PSA complexity

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rocket1952
Regular Member


Date Joined Oct 2008
Total Posts : 26
   Posted 3/10/2009 8:24 PM (GMT -6)   
Just happened to see this article about PSA use in PCa diagnosis and thought people here might be interested. I am not presenting it as my opinion, but, as I've seen many posts with PSA confusion, I thought it relevent.

Rich

"WASHINGTON—As many as two of every five men whose prostate cancer was caught through a PSA screening test have tumors too slow-growing to ever be a threat, says a new study that raises more questions about the controversial tests.--------

http://www.boston.com/news/health/articles/2009/03/10/more_evidence_prostate_tests_overdiagnose_cancer/
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.


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 3/10/2009 8:56 PM (GMT -6)   
The PSA test saved my life. I had a jump in psa followed by surgery with a gleason of 8. the DRE did not detect anything abnormal. i am a STRONG advocate of PSA testing!
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
decision - surgery (robotic)
Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8
margins clear
9 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 377
   Posted 3/10/2009 10:38 PM (GMT -6)   
Yes, yes this is the question! Did all of us guys here with low amounts of prostate ca and low gleason scores jump the guns with treatment, either surgery or some type of radiation? I DUNNO? So far my PSA is undectectable after 6 months from surgery, incontinence gone, ED remains, have to use bimix/trimix injections for sex. I don't have a good answer for guys like us. All I know is that I didn't want continued PSA monitoring with followup biopsies the rest of my life. THERE IS NO CLEAR CUT ANSWER TO THIS QUESTION!

my age=52 when all this happened,
DRE=negative
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/14/08, 2/12 cores positive for Prostate Cancer on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 3+3=6 both cores,
Clinical Stage T1C
 
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery,
No signs of spread, organ contained,
First post-op PSA=.01 on 10/15/08,
Second post-op PSA <.01 on 01/15/09,
Incontinence gone in early December '08,
ED remains, using daily Viagra and 2x/wk bimix/trimix injections for penile rehab


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/11/2009 9:33 AM (GMT -6)   
Me too. PSA testing saved my life, without a doubt. Rather men be tested then found cleared, then to delay testing and allow PC to grow and foster. Had my GP not convinced me to start getting PSA testing done on my 50th birthday, would have never known about my PC and its seriousness until it was way way too late. It's just a simple blood test, no big deal. And with me, never had an abnormal DRE at any point, and never had any other symptons of prostate troubles. Yet having said that, my cancer was building up steam, and was real, real close to not being contained when it was detected.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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 .05, 6 month on 5/9
 
 


apacker1950
Regular Member


Date Joined Nov 2008
Total Posts : 122
   Posted 3/11/2009 10:17 AM (GMT -6)   
2 out of 5 chance is way over the acceptable odds for me. I'm glad that I had a PSA test. Who knows where I would be now without it. 2 out of 5 chance???? I like my odds a lot better now. Allan
Dx PCa age 54. Jly 05- PSA 8.1 Sept 05- PSA 10.7
Sept 05- Biopsy  9 of 12 cancerous, Gleason 3+3=6, T2
Bone scan and cat scan showed hot spot on hip bone.
Oct 05- bone biopsy, ouch.  benign , no cancer in bones.
Nov 05- PSA 15.4 Nov 18, 05- Nerve sparing open RP at Huntsman Cancer Center, by Dr. Robert Stevenson. 100% continence at 3 months. ED- Tried the big 3 pills with no results. Feb 06-Started VED, worked, but painful with constriction rings. May 06 started Trimix injections.
ED appears to be perminant but doing great with Trimix.


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 3/11/2009 10:39 AM (GMT -6)   

PSA Test saved my life as well!! Normal practice is to get a dre and psa test after 40 if you have family history. I took PSA test at 36 came back high, the DRE showed nothing.

Also people need to keep in mind biopsy not fool proof either, needles could miss the cancer. My biopsy on one side showed nothing but after removal it showed cancer in that side as well.

My doctor said you are lucky that it was detected on the other side.

LIVESTRONG!!!


Age Dx 37, 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA 9/2008: <0.01
2nd PSA 12/2008: <0.1 (Different Lab then 1st)
3rd PSA 3/2009
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4275
   Posted 3/11/2009 11:58 AM (GMT -6)   

I guess I just don't get the logic.  If 2 out of 5 had tumors that would never have been a threat, that means that 3 out of 5 had tumors that WOULD have been a threat.  DUHHHH...

