Confused about results

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OKboy
Regular Member


Date Joined Apr 2009
Total Posts : 55
   Posted 4/23/2009 3:49 PM (GMT -7)   
Began have PSA tests at age 47. First PSA was 1.2, second PSA year later was 1.68 (urologist), third PSA nine months later was 1.5 (family doctor), fourth PSA three months later (urologist) was 1.93. According to my urologist, these results, combined with normal DRE, were all considered normal. Four months after the 1.93 PSA, I turned 50 and was scheduled by my family doc for a thorough physical exam. The nurse called with results and said that total PSA was 2.9. When I questioned the Doc about these results, he said he would resubmit the same sample to a different lab and check total PSA and % free PSA. That result came back with total PSA at 3.4 and % free PSA at 15%. I scheduled an immediate appointment with my urologist who said that his advice would be to wait a month, let everything "settle down," and then do another blood test. He also indicated to me that the % free PSA result was not really valid unless the total PSA was 4 or above. This really doesn't jive with what I've read. I have no other "prostate" symptoms. Any advice out there?

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2456
   Posted 4/23/2009 4:21 PM (GMT -7)   
OKboy,
My PSA prior to DX was 3.5 and my free PSA was 11%. My Urologist told me that with these numbers and the velocity of my PSA I had a 33% chance of having PC and immediately scheduled a biopsy.
Age: 67
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 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 2/9/09
Surgeon: Dr. Randy Fagin, Austin TX.
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Bilateral 10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
seminal vesicles clean
Lymph nodes: not dissected
1st PSA test 4/7/09 result <0.1


TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 4/23/2009 5:48 PM (GMT -7)   

OKBoy, You numbers are still in a low range though the last sample, if valid, would call attention, perhaps FOR more "wait and watch." Your doc probably wants some time to pass and to get his own numbers from the lab. Hang in there for the month but read up on the issues so you can understand what he is telling you when you get the results.

Teddyg


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 4/23/2009 6:49 PM (GMT -7)   
OKBoy, Dont be so quick to do anything. Just begin to read about Pca and also cut down on red meat, drink green tea, take VitD3, pomegranite juice, and blueberries......Watch and wait for a few months,,,,enjoy your life, have more sex, more laughs, and more fun......Check your PSA in two months.....Come back and there will be lots of people that will jump in and talk to you.....Good luck...You sound strong.....Di
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Hip replacement total success..pain gone!!
PSA .7 2/10/09


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 4/23/2009 7:05 PM (GMT -7)   
This is just my opinion... I would not jump to conclusions but not sure why he would wait a month. My PSA went from 2.8 to 3.5 and the doctor put me on 30 days of antibiotics. My PSA dropped to 2. He said great and get re-tested in 6 months. I waited about 3.5 months and the PSA was up to 3.8. I went for the biopsy and it came back positive. Like some post above state, read up and be ready....
 
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 4/23/2009 8:17 PM (GMT -7)   
I would take your doctor's advice and wait the month and then re-test, the depending on that, re-group at that time.
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
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4168
   Posted 4/24/2009 4:20 PM (GMT -7)   
OKboy,
Your PSA velocity, psa doubling time and free psa are all abnormal. These would be red flags that I would be concerned with. Urologists unfortunately just don't have the knowlege when it comes to diagosing PC except by biopsy. I spent 10 years dealing with urologists who continued to dx BPH in the face of rising psa and abnormal free psa.. Once my oncologist saw my history he immediately knew I had PC and the only question was where and how much.
I would consult with a good prostate oncologist who has the skill to evaluate you. If it walks like a duck it's probably a duck.
A slow steady rise of psa is usually indicative of PC.
Your doctor could have estimated the size of your prostate and calculated the psa it is generating. Anything more needs to be explained. Also I would request a PCA3 urine test. If your urologist didn't perform these two simple tests with your psa history and free psa I would find someone that could.
The following link should be very helpful in helping you understand psa. Dr Strum probably knows more about psa than anyone around.
http://www.prostate-cancer.org/education/preclin/StrumPogliano_EveryDocShouldKnow.html
JohnT

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 

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