PSA calculation

PSA Calculation
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What makes the PSA rise - 0.0%
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What makes the PSA fall - 0.0%
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Why a high PSA and less cancer than a lower PSA - 0.0%
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What does it mean if your PSA goes up several different times and then decreases and then goes back up - 100.0%

 
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TTaylor
Regular Member


Date Joined Nov 2010
Total Posts : 102
   Posted 11/25/2010 7:25 AM (GMT -6)   
I am fairly new at this having had a RP just 6 weeks ago. My PSA level was 4.5 having increased about 3 points over a 4 year period , and I had Gleason 8's and 6's in 8 capsules with prostatic tissue invasion outside the capsule. I see where other members have much higher PSA levels and less cancer. I understand the best PSA is 0.00 but what exactly determines these large increases. Is the amount of cancer on the rise or is it a combination of other circumstances such as infection, tumors or sexual activity. For instance after my first PSA test following surgery; say my PSA comes back 0.60. Three months later it is at 1.2 and six months later it is at 1.6. What does this actually indicate. Many thanks for your informed response. You guys have the best source of uplifting information to be found. Quite frankly my own DR. doesn't explain things as well as you do.
Stay well and blessed.
TTaylor

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 941
   Posted 11/25/2010 7:43 AM (GMT -6)   
Hi TTaylor,

The best PSA for someone who hasn't had a RP is not 0.00 as that would mean he is born without a prostate. Healthy prostates release a small amount of PSA.

My undertanding of this is that there are many reasons for inflated PSA values which have nothing to do with Cancer. As you can see from the little list below, some of these effects are very temporary causing PSA levels to fall soon afterwards:

1) Sex (temporary)
2) Cycle riding (temporary)
3) Prostatitis - infection (medium to long term impact unless infection goes away due to antibiotics or naturally)
4) BPH - inflammation (long term impact)

So the people with high PSAs and less/no cancer may also have BPH for example.

If you are talking post-prostetectomy, I understand that three increases above 0.2 are considered to be a biochemical recurrance. So if your fourth test post surgery goes up in the example that you cited then this would mean a BCR.

Regards,
An

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3620
   Posted 11/25/2010 12:03 PM (GMT -6)   
Taylor,
The average prostate generates 0.66 psa for every cc of volume. So a 30cc prostate would have a normal psa of 1.8. Anything above that is due to something else such as infection or PC. Every gleason grade develops a certain amount of psa per cc, the higher more agressive grades less psa than the lower grades. Usually if infection is not involved the rise in psa indicates how fast the tumor is growing. You can express this growth in psa doubling time (how many years or months does it take to double the psa at current rate). A psa with over 3 years doubling time is considered slow growing and one measured in months is very agressive.
Your post op psa senerio indicates a reoccurrance with a fairly rapid doubling time. Considering your high risk pre op stats and positive margins I would consider any post op psa rise a reoccurrance. If your own doctor does not explain things very well then it is time to get a new doctor or at least a coach that can explain thing well. Rigan now with your post op stats you are at very high risk for a reoccurrance and probably should be considering adjuvant radiation with your doctor.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1173
   Posted 11/25/2010 6:32 PM (GMT -6)   
Hi John. Interesting post, but should the above, "The average prostate generates 0.66 psa for every cc of volume.", read 0.06 psa for every........?
Just curious.
Wishing you all the best.
 
Mag
 
Born 1936
PSA 7.9, Gleason Score 3+4=7, 2 of 8 positive
open RP Nov 06, T3a, Gleasons 3+4=7, Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; at SRT Start=0.1, Salvage RT completed (33 days-66Gy) 19 Dec 08
PSA: in Jan 09 =.05, all tests to date (Jul 10) <.04

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2593
   Posted 11/25/2010 9:07 PM (GMT -6)   
I wish I could reduce this all to a simple formula.  I just can't, and I can't seem to keep track of all the variables, and apparently, most doctors can'r either.
 
In my simplistic approach to this complicated disease, I have just reduced it to a simple formula.  PSA up, bad, PSA down, good.  Too high, take the next step, otherwise, just keep on enjoying life, and let tomorrow bring what it may.
 
Besides, all that thinking makes my head hurt.  My simple life is easier for me.
 
Goodlife

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2062
   Posted 11/26/2010 2:18 AM (GMT -6)   
I think I'm right that with the very high Gleason scores the prostate cells are so messed up that they produce less PSA.
Alf

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/26/2010 1:03 PM (GMT -6)   
TTaylor said...
I am fairly new at this having had a RP just 6 weeks ago. My PSA level was 4.5 having increased about 3 points over a 4 year period , and I had Gleason 8's and 6's in 8 capsules with prostatic tissue invasion outside the capsule. I see where other members have much higher PSA levels and less cancer. I understand the best PSA is 0.00 but what exactly determines these large increases. Is the amount of cancer on the rise or is it a combination of other circumstances such as infection, tumors or sexual activity. For instance after my first PSA test following surgery; say my PSA comes back 0.60. Three months later it is at 1.2 and six months later it is at 1.6. What does this actually indicate. Many thanks for your informed response. You guys have the best source of uplifting information to be found. Quite frankly my own DR. doesn't explain things as well as you do.
 