So, for me I have the same answer that I always have given when asked about the advisability of PSA testing.  Knowledge is power.  I was not happy to find out I had PCa.  However, when learrning of my grade and % I was very glad to have found it early so I had lots of treatment options.  If I had the right stats I would have chosen active surveillance but I was not so lucky.  So, now I feel fortunate to have had docs who insisted on PSA testing and recognized when things didn't look right.

There is a very sad post today called "PSA over 400" from someone whose uncle just had his first PSA test at age 63.  The outlook is grim.  I wonder if his doctor was one of those who didn't believe in PSA testing for fear of overdiagnosis...

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 3/6/09.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/11/2009 1:15 PM (GMT -6)   
Tudpock, all to save taking a simple blood test perhaps. That would be short sighted at best if that is what the doctor or the patient thought.

David
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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 .05, 6 month on 5/9
 
 


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 3/11/2009 1:37 PM (GMT -6)   
Maybe someone's posted the information, but in the time I've been reading this forum I don't recall reading a comment from someone that they had surgery only to later learn that they had been cancer-free, and that the M.D.'s made a mistake. I doubt anyone here has read the report being quoted in the linked newspaper article, but it disturbs me that the head of the American Cancer Society seems to be critical of the Prostate Cancer testing/procedures and early action. At 58 years of age, I was not disappointed to have the opportunity to remove the cancer from my body. I don't doubt we'll be reading more of the details of all of this and I await that further information.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0

 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 3/11/2009 7:07 PM (GMT -6)   
PSA testing saved my life as well. My PSA never reached the magic number 4, but it did jump from 2.7 to 3.5 which set an alarm that led to a biopsy showing a very aggressive cancer.
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


coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 3/11/2009 8:20 PM (GMT -6)   
"two out of five". How do they come up with stats like that? Is there a way to determine if one man's cancer is / was slow growing and "WILL NOT" be the cause of death vs. another "WILL BE"?
Age 51, (50 at DX)
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
ED, need a little help from Levitra
First post op PSA 11/11/08, 0.00
Second post op PSA 2/10/09, 0.00


Ralph Alfalfa
Regular Member


Date Joined Nov 2008
Total Posts : 469
   Posted 3/11/2009 8:25 PM (GMT -6)   
Never had a Psa test until I was 56 and then had two in one week. First one was 13.5...thought it was lab error, second one 14.5. Prostate, through DRE was, as the doc said, "Generous." PCa never entered my mind, as I thought I was a walking Flomax commercial. Subsequent testing proved otherwise. Since that time I have learned so much about this albatross that I usually wind up talking with my friends about their need to be tested. Believer in testing? You betcha.
Bob
 AGE:57
 Dx: October,27(the day after my birthday)
 Psa 14.5
 Gleason:(4+3) 7 T1c
 Bone scan:Negative
 Cat scan: Negative
 Biopsy: 4 of 12 positive, left side, pre-cancerous on the right.
 Confined to prostate.
 DaVinci scheduled for Jan. 19, 2009.Dr. Scott Montgomery, KC Urology,
Shawnee Mission Med. Center. Kansas


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/12/2009 8:01 AM (GMT -6)   
Selmer, I just read the second article, word for word, and couldn't disagree anymore than I do. It looks like it was written by people that have no exposure to PC in anyway. Their baaic assumption is wrong, and they did nothing to prove their point in my opinion. The facts are simple, early PSA testing saves lives, period. Earlier testing for all men, say 40-45 will save lives. Reaching out harder to the African-American community will save lives. Lowering the threashold for a biopsy from 4.0 to something less will save lives. Look how many men just in our group here were dx. with PSA well below 4.0. To me, jmo, watchful waiting for someone elderly or someone dealing with other complex medical maladies can make perfect sense. But if your health is generally good, and let's say you are under 70, and you have a proven dx of PC, from biopsy's, then it means you have PC. The pathology from the biopsy is just an estimate, it may be much more serious or aggressive than small samples indicate, and is often that way. So watchful waiting with a proven dx to me, imo, risky and perhaps even foolish, as cancer doesn't go away on its own. It's all about containment, not whether a person wants to avoid treatments or the side affects of treatment. I honestly think there are those that don't truly understand the mechanics and horror of having cancer. Perhaps they are in denial. Denial itself can be a form of watchful waiting. It is frustrating with PC in particular. I was in good health prior to dx at age 56. No prostate problems, no ED problems, great sex life, there are still times that I wished I had never been checked for years on the PSA tests, but then reality sinks in, and it scares me that I could still be living now, with an unknown and unchecked PC agressively growing in me, and sure would have been more shocked to hit age 60 one day and find out that I had a full blown T4 situation and cancer in my bones.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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 .05, 6 month on 5/9
 
 


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 3/12/2009 10:01 AM (GMT -6)   
That is a good point. There is no way to detect whether a tumor will continue to grow and cause problems down the road. I saw the same segment on the new and it made no sense to me. Who cares if 40% of prostate cancer tumors will not cause a problem? If there is currently no *reliable* way to detect the bad from the "good" tumors then listening to anti-psa advacates is useless.

