what is considered a safe PSA count ?

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 gleason score 3+4=7   PSA 4.5  .. 3/10 biopsy sections showed adenocarcinoma.. had radical prostate removal on 10/23/2006

Post Edited (iggy_pop69) : 11/19/2006 9:13:10 PM (GMT-7)

Iggy,

Being on the other side I can tell you that I also believe like you that there is no "safe" PSA. I also wonder about the age when you should have your PSA checked given all of the men on this forum that were diagnosed with PCa and were under 50 which is the traditional age for starting PSA checks. I changed doctors right before my PCa was found because my primary care doctor at the time forgot to include a PSA check in my annual blood work and thought that it was not a big deal because the year before my PSA was only 2.8. My new doctor was much more conservative and ram me through a load of tests and even though my PSA had only gone up to 3.2 from two years earlier he had me see a urologist who did not find anything but put me on a 3 month PSA check and that led to a biopsy. I am telling all my male friends to make sure that you do not take for granted a PSA below 4. With the statistics that 1 in 3 men over 50 have PCa and 1 in 2 over 70 that any rise in PSA from a baseline should be quickly followed up with a 3 month interval PSA check. While I consider myself lucky that my PCa was caught early and was prostate confined there have been too many men on this forum that have had it get outside the margins when this could have been prevented. Society is just not attacking this cancer with the awareness level needed.

Tamu

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Diagnosed 7/6/06

Tamu,

Iggy,

There is no "safe level" exactly. But, there are age adjusted numbers that provides information, a guide so to speak for different. The PSA level is not as valuable a tool as the changes that occur with it.

There is an article called "Intelligently managing the PSA." I think that's
the right title. Google it. I believe you wil have a clearer understanding.

Swim

Yes, it's the TREND in PSA that's relevant, not necessarily any one individual reading. Fast increases and "PSA doubling time" are of concern as they can indicate a more agressive tumor.

To logically interpret PSA, size of prostate needs to be factord in, as a larger prostate naturally produces more PSA. Epstein's treatment criteria refers to "PSA density" which is simply PSA divided by prostate size.

 

Also being on the other side of this, my research has time and time again shown that the PSA readings are age related. In his 50's Bob's PSA remained constant at 2 and the doctor was not concerned. However it made a jump to 5.9 during an infection in 2005 at age 59 . . . the doctor waited 3 months and even though it dropped to 3.9 the doctor said this was too high for someone who was then 60, and referred him to his urologist. . . . .of course the subsequent biopsy did in fact show cancer. However, someone in their 40's with a PSA of 2 would probably be investigated immediately. So, without factoring in age you cannot accurately come up with a "safe" number.

Take care! Oh yes, no matter what the test, I always ask my doctor the numbers . . .BP; cholesterol; you name it. And in the past, if Bob was at a doctor for a physical and there was no PSA included, we asked for it.

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Bob (60) had laproscopic prostate surgery on Sept 27, 2006 - 2/12 malignant biopsy samples - gleason 3 + 3 = 6.  Follow up PSA results and pathology results received Nov 14th are NO MORE CANCER!  Gleason changed to a 3 + 4; cancer completely confined to prostate; (even a second more agressive, previously undetected cancer)      PSA UNDETECTABLE.

My understanding has always been that the safe PSA had to be under 4.0.  But there is another test and I suggest that you ask your urologist to test your "free PSA".  This test measures the percentage of PSA that is not bound to the proteins in your blood.  The safe score here is at least 25% or higher.  When I was sent for a biopsy, my PSA was 5.7 and my free PSA was 9%.  That was certainly grounds for a biopsy.  And I just completed my high dose radiation treatment last week.  My suggestion is that you ask your doctor for the free PSA test, it's important!

I have what is probably a stupid question and would love some help.  My dad is 74 and had a PSA test done yesterday.  They told him his count was 153 and that 100 was considered normal.  From everything I look at, that's totally different from the usual numbers given in results.  He's been given a referral to a urologist, but I'd like to understand what's going on now while we wait for the consultation.  Can anybody explain this to me?  Thanks so much!

unfortunantly my urologist used the old magical 4 as the concern number, disreguarding the fact that my psa was going up 1 point per year for 3 years, while allowing the cancer to grow to the point that a nodule was felt and was told that it had already escaped prostate.

I tell everyone I can, to keep track of your numbers and don't rely on uro to tell you your numbers are within nornal limits, know what psa velocitiy is and track your numbers from year to year.

on a side note, I had my 15 mos psa report this past Good Friday and it it still <0.04, a number that no one thought going in would be possible post op, must less 15 mos post op, but with path, still have to get one every 3 mos.  God has been blessed me more than I deserve!

