Dr Catalona's most recent Quest newsletter

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 8/27/2009 10:19 AM (GMT -6)   
I thought it was a very interesting newsletter. I don't have it in front of me, but from recollection Dr Catalona was commenting on PSA cutoff points and when it's best of proceed for further diagnostics. He mentioned that when the PSA test was first introduced 4.0 was the first cutoff point for further evaluation. Overtime upon his examinations the 4.0 cutoff point was too high, 70% of the cancers could be cured, but believed that a lower threshold would catch more cancers in the earlier stages while still avoiding unnecessary biopsies.
 
The threshold was lowerd to 2.5 and upon further research found 81% of the cancers were able to be cured. Now the emphasis is age specific PSA and PSA velocity as markets and not nessarly the static number. Although overall 2.5 is still the cutoff point if there is a rise in PSA, although if your PSA is below 2.5, a yearly increase of .35 or more takes precedence. If your PSA is above your age specific PSA, then it's cause for concern too.
 
I hope I got this right, I will double check tonight.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/27/2009 12:37 PM (GMT -6)   
Squirm, I agree. I am the victim of the old school thinking of a static mark in the sand of PSA of 4.0 means you should get a biopsy. I was faithful at age 50 to start on my own getting psa's as part of my yearly exam. There has never been a known case of PC on either side of my family. My GP stayed withing the 0.0 to 4.0 for 5 years until it hit that magic number and went over 4.0. He wasn't aware at the time of the newer thinking of PSA velocity. If, and its a big if, I had a biopsy 2 years before I did, I may have been dealing with a slower gleason 6 situation instead of what I am dealiing with. Do I blame my GP of 12 years? No, he was just following established guidelines, and urology and PC isnt any specialty to his general practice.

I hope the standards have changed, it will help the next generation of men down the road. Doesn't do me any good to know that, but that's life.

David in SC
 Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


montee
Regular Member


Date Joined Mar 2007
Total Posts : 315
   Posted 8/28/2009 5:36 AM (GMT -6)   
Check my signature, same here as far as the magical 4 number, you would think all uros would be up to date on psa velosity. It doesn't stretch the imagination to order a biopsy when you see psa rising 1 point a year.
diagnosed sept 2006 @ 54 years old, live in Georgia, gleason 3+4=7, (r) lobe only

psa 4.7 (psa rose 1 point per year for 3 years, urologist said still under 4 and no concern. If I can find out about PSA velocity, why didn't he know!)

Told not to have surgery at Dana Farber as cancer had already penetrated prostate, in seminal vesicles, would have positive margins. Would only treat with radiation and HT

RP Emory Atlanta December 2006. Path-negative margin, negative lymph nodes, negative SV, both Lobes involved, 40% gland involved
multifocal perineural invasion, Gleason 3+4=7

1st psa April 2007-<0.04, 6 mos-<0.04, 9 mos <0.04, 1yr <0.04, 21 mos <0.04, 2 yr 0.04 (rising?) 26 mos-0.05, 27 mos-0.04, 29 mos 0.06


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 377
   Posted 8/28/2009 11:38 PM (GMT -6)   
I guess you guys above are on the mark on this issue. My urologist of 17 years said I had to get a biopsy after PSA went from 1.9 to 2.85 in one year. I felt he was being paranoid, but what do I know? Second biopsy found the cancer. He didn't do deVinci, only open and he saw 20 people/day, jammed them all into an 8 hour day. I didn't feel he would really try to save my nerves when it came down to it. I went to a robotic surgeon for a better outcome, hopefully. Nonetheless, I should thank him for his persistance about getting biopsies. Sometimes in life it seems that you just fall luckily or unluckily into situations like this. I'm sure he's pissed I went somewhere else for surgery but he did find the cancer in the first place. Thanks to him for sure....
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 on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 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,
3 0's in a row now, 10 months out
Incontinence gone in early December '08,
ED remains,  still taking daily viagra for penile rehab, uro said try oral meds and then trimix for sex only now, Peyronie's Disease a problem now


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 8/29/2009 12:23 AM (GMT -6)   
I checked tonight. Catalona says PSA by age as (median):
40's = .7
50's = .9
60's = 1.3
70's = 1.7
 
If a man's PSA is above the median, his risk of prostate cancer increases. If it's below, his risk is very low.

Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2366
   Posted 8/29/2009 1:27 AM (GMT -6)   
As I understand the changing standards for prostate cancer screening and follow-up, PSA velocity carries more weight than the absolute number. 
 
