second PSA Feb 2010 0.01
Third PSA Apr 2010 <.014
Fourth PSA May 2010 <0.1

Still dry but pills for ED don't work well

Starting trimix July 10

newtopc
Regular Member


Date Joined Dec 2009
Total Posts : 57
   Posted 8/13/2010 10:05 PM (GMT -6)   
Thank you Reachout, the uro didn/t even bother with free psa when it was 3.95 but at over 6 he tested, I have not got that number yet, my doctor left me a voicemail regarding the lower total psa number, she knows I have done my research. You are right, free psa below 4 has much less meaning, the higher the totoal psa the more meaningful free psa becomes as you get closer to 10.
47 Year old male, smoker, healthy
Routine physical May 12, 2009, PSA 4.12
Follow up PSA October 27, 2009, PSA 4.61 / Free PSA 4% (Not good)
Referral to Urologist Feb 18, 2010
Follow up PSA January 7, 2010, PSA 3.95, Free PSA 4% (still not good)
Biopsy March 16th, 2010, 8 core samples taken, Results April 5, 2010
Results - very small prostate, DRE normal, all core samples negative
July 22, 2010, PSA 6.18

reachout
Veteran Member


Date Joined May 2009
Total Posts : 583
   Posted 8/14/2010 10:19 AM (GMT -6)   
Greg, as you know, the only test that can give you 100% odds of having PC is a positive biopsy -- and, even then, the findings might indicate that it's not aggressive enough to do anything but watch and wait.  Everything else, PSA, free PSA, PSA velocity, doubling time, etc, is only an indication that something is going on that needs to be checked out.  In my case the nomograms said my PSA and free PSA  gave me about a 30% chance of PC, but I drew the short straw per the biopsy.  That means 70% of similar cases would have been something other than PC, and/or would have needed continuous monitoring.  This board, understandibly, has more of the 30% cases than the 70% cases, but I really hope that you are one of those guys that demonstrates that PSAs don't tell the whole story, and never get PC.
PSA history:

May 2005 2.7

Mar 2006 3.2
10 May 2007 4.1
24 May 2007 2.9
20 Jun 2007 3.3
Sep 2007 2.6
Jul 2008 3.8
May 2009 5.6, followed by biopsy (age 64)

8 out of 12 cores positive Gleason 3+4=7 Stage T2a
Da Vinci Surgery 08/07/2009
PathologyuUpgrade to Gleason 4+3=7 Stage pT2c
Neg Margins and Nodes
Extracapsular extension noted but neg Extraprostatic Extention (??)
Dry immediately
Daily Cialis 5mg slow recovery
First PSA Nov 2009 <0.1
Second PSA Feb 2010 0.01
Third PSA Apr 2010 <.014
Fourth PSA May 2010 <0.1

Still dry but pills for ED don't work well

Starting trimix July 10

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 962
   Posted 8/14/2010 10:52 AM (GMT -6)   
In response to the assertion that percent free psa is not meaningful when total psa is below 4.0, I suggest looking at the article linked below, which suggests that percent free psa may be relevant where total psa is in the 2.6 to 4.0 range (as well as higher).

http://www.ncbi.nlm.nih.gov/pubmed/9145717
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 8/14/2010 11:14 AM (GMT -6)   
RE "Fairwind" - "Neg biopsy to Gleason 9 in 1 year"... I think that is EXACTLY what he was trying to convey... that with the psa bouncing around and all, I wouldn't take the number or the drop at face value. A missed biopsy CAN miss a Gleason 9. I think you're being a little hard on this poster as this was a short, yet very valid point. In my opinion. Besides, some people are going to be mnore active than others. You post every other day on average since you joined.. some may see that as a bit much.
First ever PSA test Jan 2010 @ 51 years old. 4.0.
Digital exam in March 2010 showed 1 side hard, other soft.
Biopsy, positive in 3 of 12.
Davinci @ Boston Medical Center, May 17, 2010.
Was suggested prior to it was likely contained.
June 1 advised 3+-4 was really 4+3 per pathology. Pos margins.
Listed on patholgy as PT3, but with extraprostatic extension,
microscopic invasion of the bladder neck, PT3A is perhaps the case.
Catheter removed June 1.. 1 pad/day, doing ok. ED, but not in rush.
Sore as heck down there, but doing much walking with my wife.
To meet with my Uri (1st meeting since) June 17 - 1 mo point, to discuss.
BMC already has me setup to meet with radiology.
Felling a little better each day. Cant tell if my expectancy just went from 10-15 down to 5-7, the information out there appears to be all over the place. I WILL NOT radiate my insides to the point of being a veg for the sake of a few years. QOL is primary to me. Selfish I guess. I pray for all of you as I do for myself, but must remember that i've had a pretty good 50+ years, and know others who have lost their children to disease.. so I dont have the nerve to complain! Update 7/14/2010: When I tried changing this sig a few days after creating it, system was broken. My new rad oncologist are discussing IMRT.. though he says he can see why waiting a bit and watching the PSA on super sensitive basis might make sense. I am leaning towards IMRT.. thinking is my body is pretty strong now, i'm 51, and if I can rid my body of this while trying to minimize the side effects.. I dunno. No really Good answers. When I said I didnt want radiation to the point of being a veg.. I really meant there is a limit as to where I wish to go in order to realize only a small increase in life expectancy.. and not that I am an unreasonable person. I do, after all, have an obligation to my wife and kids.