It is not only the PSA.  It is also the old dreaded DRE that men seem to hate.  The PSA can flucuate between labs also. After I was tested with PSA over 4 at 2 different labs, I was tested at MD Anderson at 3.3 even though I had already been diagnosed with PCa via biopsy.

IMHO we must teach our family members and friends that this is not something that just happens to someone else.  We must let people know that early detection is what brings a more sucessful result to the battle with PCa.  Early detection will normally only happen if guys take the bull by the horns and get regular physicals with PSA and DRE and keep track of the results.

I am a T1C throught DRE.  In other words no signs of PCa. 

I have had an elevated PSA for over 12 years with 2 previous biopsies both 6 samples and both benign.

The bottom line is that there is still much to be learned about this PCa that we fight.

 

NIck's Mom:  Those numbers don't make sense.  I'd get those results given to me again to make sure that's what was reported by the lab.  We deal in numbers of 4.O PSA or less here, according to the old standards, which is changing now, with more info and earlier age men being tested and confirmed with cancer.  Numbers over 100 are so far out of range that I can't imagine anyone saying saying less than 100 was normal.  I hope and pray that these numbers were mis-heard or mis-understood.  Maybe the urologist can straighten it out once he makes the visit.  Until then, Id ask for a restate of those numbers and an explanation of just what they are talking about....

My thoughts exactly!  My sister and I have come to the conclusion he was confused as to what numbers they were giving him.  Blood pressure and cholesterol were also elevated, and he was a little upset over the whole thing.  He's been in absolutely perfect health his whole life - doesn't take a single pill - so it's rather daunting to him to find out his body is starting to wear out a little!

I'm going to try to talk to my step-mom tonight and see if he actually brought any papers home with him that I can look at or if she can give me a better understanding of exactly what was said.  Daddy doesn't hear as well as he used to! ; }

Thanks a bunch for helping out.  I just wanted to make sure there wasn't a different method of computing the numbers that I wasn't aware of.

CarolAnn

Hey Selmer,

I am very glad my docs found my cancer. Saying we don't want to find it is really sticking your head in the sand. Look at the guys here on this forum in their 40s that have stage 3 or 4 cancer. If they didn't want to find out about it, they would be dead.

Get tested. Got cancer? Get rid of it.

Jim

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Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.

An interesting discussion. I feel that most G.P.s look at PSA in relation to age before they are inclined to say anything other than "good numbers"

Men younger than 40:.................Less than 2.5 nanograms per milliliter (ng/mL)


Men age 40 to 50:......................0–2.5 ng/mL


Men age 51 to 60:......................0–3.5 ng/mL


Men age 61 to 70:......................0-4.5 ng/mL


Men over age 70:........................0–6.5 ng/mL

However from the PSA of members here diagnosed with PCa this would miss quite a few cancers. Alarm bells should automatically sound if PSA increases quickly (up 75% in 12 months) regardless of the initial level
Knowing what I know now, DRE together with a blood test that gives the Free-PSA ratio is the road I'd follow.

For Nick's Mom,
One thing I have learned with my dealings with this disease and doctors is "don't leave the office without a hard copy of any test results or reports"
Bill

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1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcima-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP 8/07
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable

Post Edited (BillyMac) : 3/27/2008 5:02:44 PM (GMT-6)

I have an interesting point of view about PSA acceleration. While I know I have a lot of unusual circumstances the PSA tests below would conflict with using PSA acceleration as a marker.

October 3, 2006: PSA 19.8
October 10, 2006: PSA 18.9
November 3, 2006: PSA 13.9

My urologist was encouraged by the first drop in the retest of my first test. I thought the 13.9 was cool but he ordered the biopsy, thank goodness. He could have decided to wait more, but he said my number should have been lower. For what it's worth, the results after surgery were more in line with the original PSA probabilities. My oncologists have all told me that for all future prognosticating considerations the highest PSA number would be used. But irony for me is, every PSA test I EVER had has been lower than the last until it was finally undetectable. That would never have happened without treatment. I doubt that my decisions were the wrong ones. Yet even more irony, I have an undetectable PSA yet none of my oncologists can say this isn't still serious. If I get a first ever rising PSA test, I will likely be incurable. And probably worse.

Tony

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Age 45 (44 when Dx)

Selmer-

Hogwash!

