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Posted 1/27/2008 6:16 AM (GMT -8)
I have had a question for months now, but found no definite answer.  In reading here and elsewhere, I see that PSA doubling after surgery is an indication of possible cancer return, even if it is from .5 to 1.0 or 1.0 to 2.0.  Now, almost all men have higher than that scores before being diagnosed with PCa.  I'd guess most men have a 'normal' test of 2.0 to 3.0 and think nothing of it, along with their doctors.  Some have had docs who suggest they do a biopsy if in this range, my brother-in-law being one.  His was triggered by a PSA of 2.6 and a 'slight abnormality felt' during a DRE.  In my case, I had PSA results ranging from 3.8 to 4.2 with a grossly enlarged gland but nothing detected DRE for 15 years or more, before it jumped to a level (7.6 in 6 months)to trigger my doc to refer me on to a specialist. 

I have lots of my friends who, when I asked about their score after I became aware of my cancer, are in the range from 2.0 to even 3.5 or higher and they and their docs aren't doing anything about it. 

So, just what would the PSA limits be for possible un-detected PCa before further testing by biopsy or otherwise be started.  Is there an agreed national standard, like "no greater than 100/150 for bp or for triglycerides , etc."  I realize that PSA testing, especially at an earlier age, is controversial in some circles of medicine, so what does the average man need to know about it, if their docs aren't educated enough or aggressive enough in reacting to their PSA tests.  Should a guy accept a running series of 3.1 PSA's or 2.6 PSA's and wait for a sharp increase or detectable DRE, or should he be pro-active in pushing for further exams?

When's a guy gotta worry?

Posted 1/27/2008 6:28 AM (GMT -8)
I think the standard use to be 4. and that unfortunately my 45 year old urologist used in my case, but I have read almost everywhere that they should be lookiing at psa velosity or how much the psa rises over a year period.  Mine went from 1.8, 2.8, 3.5 and 4.5 in consecutive years and I was told nothing to worry about still under 4, while all the while the cancer was growing for 3 years.  I have seen where cancer has been found via biopsy with a psa of 2.5, so I hope for my son's sake and all those other men out there that they know their numbers each year and don't just take the urologist word that it is within normal limits, know how much it rises each year!!!  PSA is a crazy marker, mine was 4.5 with gleason 7,  40% gland was tumor, I know another guy whose psa was 19 and gleason 6, 10% involvment.

Posted 1/27/2008 7:03 AM (GMT -8)
The published threshhold is 4. But, that is just a vague attempt to put a number on a wildly different scenario for every guy. Basically, the younger you are, the lower your PSA should be. Mine should have been under 1. As you age, things like BPH and stress, infection, anything, can increase your PSA with no danger of cancer. So, a guy in his 70's can be perfectly healthy with a 4 or higher.

For me, my doc should have sent me to a urologist when I hit 2. As it was, I had a PSA in the 2's for several years, then a 3.15 then 12 months later 4.6. I'm not sure anyting would be different, but perhaps with diet, I could have bought myself some time before surgery.

Paul
Posted 1/27/2008 9:34 AM (GMT -8)
The first thing my new doctor did was pull my history of psa numbers and that was his trigger. Spread the word to your friends to keep a copy of their psa and beware of not only the number but the rise each test.
Posted 1/27/2008 11:32 AM (GMT -8)
In the low or normal range, PSA velocity is considered by urologists to be a more important indicator than the absolute PSA value when determining whether someone should have a biopsy.

That's one of the reasons it's important to have a baseline value and annual PSA testing. It used to be recommended that PSA testing start at age 50, but as evidence mounts with the number younger men with prostate cancer, baseline PSA testing should begin at age 40. Note the number of young men on this forum.
Posted 1/27/2008 12:31 PM (GMT -8)

In a study it was found that 25% of the men with a 2.5 PSA had Pca, so not sure there is a definitive number to watch for.  This is one of those times when men are going to have to learn to be more proactive in their own health.  PSA testing should begin at 40 (especially with any family history) and a man should use his first PSA as a base - keep all records yourself. your  physician is too busy to keep track of all patients.  If there is an increase of 0.5 (used to be 0.75) in a year, or between tests, further testing should be done. 

