If the PCa3 test is so good how come I haven't....

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cvc
Regular Member


Date Joined Jun 2008
Total Posts : 440
   Posted 1/27/2009 10:04 PM (GMT -6)   
heard anyone here having one ??? Is it something new ?? Will this replace all the biopsies that are being done first ??
will be 50 years old this year ( 2009 )
 
Uro said enlarged prostate 
 
DRE Negitive
 
Psa  2003- .55
 
     2007 - .99
 
     2008 -  1.01
 
watchfull worrier , lol


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/27/2009 10:25 PM (GMT -6)   

It's that new.  I have a review of it in the document below.  The Prostate Cancer Foundation hold a summit every October where the top scientists meet and review the lastest.  PCA3 is one of the highlights...happy reading.

Read highlights from the 2008 retreat

Tony



Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 15, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 1/27/2009 8:28:46 PM (GMT-7)


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/28/2009 6:09 AM (GMT -6)   
Cvc,

Just my guess, US medical arrogance and inertia. Until I was seen by an urologist trained both in the EU and in the states no one suggested it to me either. In fact two Duke oncology specialists told me my perstant Psa after two definitive local treatments was proof of micro metastatic diease and that no further diagnostics were called for.

There was a time in the recent past that Psa was dismissed by a large population of urologists who believed reaction to it was leading to unnecessay biopsy.

I think this screen should be added to everyones exam unless there is a prior history of a positive biopsy. I believe there are many thousands of men with symptoms who would be more inclined to seek evaluation if they knew the next step after Psa and DRE was not automatically biopsy. We have at least two members posting on this board right now who are conflicted about the need for biopsy.

Best wishes, Scott.
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/28/2009 6:10 AM (GMT -6)   
Biopies become your pathology, pathology is more of an art for experts that simple science, trying looking at some pictures of sides in books and see if you could determine Gleason score, Perinerual invasion, and the different 18 types of PCa variants and other parameters. There are a handful of 'expert' pathologists, other guys might be fairly good at it, but when reviewed alot of times they get corrected. Pathology can also tell you the ploidity of the cells DNA structure (costs extra is not standard pathology ordered for most patients), that info may reflect how treatable your PCa is, especially in regards to treating it chemically with drug protocols. 3-known DNA ploidities majority of people probably diploid, which is better than the other two.

Nothing so far is going to replace biopsies, grading, and assessing percentage of cancer found in what location, etc. Is the closest we can get so far to defining what is a patient dealing with.
Huge difference between 'indolent PCa' and very aggressive PCa and they are not treated the same, although sometimes are. Huge difference in Gleason scores and PCa aggressiveness too.
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/28/2009 8:20 AM (GMT -6)   
zufus said...
Nothing so far is going to replace biopsies, grading, and assessing percentage of cancer found in what location, etc. Is the closest we can get so far to defining what is a patient dealing with.
Huge difference between 'indolent PCa' and very aggressive PCa and they are not treated the same, although sometimes are. Huge difference in Gleason scores and PCa aggressiveness too.

Agreed, but this comment is not responsive to cvc's issue about when to submit to a biopsy when you have sypmtoms of BPH and nearly normal PSA.  The PCA3 can give a person a comfort level that there is no cancer and as I have already mentioned is likely more reliable than a biopsy for these men as it samples the ENTIRE gland.
 
Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 1/28/2009 8:45 AM (GMT -6)   
zufas, I agree with you on this one.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/28/2009 10:39 AM (GMT -6)   
Scott- yes I know............ But in case someone else sees this PCA3 test as defining what they actually have, that is biopsies, the PCA3 may reveal yes you have prostate cancer.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 1/28/2009 11:07 AM (GMT -6)   
I think if men new to all this, perhaps suspicious of having PC, would not look at PC biopsies as being this long, painful ordeal. Sometimes, I sense that their fear of doctors, needles, and tests put them off, and then they start looking for any other solution, or slip into some level of denial.

Got nothing agains the newer pca3 tests, but if you really need a biopsy, then get the biopsy. With a raging and unpredictable monster like Prostate Cancer out there, you can't take a chance and hope it's either nothing or that it is just going to go away. If needed, the standard prostate biopsy is a good tool, and if it ever comes out positive, then you have a starting point in front of your eyes to start dealing with the cancer.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/28/2009 11:53 AM (GMT -6)   
We are all good on this, no disagreements, the urine testing might be good for those few patients that maybe are not ready to commit to biopsies but suspecious of having PCa, but doctor has not been able to confirm, maybe non positive DRE and slightly low psas even with minor increases.
Always good for patients to consider everything, with caution on PCa. Once the PCA3 test says you have prostate cancer, then you rationally should do biopsies, but even then it is the patients choice even if other don't agree with it. The test can have a place in this mix that might lead you to biopsies.


 

Post Edited (zufus) : 1/28/2009 3:56:34 PM (GMT-7)


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/28/2009 12:04 PM (GMT -6)   

I guess I am doing a real lousy job of communicating here.

