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Tudpock18
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Date Joined Sep 2008
Total Posts : 4183
   Posted 4/30/2009 6:08 AM (GMT -6)   
FYI...the following is just out from Johns Hopkins.
 
Tudpock
 

In a recent article posted on the Johns Hopkins Health alerts website, Recent PSA Studies: What You Need To Know, H. Ballentine Carter, M.D., Director of Adult Urology at the Brady Urological Institute at Johns Hopkins wrote: "I think a lot of the over treatment we see has to do with using PSA as an absolute cutoff. I think PSA velocity, how fast the PSA moves over time, may be a better measure of the presence of lethal cancer." Here's some basic information about the PSA velocity test.

The PSA velocity measurement takes into account annual changes in PSA values, which rise more rapidly in men with prostate cancer than in men without the disease. A study from Johns Hopkins and the National Institute on Aging found that an increase in PSA level of more than 0.75 ng/mL per year was an early predictor of prostate cancer in men with PSA levels between 4 ng/mL and 10 ng/mL.

PSA velocity is especially helpful in detecting early cancer in men with mildly elevated PSA levels and a normal digital rectal exam. It is most useful in predicting the presence of cancer when changes in PSA are evaluated over at least one to two years. In a study reported in The New England Journal of Medicine, a rapid rise in PSA level (more than 2 ng/mL) in the year before prostate cancer diagnosis and surgical treatment predicted a higher likelihood that a man would die of his cancer over the next seven years.

Moreover, a Johns Hopkins study published in the Journal of the National Cancer Institute found that a man's PSA velocity 10-15 years before he was diagnosed with prostate cancer predicted his survival from the disease 25 years later. In the study, 92% of men with an earlier PSA velocity of 0.35 ng/mL or less per year had survived, compared with 54% of men whose PSA velocity was greater than 0.35 ng/mL.


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 5/1/09.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/30/2009 7:40 AM (GMT -6)   
Tud,

A good reminder article on the importance of PSA velocity. It scares me in my case, as over the 6 years I was getting PSA tests, it started out rising about .5 per year at first, then a full 1.0 and then between age 55 and 56, it went from 5.8 to 12.3, which is a rise of 6.5 in a year! There was never a doubt in my mind that a fairly agressive case of PC was soon to be dx. with me. It was still accelerating higher and faster in the 2 months before my surgery. So I am a big believer in the value of PSA velocity. When I read of the standard of .35 per year, I almost laugh, as I wish mine had been accelerating that "slowly". Good article for anyone new.

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
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 4/30/2009 8:29 PM (GMT -6)   
PSA velocity is extremely important, but I think that PSA doubling time may be more helpful. An increase in PSA can be caused by a number of things. If psa is doubling at a steady rate it is indicative of prostate cancer. If psa rises rapidily or jumps around, or levels off it's probably not PC.

What most doctors fail to do in calculating psa doubling time is to include the benign portion of psa. If someone has a 40cc prostate his benign psa is 2.6
(.066 per cc of volume). If total psa is 5.6 then 3.0 is related to the PC. If it goes to 7 the doubling time should be calculated on the 3 psa level rather than the 5.6.
This is also the reason that reoccurances have a higher doubling time than the original stats. There is no benign psa, only PC that is growing.
JT

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

 


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 5/1/2009 10:35 AM (GMT -6)   
So does this assume that the higher the PSA velocity, the more aggressive the cancer is?

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 5/1/2009 10:53 AM (GMT -6)   
Squirm,

Basically yes; it means that the cancer is growing quickly. If a high gleason (8,9 or 10) is still in the prostate capsule it will generate low psa. If gleason is high and psa is high it usually means it is growing somewhere else. There are nomograms where you can estimate the size of the tumor pretty accurately by pluging in the prostate volume, gleason grade and total psa. There are some exceptions as with transition zone tumors, so it is best to have an oncologist run these numbers.
JT

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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