Dutch


Posted 1/27/2008 3:33 PM (GMT -8)
All of us men look for a magic number in a lot of things. This is especially true when it comes to health numbers. With PSA's and PCa there is no safe or magic number that can provide comfort. I changed primary doctors because of the lack of completeness my first doctor was exhibiting. I had to ask that a PSA test be run. The first one was 3.2 and I was told not to worry. The next year she forgot to order it in the blood work. That did it for me. My new primary ran me through a lot of tests which all turned out good but my PSA was now up to 3.8. That was enough for him and he sent me to a urologist. The urologist waited three months and ran another PSA and now it was 4.3. A biopsy confirmed PCa which I probably had for two years. Everyone I know that is over 40 years old I am telling them to get a PSA baseline. Many of them have come back and told me that they had followed my recommendation even though their doctors did not think it was necessary because they were not 50. It is the trend of PSA'a that is important, not just the PSA number itself.

Tamu
Posted 1/27/2008 8:09 PM (GMT -8)
Excellent postings above, but I believe that one important component was omitted here (i.e., free PSA).  The free PSA should be determined along with the basic PSA test. The generally accepted normal range for free PSA is above 25.  The lower the free PSA, the higher probability that a patient may have prostate cancer.  I had free PSA of 27, which put me in a less than 20% risk category of having PCa.  Unfortunately I fell into that group.  The bottom line today seems to be monitoring PSA carefully once it jumps above 2.0, especially for abnormal velocity in subsequent testings.  I believe that the free PSA test is another important (but not perfect) PCa indictor--even those with a PSA below 2.0 should have this test performed.  As we all know, there is no absolute assurance that a PSA below 2.0 guarantees that you do not have PCa. 

Dave

Posted 1/27/2008 8:21 PM (GMT -8)
Wow, a guy could drive himself nuts with the numbers, controversy about what test is right, diet, and all that stuff. It seems pretty simple to me: if the PSA goes up, get a biopsy - got cancer, get rid of it.

Sorry, I probably missed something...

Jim
Posted 1/27/2008 9:02 PM (GMT -8)
Stamey, Walsh, Partin, Epstien....what the heck? What does the biopsy say? Gee whiz, get tested and find out one way or another then research what the options are then. No diagnosis, no options...pretty simple equasion.

swim
Posted 1/27/2008 9:56 PM (GMT -8)
This thread is getting interesting and through a process of synergy here, I think we are really getting to the point. The thought of a prostate biopsy scared me off and I delayed having it done until I got a big red flag when my PSA jumped way up three years later. It turned out that my biopsy (29 core) was relatively easy and painless. If in doubt, get the biopsy done early in the game--it may save your life by keeping you from progressing into an advanced stage of PCa. You don't have to wait for a doctor to tell you that it is time to do a biopsy. If your PSA is moving up you have to be concerned about the probability of having PCa. Be your own doctor if necessary! When having the biopsy done, just make sure that you review the procedures to be followed by your urologist, especially how your prostate will be numbed so that you have little or no painful discomfort. A preferred biopsy is one where at least 20 core samples are taken. Taking two few samples may not uncover all or some cancer which may be in your prostate.

Dave
Posted 1/27/2008 10:08 PM (GMT -8)

I agree with Swim and Pcdave.  We see what stage 3 and 4 guys are going through here.  Why risk it?

Jim

Posted 1/27/2008 10:48 PM (GMT -8)

swimom said...
Stamey, Walsh, Partin, Epstien....what the heck? What does the biopsy say? Gee whiz, get tested and find out one way or another then research what the options are then. No diagnosis, no options...pretty simple equasion.

swim

Or one could just stick his head in the sand and hope for the best. I'm with you. Good equation!
Posted 1/28/2008 7:12 AM (GMT -8)
Hi Selmer

I don't think anyone is trying to put you down here.  There is a lot of truth in what you are saying.  There seems to be a very fine line at times as to what point a man should have a biopsy if it is suspected that he may have PCa.  Forget about the PSA tests, if a man has a positive DRE, a biopsy should be performed. Some think that too many biopsies are performed needlessly.  Medical research is attempting to develop a test which will more definitively pinpoint whether or not a man has PCa and therefore determine if a biopsy is needed.  Until then, it is best to be safe rather than later sorry.  You just have to read the postings of those members in this forum who are in an advanced stage of prostate cancer because they weren't caught sooner.  It really gets to me emotionally.  The recent passing of Lance in his 50's was heartbreaking.  Any of us could be Lance--once you get PCa it becomes a life long process of testing after treatment and praying that the cancer is gone and will not return.

