You are missing my point

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 11/20/2009 9:38 PM (GMT -6)   
First of all, I wish to thank all of you for taking the time to respond to my Bad News post. I appreciate it very much. You all correctly read the panic in my post. Frankly, I have been in a somewhat stressful state since the original PSA result from my August physical. I'm sure this is normal.
 
However, almost all of you responded to my fear of the biopsy. While true to a degree, I had actually agreed to have it done the usual way (ie: no sedation). At first I wanted the sedation, but the urologist indicated that the shot of lidocaine should be enough, coupled with the fact that it is a 5-10 minute procedure. However, when they connected me to scheduling, they had appointments for 12/18 or could overbook on 12/11 OR, IF I wanted to go the sedation route, the OR was available on 11/30. So, I chose sedation because it was the earliest available time slot. Period.
 
What has now made me panic was the extreme score of the PCA-3. The cutoff point is 35 and I hit 75.9. In the back of my mind, given my PSA numbers, I'm thinking that even if it is PC it is probably somewhat indolent or at least amenable to surgical treatment. In other words, the PSA numbers certainly didn't indicate an aggressive cancer. I realize that nothing is set in stone, but that was my thinking. But now that recent figure has really upset that apple cart! This has me greatly distressed. Of course logic tells me there is nothing I can do until the biopsy results come in.
 
Actually, and this is for Sonny, I did talk to Arleta and we are all set for me to convey the biopsy results to her if it does show PC. So, some things are in motion, as much as I could reasonably do. (For you other folks, Arleta works with Dr. Menon, who would probably be my choice if I had PC and surgery was an option).
 
Mel
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future. Just in: BAD NEWS: PCA-3 = 75.9! Cut-off is 35. Biopsy scheduled for 11/30


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 11/20/2009 10:28 PM (GMT -6)   
Mel,

My problem is I don't know what 36 or 75 means on the PCA 3 test because it is so new. We all go by the standard PSA testing. Maybe you could have a 200, I don't know.

Did your Dr. talk about results at all ?
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 11/20/2009 10:35 PM (GMT -6)   

The doctor said very little. She called and said my PCA-3 was on the high side and I need a biopsy as we had discussed previously. I had to ask what my PCA-3 score was and it took her awhile to find it. I also asked what that meant regarding the prob. of finding PC on biopsy and she said "it isn't reported that way."

 

In short, she wasn't very forthcoming. OTOH, let's face it, all this is pissing in the wind (a good metaphor for this group). But I was not pleased with her reticense. It just confirms in my mind that this is very bad news.

 

But, still, my PSA results are not (THAT) bad at all!

 

Mel


PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future. Just in: BAD NEWS: PCA-3 = 75.9! Cut-off is 35. Biopsy scheduled for 11/30


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/20/2009 11:05 PM (GMT -6)   
This may help take some of the mystery out of the PCA-3 test. I don't promote the website, but this description is very good.

www.diagnocure.com/en/products-projects/prostate-cancer/pca3-test-healthcare-practitioners.php

Mel, this is a test that can be as high as 80% in determining the presence of prostate cancer. but it does not distinguish between a dangerous cancer and one that is not life threatening (indolent). Clearly your next course of action is to obtain a biopsy result. You are likely in the very early stages if it is cancer...

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 11/20/2009 9:08:44 PM (GMT-7)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 11/21/2009 12:24 AM (GMT -6)   

Tony:

 

It appears that the PCA-3 does indicate aggressive vs. non-aggressive cancers (ie: higher scores seem to indicate more aggressive cancers -- kind of like the PSA)

 

Mel


PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future. Just in: BAD NEWS: PCA-3 = 75.9! Cut-off is 35. Biopsy scheduled for 11/30


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/21/2009 12:44 AM (GMT -6)   
When combined with a T2-erg test it has promise in indicating a more aggressive tumor. But the error margin is still pretty wide. The medical community is still searching for a test that can differentiate potentially lethal tumors from indolent ones. The brochure from PROGENSA, the maker
of the PCA3 test properly sets expectations on the what the assay can tell us.

www.tdlpathology.com/images/downloads/ProgensaPCA3_6page_screen.pdf

There is a fantastic presentation on PCA3 and the T2-erg combination in last years PCF Scientific Retreat that showed the ability to differentiate Gleason 8 and above disease with much better accuracy than a PSA test. However there still was a significant error margin. I can navigate you to that presentation if you like. It's not a direct link...The presentation was from the lead scientist working on the development of the assay.

