hi, Salva -
Velocity is important, to be sure, but I wouldn't necessarily agree that it trumps everything. I would say it trumps pre-operatively if the evidence otherwise is ambiguous.
I did a lot of research on the velocity question, because it affects me personally. In the three months between the PSA test that sent me to biopsy (3.6) and the RP, my PSA jumped up to 5.6. Now, many people don't bother to get another PSA after the diagosisis and before treatment, but I wanted to see if a radical improvement in nutrition might help. Obviously it didn't The jump in PSA freaked me out and started me reading the journals and talking to people. I asked my surgeon whether I should seek adjuvant treatment, given the high pre-op PSAV and short PSADT. He said no, given that my pathology (EPE-, SM-, SV-) was favorable. He said the path report trumps the pre-operative PSAV and PSADT. I said, "so what does it mean that my PSA moved up so quickly just before surgery" and his answer was "it means it's good that we got it out when we did. That's about
it." Another well respected doc said essentially the same thing.
Still, I was bothered by the publications by D'Amico and Catalona et. al. around 2004 and 2005. And at the same time, I was encouraged by the nomograms (Stephenson, et. al.) Those authors said that they tested PSAV and PSADT and it didn't add any explanatory or predictive power once other factors were taken into consideration. Then finally, there was another article (Catalona also one of the authors) that said that PSA kinetics are predictive of a worse pathology report after surgery, but after pathology is taken into consideration they are NOT predictive of a worse overall outcome.
So, I am still trying to make sense of it all. The jury is still out on this. There is clearly a controversy raging in the literature; I found one "letters to the editor" exchange where Kattan and other challenge D'Amico's findings and D'Amico defends his work. I am thinking of seeking out D'Amico or Catalona for a consultation, just so I hear their views in my particular case.
Each stage of the process brings different information and different decisions to make. Which information is most important depends on the where someone is in the process of diagnosis and treatment. To stay sane, I try to keep my focus on the decision at hand.
Best wishes, and please share what you discover.
DX at age 54 12/2009
Initial clinical profile: PSA 5.6, DRE-, high pre-op PSAV. Clinical stage T1c
Biopsy: Gleason 3+4 with PNI / 6 of 14 cores + / 10% of total length + / worst 45% +
TX: Robotic assisted RP 2/2010
Pathology: pT2cNx / Gleason 3+4 / PNI+ / SM- / SV- / EPE- / Tumor vol 7% / vol 40cc / 63 Grams
PSA - post-op 0.01
Post Edited (proscapt) : 9/7/2010 10:48:43 PM (GMT-6)