reachout
Veteran Member


Date Joined May 2009
Total Posts : 583
   Posted 8/14/2010 11:52 AM (GMT -6)   
Thanks for that link, medved, goes to show how much is being learned through continuing studies. The 4 to 10 range for meaningful free PSA, as I recall, was due to the original Japanese study that focused on that range. The link you posted suggests that even down to 2.6 the free PSA may add value. As that study concluded: "Using a percentage of free PSA cutoff of 27% or less as a criterion for performing prostatic biopsy would have detected 90% of cancers, avoided 18% of benign biopsies, and yielded a positive predictive value of 24% in men who underwent biopsy." The good news is that at this low range of PSA, only 22% of the biopsies were positive, and the cancers found were localized.

My guess is that most practicing urologists are far less willing than researchers to act on low numbers. In my own case, even with a PSA of 5.7 and a free PSA of 10%, my uro (who is well respected) didn't think a biopsy was that necessary. Not until the positive DRE did he recommend one.
PSA history:

May 2005 2.7

Mar 2006 3.2
10 May 2007 4.1
24 May 2007 2.9
20 Jun 2007 3.3
Sep 2007 2.6
Jul 2008 3.8
May 2009 5.6, followed by biopsy (age 64)

8 out of 12 cores positive Gleason 3+4=7 Stage T2a
Da Vinci Surgery 08/07/2009
PathologyuUpgrade to Gleason 4+3=7 Stage pT2c
Neg Margins and Nodes
Extracapsular extension noted but neg Extraprostatic Extention (??)
Dry immediately
Daily Cialis 5mg slow recovery
First PSA Nov 2009 <0.1
Second PSA Feb 2010 0.01
Third PSA Apr 2010 <.014
Fourth PSA May 2010 <0.1

Still dry but pills for ED don't work well

Starting trimix July 10

newtopc
Regular Member


Date Joined Dec 2009
Total Posts : 57
   Posted 8/14/2010 4:13 PM (GMT -6)   
Thank you all for the posts, a special thanks to reachout, although I am very aware of the risks with my numbers Reachout makes a good point, only 22% had cancer in the lower range psa's.. Even though the biopsy was negative I consider myself on active survelance or watchful waiting. If it never happens, great, if it does I am somewhat mentally prepared.
47 Year old male, smoker, healthy
Routine physical May 12, 2009, PSA 4.12
Follow up PSA October 27, 2009, PSA 4.61 / Free PSA 4% (Not good)
Referral to Urologist Feb 18, 2010
Follow up PSA January 7, 2010, PSA 3.95, Free PSA 4% (still not good)
Biopsy March 16th, 2010, 8 core samples taken, Results April 5, 2010
Results - very small prostate, DRE normal, all core samples negative
July 22, 2010, PSA 6.18

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 8/26/2010 2:57 PM (GMT -6)   
Low free psa can also mean prostatitis!

ejn
Regular Member


Date Joined Jun 2010
Total Posts : 87
   Posted 8/26/2010 4:18 PM (GMT -6)   
I had a 12 core biopsy and it came back negative.  My uro was still convinced I had cancer from my PSA.  I ignored it for 2 years and finally had a free PSA then another biopsy.  This time he took 36 cores and found cancer.  Although it was small (see below), I opted for surgery.  In my case it was caught early and I have a very good chance for complete cure.  So, I am glad I decided to go for the 2nd biopsy.  I stressed for those 2 years between biopsies and ignoring it did not make it better. 
53

Pre OP PSA: 1/2008=5.9, 2/2010=6.0 (free=9%)

Biopsy, 4/10/2010 This was my 2nd Biopsy. The Uro put me out and took 36 samples. 3 samples positive 1%, 2%, 2% no evidence of perineural invasion. T1c

April 2010


CT Scan: Negative


DaVinci: Coming up 8/11/10, Dr David Bryan, SSM DePaul-St Louis
Post Op Path:
Gleason 3+3=6
Tumor involves left lobe only
Tumor constitutes less than 5% of gland volumne
No vascular or neural invasion detected
No capsular invasion detected
Distal urethral margin of resection free of tumor
Proximinal urethral margin of resection free of tumor
Radial margin of resection free of tumor
Seminal vesicles uninvolved by carcinoma
TM stage T2a (unilateral less than 1/2 of one side), NX, MX
ALL Margins uninvolved
Extra Porsaatic extension: Absent
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