Another important point.  There are no tests today that can tell a man with great accuracy the exact stage of his PCa, once it is determined that he has it.  This has been borne out time and time again when men have surgery and the biopsy from the removed prostate often indicates that the stage of cancer is worse than the pre-treatment tests indicated.  This is just another reason for a man to have a biopsy if there is the slightest reason to believe that he may have PCa.  The sooner one is treated the better.  Watchful waiting is for fools. For some of us lucky ones, the cancer grows very slowly; for others the growth can be rapid and lead to an advanced stage of cancer much sooner.

I commend you for your contributions to this very lively discussion which has solicited many viewpoints, giving all members and non-members who read our postings something to think about and consider.  It may motivate some to take action sooner rather than later in getting a biopsy, unless one likes to play Russian Roulette with their life.

Posted 1/28/2008 2:02 PM (GMT -8)
Remember - The younger you are, the faster the PCa will metastasize. (This is true with most cancers.) Therefore, if you are in your 60's, 70's there is not as much need to be concerned with the small increase in numbers as there would be if you are in your 40's and 50's--that is when it will grow much much faster because as a rule, PCa is a very slow growing cancer.
I believe doctors should begin testing men at 40, not 50. Even though my husband was diagnosed at 54, he would not have even been tested until age 50 and it still would have been advanced. His onc feels he had a tumor 15 to 20 years. Therefore, I stress to my son that he insist that his doctor checks his PSA levels when he is in his 30's.
Prayers to you all
Posted 1/28/2008 2:53 PM (GMT -8)
For those who have sons (we have 2 - 37 & 41) it's imperative for them to be tested. It could make the difference between a late diagnosis, as Don had, or one caught early enough.

That being said, this disease is sneaky.
Don's post path report showed clean margins but it had already metastasized to distant lymph nodes and he never had symptom one.
Tony, a mere 44 at diagnosis, went into surgery with a PSA over 19 and has had Radiation & HT since.
Les (aka Gordy) his PSA NEVER went up and he has advanced pc that has mutated.

Just a sample of who is here because of pc...

So, get your PSA tested AND a DRE...it's the smart thing to do.

Susan
Posted 1/28/2008 4:09 PM (GMT -8)
Good reminder Susan. My son is almost 31 and I have strongly reminded him recently that he should have his first base line PSA test (including free PSA). Some men do get prostate cancer in their 30's, so if there is a family history, there is no sense in taking a chance. Depending on the test results, my son does not necessarily have to repeat it each year because of his young age. I appear to be the first in my family tree to have prostate cancer.

Dave
Posted 1/28/2008 10:45 PM (GMT -8)

Excellent topic... thanks, James C.

As it is with treatment options, diagnosis of PCa is a very personal thing. 

With cancer or most serious illnesses, we're dealing with an unknown invasion of a microscopic nature.  So, we give our diagnosis and treatment the "best shot."  With PCa, the patient studies and ponders all that he can and makes a decision.  Yes, it is a "numbers game," but in the end, the patient is in the decision-making driver's seat and no one can fault him for his personal decision at any stage of diagnosis through treatment. 

All the very best,

Barry

Posted 1/29/2008 5:37 AM (GMT -8)
This is a good topic to bring to light.  Since my husband's encounter with PCa I feel it's my duty to inform all men to take charge of their health and be proactive and have the PSA test.  My brother who is 55 and in the Army, had some prostate tests two years ago because of some symptoms.  He has an enlarged prostate, up several times during the night, and some ED issues.  They did a biopsy and said it was negative.  Recently I asked him what his PSA level was, and he said it was normal.  So that's what the Army doc said... normal.  Whatever that means!  I worry that the biopsy could have missed the target. 

I have asked him to research his medical history and get the facts. Guess I'll have to nag him just a little harder. 

Worried,

Marie

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