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AstroNerd
Regular Member


Date Joined Sep 2008
Total Posts : 56
   Posted 2/5/2009 11:05 AM (GMT -6)   
I keep forgetting to ask my doc....

How can I have a PSA value if I've had my prostate removed? This antigen they're testing for is produced by the prostate, and now I don't have a prostate. Even if there was cancer outside my prostate (it's not), how could it produce PSA to find in a blood test? Does not compute...

cheers & beers,
Chris
Diagnosed on 9.23.08, age 47
Gleason 6, T1c
da Vinci LRP performed 1.22.09 at Moffitt Cancer Center
Catheter out on 2.4.09!!!!
Pathology: Gleason 7 (3+4), T2c. Tumor 15%, fully contained, margins clear, lymph clear.


strawberry man
Regular Member


Date Joined Dec 2008
Total Posts : 23
   Posted 2/5/2009 11:16 AM (GMT -6)   
AstroNerd- I am no expert, but I believe they test for psa after Prostatectomy to see if the prostate cancer migrated to another part of your body. Not likely, if your margins were clear.

take care

Dx 4/21/08 psa 9.7  Age 58 OMG

Biopsy results  3 areas of  3+3=6 gleason

Di Vinci surgery 6/3/08

Post op 3 months and 6 months -  all clear

0 psa TYG  (thank you God)


AstroNerd
Regular Member


Date Joined Sep 2008
Total Posts : 56
   Posted 2/5/2009 12:01 PM (GMT -6)   
Right, but that's my confusion. If I do not have a prostate, how can my non existent prostate produce any antigen to test for?

From here: National Cancer Institute

Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of PSA in the blood.

I no longer have a prostate gland, therefor there is no longer anything in me to make that protein. How can a metastasized prostate cancer show up in a PSA test if there is no prostate glad to make the "A" in PSA? Does that make sense?
cheers & beers,
Chris

Diagnosed on 9.23.08, age 47
Gleason 6, T1c
da Vinci LRP performed 1.22.09 at Moffitt Cancer Center
Catheter out on 2.4.09!!!!
Pathology: Gleason 7 (3+4), T2c. Tumor 15%, fully contained, margins clear, lymph clear.


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/5/2009 12:03 PM (GMT -6)   
Actually...PSA is not only prostate specific...it is an antigen that is produced by the glands...the prostate produces the most however...but there are other glands that will produce PSA as well...just at levels so low that only the ultra-low 3rd generation asseys can detect. You body after surgery will seek a new level of PSA...generally below the .1 mark and most likely below the .01 mark. Like strawberry man said...it is used to watch for any escaped PCa cells that may be leaked out through the blood and taken root somewhere else in your body and below detection levels at the moment. Most of the time this won't happen...but it can and you will be tested for the next five years or longer just in case they become active enough to grow large enough that a second treatment is required. The PSA is used to determine how rapidly they are growing and determine if treatment is even needed.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


AstroNerd
Regular Member


Date Joined Sep 2008
Total Posts : 56
   Posted 2/5/2009 12:11 PM (GMT -6)   
Les.... OHHHHHHH! OK, I didn't know that antigen could be produced by something other than the prostate. Thanks.
cheers & beers,
Chris

Diagnosed on 9.23.08, age 47
Gleason 6, T1c
da Vinci LRP performed 1.22.09 at Moffitt Cancer Center
Catheter out on 2.4.09!!!!
Pathology: Gleason 7 (3+4), T2c. Tumor 15%, fully contained, margins clear, lymph clear.


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/5/2009 12:25 PM (GMT -6)   
Well just a bit of clarification...prostate cells are actually gland cells which produce a detectable amount of PSA. While normally it doesn't leak psa into the blood system except in very small quatities, but when they turn cancerous they will leak large amounts. So each cell that is cancerous leaks a tiny amount of antigen into the blood. The more cells that leak into the blood stream, they more likely it will be picked up on the assey test. So if you have some cancer cells that have migrated or were left behind during the surgery...there may not be enough of the cancer cells leaking psa into the blood stream to be detected. But as cancer cells multiply then there can be enough of them to be able to measure the psa level. How long it takes for just one cell to multiply into enough cells to measure the psa is determined by how aggressive the cancer is...hence the doubling time...how long it takes for them to double in quantity. This often will take years before they have grown significantly to be detected. Funny thing about cancer cells...they don't die...they just keep on living, unlike normal cells that die and get replaced with new healthy cells. So when the cancer cells don't die they form tumors and continue to multiply and can be monitored by the psa blood levels.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


Comdon
New Member


Date Joined Nov 2008
Total Posts : 16
   Posted 2/5/2009 5:15 PM (GMT -6)   

Regarding, PSA. My take on it is that it is a fairly good indicator of trouble when you have a prostate, it is an even better indicator of trouble after it is gone. It is still not the end all be all for diagnosis, but it is what we work with. Others here have explained it well, Thanks.

Best of luck to you all.

Don


Age 53 @ DX
start age 45, 8 yrs tracking PSA at .4-1.5 / DRE suspicious-lumpy left side/Biopsy @ 2001-neg, 2005-neg then in 2007- PSA 2.5/ Biopsy-4left pos, 4 right-neg/Gleason 4+4=8 /
Davinci RP June 17, 2007@ Henry Ford, Detroit./ pT3bN1Mx/ seminal vesicles-yes; 1 of 4 Nodes=pos/Margins=clear/
Recovery very good, 10 days catheter, physically excellent. Sexual dept, showed good signs, injections  for 2 mos. Cialis a couple more mos. Now 80%, no drugs and no complaints. I would trade this for 0's
PSA's. 8/07=.008;11/07=.028;2/08=.062;5/08=.162;8/08=.219
11/08,To Oncologist, Wm Beaumomt Hosp, IMRT 36 trmts. starting PSA=.2, after 30 trtmts,1/09=.1
 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/5/2009 5:24 PM (GMT -6)   
As LV-TX has so eloquently said all prostate cells produce PSA and some of it leaks into the bloodstream. When you are a child the prostate gland is quite small (even in relation to your size). When you hit puberty the size of the prostate increases to about walnut size (about 20 grams or 20cc). On average it remains this size for about the next 30 years and leaks very small amounts of PSA into the bloodstream. On hitting middle age it is common for the prostate to begin growing again sometimes resulting in problems urinating. (it can hit sizes larger than 100 gms or 100cc). Of course this increase in size produces a corresponding increase in the amount of PSA leaked into the bloodstream. All prostate tissue, including cancerous tissue, produces PSA. Cancerous prostate tissue usually leaks a greater volume off PSA than healthy tissue. So later in life the problem becomes .....is that PSA increase due to an increase in size of a relatively healthy gland or is there tumour growing within the gland. To complicate matters further a benign prostate infection will also cause more PSA to be leaked but this is usually a temporary issue. Once the prostate is removed then the production of PSA is essentially stopped with the following exceptions. (a) There are a couple of other glands which can produce very minute amounts of PSA: (b) A small portion of healthy prostate tissue can be left behind which will continue to produce PSA (this can easily occur with nerve saving surgery where a little tissue can be left attached to the nerves) or (c) the tumour may have escaped the prostate ( even microscopically) into lymph nodes, surrounding tissue or distantly and thus will produce increasing amounts of PSA if it survives and continues to slowly grow.
Bill
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 Adenocarcinoma-------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 Aug 10th 2007
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
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)

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