PSA-when it too much?

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James C.
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Date Joined Aug 2007
Total Posts : 4461
   Posted 1/27/2008 7:16 AM (GMT -7)   
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?
James C. 
 
Help support the forums so they can support you:  http://www.healingwell.com/donate 
 
Age 60 
4/19/07   PSA 7.6, referred to Urologist, recheck 6.7 06/05/07
7/11/07   Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07   Path report:  3 of 16 PCa, 5% involved, left lobe , GS 3/3:6. 
9/24/07   Retropubic Radical Prostatectomy performed 
9/26/07   Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07  ED- begin 25mg Viagra nightly, Fully continent
11/15/07  ED-continue 25mg Viagra, no response, begin Vacurect pump-
11/15/07  1st PSA-0.01
12/17/07  ED- 3 mts.-continue Viagra and pump-no change-no response
01/01/08  First use of Caverject 2.5mcg, successful, erections at last
01/14/08  Caverject abandoned due to pain and aching, Bimix ordered


montee
Regular Member


Date Joined Mar 2007
Total Posts : 315
   Posted 1/27/2008 7:28 AM (GMT -7)   
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.

diagnosed sept 06
gleason 3+4=7, right lobe only
psa 4.7  (psa rose 1 point per year for 3 years, urologist said still under 4 and no concern.  If I can find out about PSA velocity, why didn't he know!)
Told not to have surgery at Dana Farber as cancer had already penetrated prostate, in seminal vesicles, would have positive margins. Would only treat with radiation and HT
RP Emory Atlanta December 2006
Path-negative margins, negative lymph nodes
negative seminal vesicles, multifocal perineural invasion, both lobes involved
40% gland involved
gleason 3+4=7
Fully continent 2 weeks post catheter removal
1st psa April 2007-<0.04
 6 Mos PSA <0.04
9 mos PSA still <0.04
12 mos PSA still <0.04


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 1/27/2008 8:03 AM (GMT -7)   
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
47 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6      (Biopsy 3/07 just suspicious)
10/07 PSA 5.06   (Biopsy 11/07  1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC  www.roboticoncology.com
Saved both nerve bundles.
Path Report:  Stage 2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
 
 


wd40
Regular Member


Date Joined Jan 2008
Total Posts : 218
   Posted 1/27/2008 10:34 AM (GMT -7)   
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.
12/06/07 DaVinci and LRP


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2248
   Posted 1/27/2008 12:32 PM (GMT -7)   
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.


Age 59 PSA 2.6 PSA velocity quadrupled in 1 yr 
1 of 12 biopsy cores positive Open RP 6/21/06  Gleason 5
Cancer confined to prostate  Post-op PSA's non-detectable

Post Edited (TimG) : 1/27/2008 12:41:25 PM (GMT-7)


Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 1/27/2008 1:31 PM (GMT -7)   

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



Diagnosed Feb 2001  (Age 65)  Currently 72
PSA 4.8      Gleason 3+3=6      Stage   T2b
Completed Proton Therapy @ Loma Linda - Aug 2001 - No side effects.
6yr PSA - 0.19
Our responsibility now is to educate men about Pca, PSA and the importance of early detection. 
 
 
 

Post Edited (Dutch) : 1/27/2008 4:36:24 PM (GMT-7)


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 1/27/2008 4:33 PM (GMT -7)   
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
Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07
 


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 1/27/2008 9:09 PM (GMT -7)   
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
-69 years young!
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI. 
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.   
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo). Radiation oncologist said the 3-mo. drop of 70% exceeded expectations and the slight 6-mo. movement upwards was not a cause for concern now.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.  
 
 


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 1/27/2008 9:21 PM (GMT -7)   
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
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
PSAs from  1/3/07 - 1/17/08 0.00. 
Next PSA test on 7/17/08
 
"Patience is essential, attitude is everything."
 


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 1/27/2008 10:02 PM (GMT -7)   
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
 


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 1/27/2008 10:56 PM (GMT -7)   
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
-69 years young!
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI. 
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.   
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo). Radiation oncologist said the 3-mo. drop of 70% exceeded expectations and the slight 6-mo. movement upwards was not a cause for concern now.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.  
 
 


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 1/27/2008 11:08 PM (GMT -7)   

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

Jim


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2248
   Posted 1/27/2008 11:48 PM (GMT -7)   
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!
Age 59 PSA 2.6 PSA velocity quadrupled in 1 yr 
1 of 12 biopsy cores positive (5% involvement) Open RP 6/21/06  Gleason 5
Cancer confined to prostate  Post-op PSA's non-detectable


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 1/28/2008 8:12 AM (GMT -7)   
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.

-69 years young!
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI. 
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.   
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo). Radiation oncologist said the 3-mo. drop of 70% exceeded expectations and the slight 6-mo. movement upwards was not a cause for concern now.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.  
 
 


belindafeathers
Regular Member


Date Joined Aug 2006
Total Posts : 21
   Posted 1/28/2008 3:02 PM (GMT -7)   
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
Sandy


myman
Veteran Member


Date Joined Feb 2007
Total Posts : 1219
   Posted 1/28/2008 3:53 PM (GMT -7)   
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
Husband Diagnosed 11/17/05 Age: 63 PSA: 7.96 No Symptoms
2/09/06: LRP - Post Pathology - Gleason 4+3 Stage T2b NO MX
3 mo. PSA: 11.8 Stage T3a
6 mo. PSA: 18.8 Stage IV Systemic w/ distant lymph node involvement
Start HT - Lupron 3 mo. shots
12/06/06: PSA 0.8
03/07/07: PSA 0.3
06/06/07: PSA 0.1
09/05/07: PSA 0.1
11/27/07: PSA 0.1


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 1/28/2008 5:09 PM (GMT -7)   
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
-69 years young!
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI. 
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.   
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo). Radiation oncologist said the 3-mo. drop of 70% exceeded expectations and the slight 6-mo. movement upwards was not a cause for concern now.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.  
 
 


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 1/28/2008 11:45 PM (GMT -7)   

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


"Idaho" ~ Barry

 

Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

1st PSA  9/11/2007   <0.04 (undetectable)

2nd PSA 12/10/2007  <0.04

My web site: http://pca-info.blogspot.com


DesertGal
Regular Member


Date Joined Dec 2007
Total Posts : 65
   Posted 1/29/2008 6:37 AM (GMT -7)   
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
Husband 55 years old
No symptoms
PSA taken on routine health exam
06/18/07  PSA 9.2
07/14/07  Put on antibiotics for a month
09/18/07  PSA 8.77
09/18/07  PSA % Free  9.61
10/17/07  Biopsy =  Gleason 3 + 4  (7)
10/17/07  Biopsy 40% Right Side less than 5% Left Side
12/31/07  D Day!  Davinci Surgery Day - Jon Huntsman Cancer Institute
12/31/07  Left side nerves spared, Right side partial, right nodes taken
01/03/08  Home from the hospital! Let the healing begin!
01/11/08  Cath removed, post-op gleason 3 + 3 = 6, nodes clear
                Margins - capsular invasion but no penetration.  T2C

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