Hi TTaylor,
 
You've already gotten some excellent responses; I hope that my comments bring additional value to the big picture for you.  I'm sorry I couldn't really understand your poll, but I'll comment on your posting, and add to some of the postings that followed.
 
 
First of all (adding to Goodlife and Alf's postings), the most typical scenario prior to treatment is for PSA and Gleason scores to both go up together (as in Goodlife's "simple formula") in the presence and growth of prostate cancer (above and beyond the base level of PSA a non-cancerous prostate generates given in JohnT's equation). 
 
However, please be aware that in an atypical, smaller percentage of cases of low PSA levels may be seen in the presence of high Gleason scores and high tumor volumes (Alf's comment).  Dr Patrick Walsh's book Guide to Surviving Prostate Cancer says it this way:
However, as the tumor grows, it tends to be overrun by more malignant, poorly differentiated cancer cells that have a higher Gleason score.  These poorly differentiated cancer cells are different from normal prostate cells, and as a consequence, they make less PSA.  In fact, these cancer cells elevate PSA less per gram of tissue than well-differentiated cancer cells--which means that as cancers grow, the PSA level doesn't go up in a directly corresponding way.  That'w why PSA levels can be normal even when cancer has spread to the seminal vesicles or pelvic lymph nodes, or it can be higher than expected in men with cancer that's confiineed to the prostate.  PSA levels do not accurately estimate the growth of cancer. Thus, the true meaning of a PSA level can't be interpreted without knowing the Gleason Score.   [Italics added by Walsh for emphasis.]
This is understanding led scientists to develop the multi-dimensional nomograms which exist today to accurately estimate the extent of PC by correlating the combination of clinical stage, PSA and Gleason score based on the past history of thousands of men.  Have you found any of the online nomograms?
 
 
 
Please do also be aware in advance, as An has replied, that as you look ahead to your first post-RP PSA test, there is no such thing as zero PSA in a living, breathing man...with or without a prostate.  It seems intuitive, in a simple sense, that without a prostate, the PSA would be "zero".  Many men get immediately worried if their post-RP result is not "zero", but if they understand that "zero PSA" (and the "zero club") is a bit of a misnomer which sometimes causes un-due worry to newcomers, then it's not such a big deal.  Here's something I previously posted in another thread which might help:
 
There is no such thing as zero PSA in a living, breathing man. Most men without a prostate, however, have very low levels of PSA, and in some cases they have such a low level that it is below the most sensitive PSA test's lower detection limit (LDL). The "ultra-sensitive" PSA test has a LDL of 0.01ng/mL (some lesser used ultra-sensitive PSA tests have an even lower LDL). So, <0.01 ng/mL is the test result for an ultra-sensitive PSA test which was below the lower detection limit.  The "standard" PSA test, on the other hand, has a LDL of 0.1 ng/mL.

There are sources in the body besides the prostate which produce low levels of PSA, including neurovascular bundles. These sometimes produce small amounts of PSA right around the ultra-sensitive test lower detection limits, so sometimes the results jump around a little right around that low level simply because of the natural variation of the small amounts produced. Of course, if there are remaining cancer cells, they too will produce amounts of PSA which will increase over time.

The notion of "zero PSA" is somewhat of a misnomer which sometimes causes anxiety in men until they learn these facts. Low levels might be considered by some to be essentially "zero", or functionally "zero", but the threshold in one person's opinion might be different than the threshold in another person's opinion. Your example is very illustrative:  is "zero" less than 0.01?  less than 0.05, which is what you had heard?  (this was in reference to an earlier poster's question about "what is 'zero PSA?'"; but, the point is that if you ask 3 different people (non-medical professionals) their "opinion" on the term "zero PSA" you are likely to get 3 different answers) less than 0.1?  It can be a confusing term, and you won't likely hear a medical professional or an informed layperson tell you that you have "zero PSA."  The best possible result is "undetectable."
 
So, TTaylor, back to your hypothetical question "For instance after my first PSA test following surgery; say my PSA comes back 0.60. Three months later it is at 1.2 and six months later it is at 1.6. What does this actually indicate."...well that would likely indicate that cancer was left behind and rapidly growing.
 
I hope this information adds value to your learning process.  TTaylor, having high Gleasons and extension beyond the capsule, like you had, is indicative that surgery-alone might not be enough to fully cure your prostate cancer.  If you don't already have one of the two "bibles" of PC, then I might recommend getting one or both.  One was the Walsh book I mentioned above, and the other is A Primer on Prostate Cancer:  The Empowered Patient's Guide by Strum and Pogliano.
 
very best wishes...
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