Smokie
Regular Member


Date Joined Oct 2008
Total Posts : 46
   Posted 3/12/2009 10:40 AM (GMT -6)   

All this discussion aroused my curiosity, which led me to the American Cancer Society website. I'm not computer savvy enough to post the site, but go to cancer.org and search "what are the key statistics for prostate cancer".

The good news, according the above site, is that 1 in 6 will be diagnosed with PC, while 1 in 35 will die from it. The mortality rates are far better than some cancers. They show 100% survival at 5 years (for glandular carcinomas).

The bad news. It is the 2nd leading cause of cancer deaths in men. An estimated 28,660 American males died from PC in 2008.

My take on this? 28,660! Choose whatever treatment option you're comfortable with. But test your PSA and, when signs of trouble appear, have the stinking biopsy!!! How can not knowing be a good thing?


Age: 43
Diagnosed at 41 by routine blood test
PSA at diagnosis: 5.1
Pre-op Gleason: 3+4=7
Post-op Gleason: 6 (different labs?)
No luck finding local experience with DaVinci
Scheduled RP at Vanderbilt: 8/06
Insurance trouble, rescheduled at Centennial Hospital, Nashville
Prostate removed 9/06
Robotic, nerves spared, no positive margins
PSA since RP: good (less than .05)
Currently suffer ED
 
 


BooMan
Regular Member


Date Joined Oct 2006
Total Posts : 27
   Posted 3/12/2009 9:32 PM (GMT -6)   

I seldom come out from under my rock to post, but I visit this site daily.  I believe active surveillance is appropriate for many of us. It is not necessarily, as suggested above, a state of denial. I have been diagnosed with prostate cancer.  I know it will not go away on its own.  In my case, it doesn't mean that I must do something immediately. Neither is active surveillance risky or foolish for those of us that choose it.  It might be risky or foolish if I were in a state of denial.  I'm not, and I find those terms a little insulting.  Just as some men are very fortunate to recover continence and erectile function quickly after treatment, some of us, through luck of the draw, get a diagnosis that doesn't necessarily require immediate action.  I'm well aware that clinical staging and Gleason sum from biopsy can vary significantly from post-operative pathology.  I get PSA tests and a DRE every 4 to 6 months.  My doctor and I know to look for PSA velocity changes and she will notice a change in the DRE.  A yearly biopsy looking for a change in percentage of core involvement, number of cores involved, or Gleason sum will alert us to any need to change course.  I've been fortunate in not having any increase in any of those numbers.  I believe that PSA testing is important, particularly in establishing a baseline and recognizing a velocity change.  Researchers can and will debate the statistical significance of PSA testing in relation to death rate, lead time to death rate, or number of lives saved per number of interventions.  They've got research and grant dollars to secure.  My hope is that they will concentrate on developing reliable predictors or diagnostic tests so that choice of treatment (including active surveillance) is not such a craps shoot. 

Boo

       


maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 789
   Posted 3/13/2009 2:20 AM (GMT -6)   
I had no symptoms whatsoever, DRE normal the PSA test was the trigger which sent me to the Urologist and the biopsy confirmed Pca, so I support the PSA test 100%.

Regards Mal.
age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive

Gleason 3+4=7 right side tumour adenocarcinoma stage T2a

RP on 30th July,

Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck, free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.



Post op PSA 0.5 26th Sept.

PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.

Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA 30th April 0.4
PSA 30th July 0.5
PSA 27th Oct 0.4 (I am now 68)
PSA 11th March 0.5


kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 3/13/2009 8:14 AM (GMT -6)   
My post would be an exact duplicate of maldugs' - no symptoms whatsoever.

After surgery I was told it had bulged out, and if I had (not had the PSA test, and) done nothing for a year, it probably would have broken out, spread, and I might very well have been too far gone to save. Of course that is all speculation. But - tomorrow is the one year anniversary of my cancer diagnosis, and I feel MUCH better sitting here knowing that I am cancer free, as opposed to knowing nothing and dying from the inside out.

Just my opinion,
kcragman
Age: 53; 52 at DX
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late
Jan '08 - after I was rejected. Their lab said PSA 4.5.
Feb 2008: PSA 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were
cancerous and the 6th was suspect.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph node and nerve samples taken, and appeared to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.
Feb 2009: PSA at 9 months was undetectable.

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