-Les

Just joined and thought I would give my opinion.  I have found out a couple of things "after the fact".  The fact is I just had a prostatectomy on 3 February 2009.  Background:  I retrieved copies of all my blood test and lab test *after* being diagnosed with prostate cancer.  My father and his father had prostate cancer.  My father lived to be 81 and my grandfather 71.  I'm 69.  There is no such thing as a SAFE PSA count.  It is the velocity or rate of change that is significant.  And, there is another test that could be significant, "Free PSA Percent".  I found in my records that I only had one "Free PSA Percent" blood test, in April 2007.  It was 15% which indicated a probability of 20-28% that I had prostate cancer.  My PSA at the time was 2.85.  My doctor never discussed the "Free PSA Percent" and had I known about it in April, 2007 I might have saved myself the agony of having a prostatectomy!  One year later my PSA was 3.14.  Ten months later during an examination for an Insurance policy, the PSA was 4.2.  I went to my family doctor for another PSA and it was 4.42.  He said "That's not bad".  I said, "Yea but it's my life and I want to see a Urologist".  (I've since learned that a general practioner or family doctor is not the best source for determining a cancer diagnosis).  The Urologist did the finger business, told me my prostate was about 50cc (normal 20cc) and scheduled me for a biopsy.  All during this time I was not thinking cancer I was thinking this is just a routine percautionary examination.  Biopsy results:  5 of 6 sections on one side were cancerous with a Gleason score of 7, 7, 6, 6, 6.  That came as a real shock!  The Urologist also stated that the pathology report is almost always on the safe side or down side and the cancer could be more wide spread.  He was not trying to scare me into doing anything he just wanted to give me the facts.  He has been in the business for 24 years and studied at the Mayo Clinic.  Just prior to surgery, my PSA was 4.96.  I opted for the prostatectomy and removal of the lymph nodes and sure enough the cancer was in both sides and came within a millimeter of breaching the margin.  It may have in fact breached but I will not know until 20 April when I get my first post surgery PSA test.  I'm sorry for the lengthy description but I just want to let everyone know that it is the rate of change and not the PSA count that is important.  And, ask about a "Free PSA Percent" whenever you have your blood checked for PSA.

Welcome to HealingWell snik67. This is a pretty old post but relative to what most agree with. It is the rise in PSA in conjuction with the total PSA and Free PSA that should be looked at. The standards to when to biopsy are very fluid and ever changing. What is the norm today will be changed more than likely a few months down the road. As of last July for my age group the PSA cut-off was 4.0...now it is 2.5 go figure.

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You are beating back cancer, so hold your head up with dignity

Les, that's the fun, isn't it? From the time I first started faithfully getting my yearly PSA, the standard was 4.0. What's sad, is my very first one at age 50, in 2002, my PSA was like 2.8, which is higher than the new 2.5 standard, and higher than what was accepted ok for my age at the time. But again, my GP continued to use the 4.0 threshold. I wonder what would have happened if I had been biopsied in 2002, instead of my first one in 2007, 5 years later. Can't unscramble those eggs now, I realize. I think the threshold should be 2.5, and the first PSA should be done at age 40, regardless of race or family history. Just my take.

David in SC

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Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5

Yep David...same for me...my first PSA was 2.8 and my urologist that I went to see told me he would have recommended a biopsy back then. The worst part was the blood test results I got...it still had the 4.0 as the cut-off for PSA. If I had been under the 4.0, my GP wouldn't have even said a word to me. I think the GP's use the recommendation from the lab on blood tests whether to recommend follow up or not.

I don't think the GP's will make any recommendation unless the lab report initiates it first. And supposedly the labs use the recommendations from the American Urology Society, but I could be wrong on that. Seems somewhere I read that labs only follow the industry recommendations and not necessarily the cancer society recommendations. I think Tony (TC Las Vegas) had some info on that. Maybe he will chime in.

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You are beating back cancer, so hold your head up with dignity

Hi Les and David. Thanks for the updates and great information. I've updated my two brother's (ages in 2009 66 and 64) and one half-brother (same father) age 46. I was appalled that the 64 year old and the 46 year old have never had a PSA count. They are both going to do so this month, I hope. I have another question concerning diet. My doctor has put me on a high fiber diet but the list includes just oil fish (salmon, trout), some fruits, vegetables, but not meats. (Oh, he did say red meat just once a week). I've just bought the book "Eat to Beat Prostate Cancer Cookbook". I'm not sure it has anything to do high fiber however.

Gee guys,

I always like questions where there is no right answer or for which there are many right answers depending on all the parameters. It is amazing how many differing opinions there are.

It always makes me angry when I have my GP draw blood and get the PSA test for me. I always get a copy of the results for my personal files and have to call to see if the results are back from the lab. The nurse, and he has a big turnover of them, will say yes it's back and you're normal, obviously not understanding anything but the printing on the lab form that says the normal range is 0-4.

Sure drew a lot of fire.

