PSA and Metastasis

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mr bill
Regular Member


Date Joined Sep 2010
Total Posts : 476
   Posted 11/10/2011 7:50 AM (GMT -6)   
A few weeks ago, as I recall, there was a post concernig the correlation between PSA and Mestastasis. In any event it eluded to the fact that not all Metastasis or advanced PCa is also grounds for a raise in PSA. Does anyone recall where that post may be?
 
Thanks,
Mr. Bill

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 2689
   Posted 11/10/2011 9:00 PM (GMT -6)   
No, but I may or may not be able answer a question reference that point. Actually I will tell you what I know, not much but, There are strains of PCA, usually aggressive which do not release/putout psa. Ergo they can metatasise/advanced cancer " silently " ,therefore, paraphrase, no grounds for rise in psa. Logo
Diagnosed 8/14/09 psa 8.1 66,now 68
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving 7/11<.1

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24282
   Posted 11/10/2011 9:19 PM (GMT -6)   
True, there are PCA variants that give off low PSA readings that are extremely aggressive. And as time goes by, I am finding more and more evidence, that you can have bone mets with lower PSA readings, not the normal thinking of mets at 20 and above

david
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 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 margin
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, 2/11 1.24, 4/11 3.81, 6/11 5.8
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4051
   Posted 11/11/2011 4:58 AM (GMT -6)   
Click the SEARCH link and type-> Mestastasis  to find four other threads.

Oncas
Regular Member


Date Joined Jan 2009
Total Posts : 340
   Posted 11/11/2011 6:22 AM (GMT -6)   

My PSA was 4.8 when my bone mets first showed up in imaging. Aggressive disease often breaks the rules. Armed with the belief that mets don't happen with a PSA less than 10 I cautiously watched mine slowly climb not wanting to pull the trigger on HT. Needless to say I got sucker punched. Take nothing for granted with PCa.

Jim


Age 61
Northeastern Penna.
11/08/08 annual checkup (3 yrs late) PSA 8.04 from previously 2.7 in 11/05
1/23/09 biopsy 12 cores positive, 10 cores Gleason 7, 2 cores Gleason 8 70% tumor
2/06/09 cat +bone scans clean ..
3/26/09 RRP surgery Post op path .. upgraded to Gleason 9 (5+4), seminal vesicles involved, several positive margins, 2 of 9 lymph nodes positive
8/22/11 bone mets confirmed

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3139
   Posted 11/11/2011 8:01 AM (GMT -6)   
Here is some more on variants, and two that mention Gleason 6 patients and easily confused clinicians for finding these types. Exactly why patients should employ expert pathologists (few experts exist) and use expert oncologists who test for low psa but possible disease progression and markers that are useable.

You can google search PCa variants and find more info these days:
www.propath.com/newsletters.../500-variants-of-prostate-carcinoma  
www.jama.ama-assn.org/content/306/13/1431.1.full

Partial info from propath link:
VARIANTS OF PROSTATE CARCINOMA by Bahram Robert Oliai, M.D.

Although the overwhelming majority of prostate cancers are acinar adenocarcinomas, behaving in accordance to their various Gleason scores, peculiar variants account for 5-10% of prostatic carcinomas (4,9). Additionally, there are some variants of acinar adenocarcinoma (psuedohyperplastic and foamy gland carcinoma) which tend to confuse both clinicians and pathologists for various reasons. Given the previously mentioned statistics, we are bound to run into these unusual cases at some time in our career. ===================================
(do read the rest of his info on some nasty variants like: Small cell, Mucinious, Singet ring, and such.)  I am most curious about the state of the art of average pathologists and what they actually can decipher.

Post Edited (zufus) : 11/11/2011 6:11:33 AM (GMT-7)


houseboy
Regular Member


Date Joined Jul 2011
Total Posts : 123
   Posted 11/11/2011 12:53 PM (GMT -6)   
"A study from Johns Hopkins and the National Institute on Aging found that an increase in PSA level of more than 0.75 ng/mL per year was an early predictor of prostate cancer in men with PSA levels between 4 ng/mL and 10 ng/mL. PSA velocity is especially helpful in detecting early cancer in men with mildly elevated PSA levels and a normal digital rectal exam."

Johns Hopkins Medicine Prostate Disorders, by Dr. H. Ballentine Carter (2011)

Houseboy

Cherokee6
New Member


Date Joined Oct 2011
Total Posts : 7
   Posted 11/12/2011 9:44 AM (GMT -6)   
Thank you for this thread topic.