The huge value I see in PCA3 is that it is easy to miss prostate cancer in early stages in the typical office performed trans rectal biopsy.  You never see the urologist without being offered the cup anyway so I am wondering what percentage of men would both be spared a biopsy because he PCA3 comes back negative after the initial consult and DRE and before the biopsy as they are not performed in the same office visit; And also what percentage having a positive PCA3 would go on to a more extensive biospy after the one performed in the office comes back negative because a needle didn't find the tumor.

Its a cheap diagnositc that is conclusive for cancer and gives a piece of informaton which is not available in many cases without it.

Scott


Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/28/2009 3:20 PM (GMT -6)   
PSA3 is a new urine test and the prostate gland has to be massaged before you pee in the cup. Tests like PSA3 and free psa are ways to indicate the likelyhood of PCa vs BPH and are very useful in determining if you should get a biopsy or not. It does not replace a biopsy.
Since PSA3 is relatively new we really don't know what the numbers mean because there hasn't been a lot of data generated yet. High normal for a PSA3 test is 35 and any number higher than this indicates a probablity of PCa just like a freePSA score of less than 20% indicates a probability of PCa vs BPH.
My Doc thinks that the higher the PCA3 number is the more agressive the cancer is, but at this time without any long term studies this is just a theory.
PSA3 is just another tool and we need all the tools we can get.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 1/28/2009 3:52 PM (GMT -6)   
zufas - i agree again, its not about what we want or what we want for others, have always said, people are free to do or not do as they please. as a nurse, my wife tells me about non-compliant patients all the time, that take good sound advice, and go against it. they simply chart their records as going-against-medical-advice. not about denying people's rights.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/28/2009 6:59 PM (GMT -6)   
John T said...
PSA3 is a new urine test and the prostate gland has to be massaged before you pee in the cup. Tests like PSA3 and free psa are ways to indicate the likelyhood of PCa vs BPH and are very useful in determining if you should get a biopsy or not. It does not replace a biopsy.
Since PSA3 is relatively new we really don't know what the numbers mean because there hasn't been a lot of data generated yet. High normal for a PSA3 test is 35 and any number higher than this indicates a probablity of PCa just like a freePSA score of less than 20% indicates a probability of PCa vs BPH.
My Doc thinks that the higher the PCA3 number is the more agressive the cancer is, but at this time without any long term studies this is just a theory.
PSA3 is just another tool and we need all the tools we can get.
JohnT

 
I have not suggested it replaces a biopsy but that it is an additional bit of information that you would not have otherwise.
And it does not indicate the likelyhood of cancer, it is either inconclusive due to inadequate material epressed, or it is postive for cancer or negative for cancer.  I sure whish the cup I peed in before I was subjected to ADT and IMRT because the Dr. said I had a local issue had been subjected to this inexpensive test.
It is not new except in the US. 
Scott
 

Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/31/2009 2:47 PM (GMT -6)   

On the Prostate Cancer Research Institute's web site, under the "undiagonosed section" there is a paper on PSA3. It contains more than you would ever care to know about PSA3 and its predictive probabilities.

JohnT


I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/31/2009 3:31 PM (GMT -6)   
John T said...

On the Prostate Cancer Research Institute's web site, under the "undiagonosed section" there is a paper on PSA3. It contains more than you would ever care to know about PSA3 and its predictive probabilities.

JohnT

I don't understand the objection to an additional piece of information, does anyone else?
It was not long ago that PSA was not universally accepted or understood and now men are making life and death descisions based on it.
 
Scott

Post Edited (gpg) : 2/1/2009 9:13:10 AM (GMT-7)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/31/2009 9:29 PM (GMT -6)   

gpg,

The latest PCA3 is new.  Even in Europe.  The currently approved assay (the good one) was approved for general use in 2007 in Europe.  The scientist and genetic researcher who helped create the technology is in the report I posted earlier.  His presentation is excellent and states where we are.  In a nutshell, alone PCA3 is only slightly ahead of PSA and Free PSA test assays.  But combined with T2-ERG analysis an assay was tested in 2004 and released in Europe in 2007 (after I was dignosed).  You will see more use of this exciting technology as soon as the FDA gets a scent of coffee.  I tried to link the presentations from the summit before, so here it is...When I test this and it doesn't work I will type the instructions on how to view the presentation in it's entirety...

Edited ~ It didn't work.  See post below

Tony

Post Edited (TC-LasVegas) : 2/1/2009 3:36:29 PM (GMT-7)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/31/2009 9:34 PM (GMT -6)   

OK it didn't work

Still Click the link :http://www.sessions2view.com/pcf_library/viewer.php?pf=$MMjAvN3C7Il4aSAIv3Mp2N/Q==&ud=

> Then click "Next" twice
> Select 2008...
> Select Session VIII...
> Select PCA3...

Enjoy...lol or zzzzz

Tony


Post Edited (TC-LasVegas) : 1/31/2009 10:18:01 PM (GMT-7)

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