Dave

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Dx'd 1999, Age 60, PSA 43, Gleason (3+4=7), T3c
42-3d EBRT w/Lupron/Casodex for 24 months and PSA remaining to be <0.1 for the entire 24 month period.
July 2001 - 2nd opinion required to go intermittent ADT.
MDAnderson biopsy revised Gleason (4+5=9).
Intermittent ADT, Lupron only, with PSA threshhold established at 1.0.
March 2007 - Diminishing returns with Lupron, conferred with MDA urologist for bilateral orchiectomy. Uro asked for biopsy of prostate again. Biopsy resulted in tumors found with Gleason (5+4=9).
August 2007 - RRP and bilateral orchiectomy. PSA <0.1
99% continent immediately
September 2008 - PSA 0.45
November 2008 - PSA 0.67
December 2008 - Resume Casodex
December 2008 - Stricture in bladder neck requiring surgical removal. 99% incontinent immediately.


Life is not waiting for the storm to pass, it's learning to dance in the rain.

I agree with stxdave who notes that there is no right answer. I also find that Gordy's rebuttal of Selmers' opinion as "hogwash" is poor protocol. I think Selmer has many good points to be considered (and I agree with most of them) and am quite glad that he is willing to present his views. If there is disagreement, I would respectfully propose that one presents, specifically, the point(s) that are of issue. From my perspective it is a personal decision relating to the degree of cancer risk with which one is willing to deal and must be considered with education of prostate cancer, it's detection, and it's consequences. One problem is that the cancer risk cannot be zero no matter what test is done. The way I see it, snik67 says it well- there is no safe level of PSA, rather the best consideration is PSA velocity. One needs to establish a PSA baseline. In my case I had a PSA bump which later went back to my baseline -so I am less worried- but NOT totally unworried. So I will continue to watch my PSA carefully. BTW, What do people think about the PCA3 test???

Rich

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Age now 56.
History of chronic prostatitis.
Can't find earlier PSAs think they were in the 2-3 range
3/14/05 PSA 3.2
4/24/07 PSA 3.56
9/25/08 PSA 6.9 -note, taken after a DRE. Started concern about PCa.
12/12/08 wait until prostatitiis symptoms minimun, no DRE,
no sex, PSA 3.58
At this time, continue monitoring PSA- no biopsy (if correct PSA velocity is close to zero). Continue to have some prostatitis symptoms. Saw second Uro who did not recommend biopsy.

I agree with those who say the the velocity and the free PSA are more indicative of the presence of PC. My PSA never reached the magic number 4.0. It jumped from 2.7 to 3.5 in one year. I took the test again 6 months later and it was 3.3 with 11% free PSA. My Urologist said that with such low fre PSA I had a 33% probability of having PC. That is when I had my biopsy and the rest is history.

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Age: 67
Retired in 2001 and living in Austin TX.
PSA 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed on Feb 9th
Surgeon: Dr. Randy Fagin, Austin TX.
Post op Pathology report:
Prostate weighed 57 grams
size:5.2 x 5.0 x 4.9 cm
10-20% involved
Bilateral
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
Lymph nodes: not dissected
seminal vesicles clean

I think the answer is that there is no one right answer.
This is Cancer with a capitol "C". It doesn't play nice or by any rule book.

PSA, Hypersensitive PSA and even tesing for Biomarkers to be used as survival predictors offer no verifiable scientifically proven "safety" zone. They can be very useful tools in determining treatment options but that presumes the values are being interpreted by experts, not lay people who feel compelled to become quasi experts on their own based on their own experience with the disease because that is how they choose to live with their PC.

Remain very compliant with what your specialist(s) recommend and stay vigilant.
While there is nothing wrong with being your own advocate, know what your knowledge limits are- are you qualified to interpret the latest research out there, all the studies and trials being done and apply it to your particular situation? Do some research on your own, talk to experts as you can but don't it rule the quality of your life in the here and now.

Unless the plenitude of posts you see in this Forum for PC are from folks who ID themselves as qualified experts in the field don't ever forget once PC is diagnosed it compels people to try to become quasi experts so that they can gain a better understanding of the disease and the treatments they are being advised to consider.
The stories posted in this Forum are just that, personal stories by individuals. Some of the posts are highly technical. If that is how that person chooses to address his own PC, that's fine. Just don't think you too have to function at or should have an interest at attaining such a level for yourself. Knowledge available to all via the Internet always has to be put into context of an individual's personal situation and it can be a double edge sword. I venture to say true experts in this field are not participating in this type of Forum.

One of the reasons Cancer is so hard to treat is that it doesn't respond to all people affected in the same way. It just doesn't and that's one of the most frustrating aspects of having to live with it in one's life. What happens or works for 1 person may not for someone else with a similar history.