This has been a concern of mine since the detection of my prostate cancer after a biopsy on (Friday) November 13, 2009. I had been following my PSA for a few years without much concern as it was well below 4. During a free screening DRE in September (Prostat Caner awareness month) I was told that they felt and abnormal prostate and scheduled a biopsy. My PSA at the time was 2.2 and stable. Refer to my signature to see progression. After determining that it was likely caused by Agent Orange and after surgery and radiation locally by civilian doctors I signed up to be followed by the Veterans Doctor. No family history with 6 brothers a father and 6 uncles never having a problem. Now approaching two years and after deciding to educate myself on forums I decided to see the Surgeon that performed the DaVinci RP. I hadn't seen him for a year.

I felt it wise to speak with him to confirm my concerns. With pT3b stage cancer I was not comfortable that the VA's PSA test is only carried out to .X decimal and they only considered a .2 PSA reading as a recurrence. I noticed that the PSA tests with the civilian doctor was carried out to .XX and thought that with the more sensitive test I might be able to see a trend early enough to do something about potential mets. My civilian doctor agreed and said that if he had the stage of cancer that I have with a PSA of 2.2 pre RP he would have the same concerns. I had them draw blood for a PSA test and I am scheduled for a bone scan on Wednesday, 11/16/11. I also submitted a Urine Fish Test (bladder cancer test) as one was performed 18 months ago and came back positive only to come back negative several months later. This is a test that the VA does not do.

I am very thankful for the VA's help and I'm not complaining about them at all however because of the posts that I have read online, being my own advocate is, I believe, the most important lesson that I've learned on the forums. Thank you for listening to my rant as it certainly helps to converse with others that are going down the same road.
60 years old when diagnosed
PSA only 2.2 at diagnosis. (Don't trust only PSA as indicator)
DRE (digital rectal exam) lumpy
Bone scan negative for mets
CT scan negative for mets
Biopsy (November 13, 2009) Yes, it was a Friday
12 of 12 biopsy samples positive for cancer
Radical Prostitectomy (December 14, 2009)
Positive margins, seminal vesicle involvement. negative lymphnodes, negative mets
Gleason score 4+5= 9
Stage T3b N0 M0
Current PSA is less than .1 (August 2011)
I ware a Cunningham clamp during work hours to cut down on leaking. (hurts after a while so can't leave it on for more than a few hours)
If I don't ware it I change pads from 6-8 times per day.
At night I get up 5 or more times to go to bathroom and sometime wake up with hot flashes from hormone treatments.
Besides that, Life is good!

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 2689
   Posted 11/12/2011 9:57 AM (GMT -6)   
Hi cherokee6, thank you for the apt post for this thread. Your case proves the exception, I hope your subsequent ultra test is way low. Those are difficult SE's to live with, plus the the unknown, we all live with, with this disease. I do believe you have many, many years in you, keep your faith, something good is moving in your life........, Logo
Diagnosed 8/14/09 psa 8.1 66,now 68
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving 7/11<.1

Raddad
Veteran Member


Date Joined Jul 2011
Total Posts : 1857
   Posted 11/12/2011 10:24 AM (GMT -6)   
Cherokee6

The VA found my PCa in July 2011, so far the care I've received has been just this short of amazing.

At this point I'm not concerned with .X or .XX sensitivity. What else have you found in your experience that the VA does not do that you think is needed?

Being our own advocates is vital, it is here on healing well that I learned and continue to learn

Bud
63 as of April 2011
Gonna Make Myself A Better Man [img]tinyurl.com/28e8qcg[img]
12 July 2011 - PSA 1447 (It's just a number! )
Scans showed active prostate cancer widespread in bones
X-Rays showed bones are at this all normal
Started HT treatments Casodex, Zoladex and Zometa for bone
Last Casodex - 29 August
31 Oct 2011 - PSA 46.6

Cherokee6
New Member


Date Joined Oct 2011
Total Posts : 7
   Posted 11/12/2011 10:38 AM (GMT -6)   
Logo,

I concur that I have many years left but I also believe that my years might be less if I don't participate by keeping informed and by being my own advocate. Not that the doctors don't care but with this culprit being so wide spread with so many angles it is unreasonable to expect that they are going to or for that matter be able to take the same interest in my case as I will. Thanks for your prompt response and continued success with your journey.

Cherokee6
60 years old when diagnosed
PSA only 2.2 at diagnosis. (Don't trust only PSA as indicator)
DRE (digital rectal exam) lumpy
Bone scan negative for mets
CT scan negative for mets
Biopsy (November 13, 2009) Yes, it was a Friday
12 of 12 biopsy samples positive for cancer
Radical Prostitectomy (December 14, 2009)
Positive margins, seminal vesicle involvement. negative lymphnodes, negative mets
Gleason score 4+5= 9
Stage T3b N0 M0
Current PSA is less than .1 (August 2011)
I ware a Cunningham clamp during work hours to cut down on leaking. (hurts after a while so can't leave it on for more than a few hours)
If I don't ware it I change pads from 6-8 times per day.
At night I get up 5 or more times to go to bathroom and sometime wake up with hot flashes from hormone treatments.
Besides that, Life is good!