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 11/20/2009 11:12:31 PM (GMT-7)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 11/21/2009 12:50 AM (GMT -6)   

Tony:

 

Thanks, but the link doesn't work.

 

Mel


PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future. Just in: BAD NEWS: PCA-3 = 75.9! Cut-off is 35. Biopsy scheduled for 11/30


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/21/2009 1:10 AM (GMT -6)   
Hmmm, you are right, the link is an issue. But you can go straight to it in the link below and by selecting the "PROGENSA PCA3 test" link under "For more information".

www.diagnocure.com/en/products-projects/prostate-cancer/pca3-test-healthcare-practitioners.php


Also here is the summary document from the retreat:

www.prostatecancerfoundation.org/atf/cf/{705B3273-F2EF-4EF6-A653-E15C5D8BB6B1}/PCF_State_of_Science_2008.pdf

Also if you want to watch the full presentation Dr. Jack Schalken here is where you need to look:

www.prostatecancerfoundation.org/site/c.itIWK2OSG/b.68797/k.A368/Scientific_Retreat.htm
Select "Watch the 2008 Presentations"
Click on View Sessions
Click "Next"
Click "Next" again
Select the "2008" year
Click "Titles" in the blue tabs
Scroll down to the "PCA-3 and Gene Fusion Based Diagnostics of Prostate cancer"

Very sorry for the tough navigation....I wish they would direct link these...

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 11/20/2009 11:18:06 PM (GMT-7)


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 11/21/2009 10:28 AM (GMT -6)   
You're trying to figure out if it is going to rain today based solely on the fact that the temperature is 70 degrees.

But OK, if you want to squeeze information out of these numbers that they are not designed or refined enough to give, why don't you focus on the 24% free PSA result (which is on the very good end of the gray area and certainly much, much better than mine was) rather than your PCA-3 number, which is from an experimental test that still needs much work and confirmation?

Also, you have a history of BPH/prostatitis! Factor that in. Cipro does not always knock out prostatitis. And what does prostatitis do to a PCA-3 reading? Etc., etc.

Very soon you will have the biopsy results. Hang in there!

Zen9

Post Edited (Zen9) : 11/21/2009 8:33:17 AM (GMT-7)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/21/2009 1:25 PM (GMT -6)   
Zen,
One of the unique things about PCA-3 is that it is prostate cancer specific. It is not affected by BPH or protatitis. It is specific to the RNA signature of prostate cancer cells.

But that said, it does not accurately define the grade of prostate cancer. And Mel's numbers look favorable for a good outcome.

Tony
Prostate Cancer Forum Co-Moderator


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/21/2009 1:43 PM (GMT -6)   
Still feel bad for you Mel, your brain and worries are still way out ahead of the facts that you have at hand. A biopsy is justified with what you have going on so far, not a doubt in my mind. But remember, a single biopsy doesn't always show cancer. It took 3 for me over 18 months to hit pay dirt. Someone here, thinking Brother JohnT, had a dozen or more.

Worry is bad in our world (and yes, I am as guilty as the next brother). Knowledge is power. Preached here all the time. The best knowledge is based on fact: not speculations, what ifs, or conspiracy theories.

Soon, you will have some more facts to work with. If you end up with a bonifide PC dx, and I pray you don't, then you will still have plenty of time to study and seek treatments, if any are needed. Perhaps you will be able to do the Acitive Watching thing safely.

Until you get that first biopsy done and have results and numbers, go back to doing what ever it is that turns you on and the things in life you love.

Wishing and hoping the best for you

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 11/21/2009 3:55 PM (GMT -6)   
TC-LasVegas:

My mistake. Thanks for correcting me!

compiler:

You're right - I was missing your point! I'll pass along some advice I got when they thought I had colon and prostate cancer simultaneously - try as hard as you can to take one step at a time.

Zen9

Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 11/22/2009 9:48 PM (GMT -6)   
Mel,

I can certainly relate to your panic, you're body has gone and mutinied on you and it is a scary deal.

But you are on a good and timely course to get the additional info you need to determine the next step. Take a deep breath. You are taking the actions and doing what you can do at the moment. It's tough to relax, I know. Talking it out, like you are doing here, and with others can help tame the panic beast inside.

Stay strong. We are here with you.
51 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08 -- Great MD in New Haven, CT
Negative margins, no extra-capsular involvement
One nerve spared
PSA at 0 for just over a year now.
 
 

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