 
PSA quadrupled in 1 yr (0.6 to 2.5)  
DRE negative  1 of 12 biopsies positive (< 5%) 
Open surgery June 2006 at age 57
Organ-confined to one small area, Gleason 5   
PSA's undetectable  < 0.1  


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/29/2009 9:52 AM (GMT -6)   
Squirm thanks for printing the age related chart. That was part of my problem. My first PSA at age 50 was already over 2.0, don't remember the exact number. And each year, it moved up .5 to 1.0 in size, then at age 55, it hit a little over 4.0, then the GP sent me to my current uro/surgeon, A negative biopsy and a year later, it had nearly tripled, 2 back to back biopsies, then pay dirt, and the PSA was in full "Need for Speed Mode". In my opinion, at age 50, further investigation should have been done or suggested, but again, my GP, long term with me, simply looked at the paper with the blood work analysis, and as long as it was under 4.0, guess it never occured to him to do or suggest anything to me, and in those days, never ever once thought about a prostate, wasn't even sure where it was located or what it did, plus I was young at 50, not some old man with prostate problems. Little did I know.

Tim, thanks for your point. Yes, psa velocity both before and after primarty treatment for PC is more of an indicator of long term prognosis for men with PC, more so sometimes than someone with a higher staging or even gleason number. The velocity is a better indicator of actual agressiveness, both my uro and rad. oncologists agreed on that point. The psa number is not as important by it self, as much as how fast it got there, and is it still increasing rapidly.

I could be wrong, but knowing what I know now, I don't feel like I have a good long term prognosis. True to the nature of the psa velocity theorists, I already have evidence of reaccurance despite a good surgery. And if the theory follows through, if I do salvage radiation, at best, it will slow down the velocity a bit until it regroups on the other side. I wish someone or something could prove me wrong on this theory, but even my own doctors seem to think its on a "bent to hell" path ultimately.

My wife and I are really spending a lot of time discussing options and choices, quality of life issues, etc. What's better? Five or so years of pretty normal life together and put the cancer out of mind, or 10 years or so of always being a patient to one degree or the other, and constantly have PC on the front burner in our lives, and especially on my mind.

Just sharing some thoughts, I am sure many of you do the same thing from time to time. Not a question of giving up and doing nothing, but as a person of extreme logic and having spent a life of living in the world of stats, percentages and numbers, I am not real good at faking myself into believing something that I don't feel is possible.

Hopefully for the next generation, there will be better testing, earlier testing, lower psa standards, new drugs, and an accurate way to distinguis the difference between a slow moving pc that really requires nothing, and those that are on the move all the time, despite appearent "good" numbers. Might not help some of us, but be nice to think it could help our pc brothers in the future, or even our own sons, I have two myself and I am already worried sick for them. The older one ,age 32, promised to get a baseline psa at 35, so only 3 years from now, and my youngest 26, said he would do the same thing. That's all I can ask of them.

Sorry for the rambling, been deep in thought the past day or so.

David in SC
 Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 8/29/2009 10:24 AM (GMT -6)   
Everything said makes sense to me.

It just makes me very concerned that in the last two years medical professionals have released articles saying that regular PSAs cause men too much worry and the resultant treatment is not that effective.

I think those professionals and analysts are looking at the data incorrectly. When you have cure rates of 70% or 80% as stated here for early detection and treatment, that sounds pretty good to me! I believe that starting tests earlier (a younger age) to get baseline PSAs will really help.

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 8/29/2009 11:12 AM (GMT -6)   
David,
Does prostate cancer run in your family?

Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 8/29/2009 11:16 AM (GMT -6)   
David,
Salvage radiation can cure a local recurrence.
 
"accurate way to distinguis the difference between a slow moving pc that really requires nothing, and those that are on the move all the time, despite appearent "good" numbers."
 
That would be the holy grail. 

Post Edited (Squirm) : 8/29/2009 10:20:03 AM (GMT-6)


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 8/29/2009 11:22 AM (GMT -6)   
IdahoSurvivor said...
Everything said makes sense to me.

It just makes me very concerned that in the last two years medical professionals have released articles saying that regular PSAs cause men too much worry and the resultant treatment is not that effective.

I think those professionals and analysts are looking at the data incorrectly. When you have cure rates of 70% or 80% as stated here for early detection and treatment, that sounds pretty good to me! I believe that starting tests earlier (a younger age) to get baseline PSAs will really help.

Barry

That's a good point. I look at it as, if a man with untreated prostate cancer was to live long enough, at some point it will kill him.
 
At least we have PSA and PCA3 tests now.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/29/2009 3:46 PM (GMT -6)   
By far the best article I have seen on this subject is "What Every Doctor that Treats Male Patients Should Know by Stephen Strum. If doctors followed this there would be a huge difference in detecting PC.
http://www.prostate-cancer.org/education/preclin/StrumPogliano_EveryDocShouldKnow.html

JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

New Topic Post Reply Printable Version
Forum Information
Currently it is Tuesday, September 25, 2018 11:41 AM (GMT -6)
There are a total of 3,006,455 posts in 329,340 threads.
View Active Threads


Who's Online
This forum has 161835 registered members. Please welcome our newest member, scattycatty.
340 Guest(s), 12 Registered Member(s) are currently online.  Details
HeartsinPain, mattamx, mauricesr, LorrieL., Anitas, Admin, Bob in Elkridge, Jay79, SharonZ, CCinPA, ldog, Kay Tee