Cherokee6
New Member


Date Joined Oct 2011
Total Posts : 7
   Posted 11/12/2011 11:51 AM (GMT -6)   
Radad,
I see that you were in the USAF during the same time I was. To answer your question about the VA, I think that they do a great job with what they have, I just don't think they are using or can use the latest technology available and decisions are based on the masses without regard to the individual case. I also find the last half my previous sentance applies to the civilian counterparts as well but if you educate yourself with knowledge it is easier to guide your treatment in the civilian world than in a military world. I am trying to get ahead of the mets as soon as possible but once it occurs I have no problem going to the VA for treatment while keeping an eye on what might be available in the civilian world.
It's amazing to me that some people with bone mets have such pain and others nothing. Good luck on your journey.

Cherokee6
60 years old when diagnosed
PSA only 2.2 at diagnosis. (Don't trust only PSA as indicator)
DRE (digital rectal exam) lumpy
Bone scan negative for mets
CT scan negative for mets
Biopsy (November 13, 2009) Yes, it was a Friday
12 of 12 biopsy samples positive for cancer
Radical Prostitectomy (December 14, 2009)
Positive margins, seminal vesicle involvement. negative lymphnodes, negative mets
Gleason score 4+5= 9
Stage T3b N0 M0
Current PSA is less than .1 (August 2011)
I ware a Cunningham clamp during work hours to cut down on leaking. (hurts after a while so can't leave it on for more than a few hours)
If I don't ware it I change pads from 6-8 times per day.
At night I get up 5 or more times to go to bathroom and sometime wake up with hot flashes from hormone treatments.
Besides that, Life is good!

Concerned4You
Regular Member


Date Joined Dec 2010
Total Posts : 87
   Posted 11/16/2011 2:04 PM (GMT -6)   
Mr Bill,

I remember the post too...think I commented on it. My Dad's PSA was only 9.7 when they found his cancer, he was a Gleason 9.

At the time, abnormal bone scan but uro wouldn't confirm mets. We now know he has likely had mets all along in the bones.

His oncologist said his cancer is alarming because its a G9 yet his PSA was less than 10. She made it seem as it if would go refractory sooner rather than later...
11/10 -PSA 9.7
Biopsy reveals PCa in 12 cores, Gleason 4+5=9, upgraded by John Hopkins to 5 +4=9
Dec 2010- CT Scan- Normal, Bone Scan- Abnormal, X-Ray- Normal
Feb 2010 - DaVinci Surgery, Post Op PSA= 5.0 (something), re-checked 2 weeks later- PSA= 7.0 (something)
April 25 2011- Started Lupron
PSA Re-Checked: .04
2nd Lupron, PSA Rechecked: .02
11/2 PET/CT - Bone Mets Confirmed

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/16/2011 4:03 PM (GMT -6)   
mr bill said...
A few weeks ago, as I recall, there was a post concernig the correlation between PSA and Mestastasis. In any event it eluded to the fact that not all Metastasis or advanced PCa is also grounds for a raise in PSA. Does anyone recall where that post may be?
 
 
Mr Bill, sorry that I don't recall that specific thread you asked about, but I have some stats which might be helpful.
 
Bone mets with low (under 10 ng/mL) PSA are rare, but they do happen about 2% of the time. 
 
On the other end of the spectrum, a PSA of 100 ng/mL is generally considered to be the "round number" where bone mets are considered to be likely; the positive predictive value for PSA=100 is 74%.
 
These stats are from the Wolfe study titled, "Prostate-specific antigen as a marker of bone metastasis in patients with prostate cancer."
 
By the way, the 2% rate for bone mets in low PSA patients also happens to be only slightly lower than the occurrence frequency of a variant of aggressive PC known to secrete only low levels of PSA (but have a high Gleason score).  In my opinion, this infrequently occurring PC variant, and our current inability to precisely screen for it in specific, is the primary root cause of much PC over-diagnosis and over-treatment.
 
Hopefully, this provides the answer you were looking for...

Cherokee6
New Member


Date Joined Oct 2011
Total Posts : 7
   Posted 11/16/2011 5:55 PM (GMT -6)   
Mr Bill and Casey59,
I was concerned about my low PSA of 2.2 pre RP and my Gleason 9 score. Today I had a bone scan to convince myself that I don't have mets even though my most recent post PSA from 3 months ago was <.1. I've also had an updated PSA last week for which I still await results. I will report back in a few days once I receive results of both.

Cherokee6
60 years old when diagnosed
PSA only 2.2 at diagnosis. (Don't trust only PSA as indicator)
DRE (digital rectal exam) lumpy
Bone scan negative for mets
CT scan negative for mets
Biopsy (November 13, 2009) Yes, it was a Friday
12 of 12 biopsy samples positive for cancer
Radical Prostitectomy (December 14, 2009)
Positive margins, seminal vesicle involvement. negative lymphnodes, negative mets
Gleason score 4+5= 9
Stage T3b N0 M0
Current PSA is less than .1 (August 2011)
I ware a Cunningham clamp during work hours to cut down on leaking. (hurts after a while so can't leave it on for more than a few hours)
If I don't ware it I change pads from 6-8 times per day.
At night I get up 5 or more times to go to bathroom and sometime wake up with hot flashes from hormone treatments.
Besides that, Life is good!

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 2426
   Posted 11/16/2011 10:01 PM (GMT -6)   
"...Bone mets with low (under 10 ng/mL) PSA are rare, but they do happen about 2% of the time... "
--------

Most of these 2%ers are high gleason, but I've seen some gleason 6s.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Surgery
Jan. 2010 T3b, G9
Feb. 2010 Adj. Radiation
March 2011 PSA Rise/Scan/Spot on Pelvic Bone
April, 2011 Casodex/Lupron
May 2011 Spot Radiation
Oct 2011 Bone/CT Scan - No new spots; spot is 1/2 as intense (whatever that means)

PSA History:
-----------------
Nov. 2009 4.30
2010 <.05
March, 2011 .09
April, 2011 .06
Oct, 2011 <.05

Cherokee6
New Member


Date Joined Oct 2011
Total Posts : 7
   Posted 11/17/2011 7:29 AM (GMT -6)   
Jerry,
Knowing that I'm not in that 2% will be worth it. I've already overlooked a Gleason 9 based on a 2.2 PSA test. We have similar histories, are you still on hormone treatments? Doctor wants me on them for 36 months.
60 years old when diagnosed
PSA only 2.2 at diagnosis. (Don't trust only PSA as indicator)
DRE (digital rectal exam) lumpy
Bone scan negative for mets
CT scan negative for mets
Biopsy (November 13, 2009) Yes, it was a Friday
12 of 12 biopsy samples positive for cancer
Radical Prostitectomy (December 14, 2009)
Positive margins, seminal vesicle involvement. negative lymphnodes, negative mets
Gleason score 4+5= 9
Stage T3b N0 M0
Current PSA is less than .1 (August 2011)
I ware a Cunningham clamp during work hours to cut down on leaking. (hurts after a while so can't leave it on for more than a few hours)
If I don't ware it I change pads from 6-8 times per day.
At night I get up 5 or more times to go to bathroom and sometime wake up with hot flashes from hormone treatments.
Besides that, Life is good!

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 2426
   Posted 11/19/2011 2:51 PM (GMT -6)   
Cherokee-
 
I have been doing the HT thing for 6 months.  Not sure what the future holds for me as far as treatment.  I have conflicting plans between 2 of my doctors.  One says one more shot...another says 2 years total.
 
To break the tie and to get another expert's opinion, I will be visiting Dr. Myers in a few weeks.  Will keep you posted.
 
Since your PSA was so low going into your surgery, have you considered getting an ultrasensitive PSA.
 
Thanks,
Jerry L. 

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3733
   Posted 11/19/2011 4:04 PM (GMT -6)   
If you are concerned that you may have a varient you can send your slides to Dr Bronkhoff who is a leader in identifying varients. www.prostapath.de

JT
66 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, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 2426
   Posted 11/19/2011 4:15 PM (GMT -6)   
jT,

Interesting. Can they do that 2 years since biopsy and/or surgery?

Wonder if insurance pays for that.

Thanks.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Surgery
Jan. 2010 T3b, G9
Feb. 2010 Adj. Radiation
March 2011 PSA Rise/Scan/Spot on Pelvic Bone
April, 2011 Casodex/Lupron
May 2011 Spot Radiation
Oct 2011 Bone/CT Scan - No new spots; spot is 1/2 as intense (whatever that means)

PSA History:
-----------------
Nov. 2009 4.30
2010 <.05
March, 2011 .09
April, 2011 .06
Oct, 2011 <.05

Cherokee6
New Member


Date Joined Oct 2011
Total Posts : 7
   Posted 11/19/2011 10:44 PM (GMT -6)   
Jerry L.

I just asked for ultra sensitive PSA Last week. Still waiting for results. I had a bone scan also last week and that came back negative for mets for which I'm happy.
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