Johns Hopkins on PSA and indication of possible PCa in the future

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Sonny3
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Date Joined Aug 2009
Total Posts : 2448
   Posted 4/28/2010 7:11 AM (GMT -6)   
Seems like I can't link these reports to open for others so I have to resort to cut and paste.

This study would appear to fly in the face of those learned bodies that advocate against early psa testing to establish baselines. It is also the best definition of what PSA is, and why it is, that I have found in my research on understanding PCa.

Researchers take a close look at PSA levels in men around age 50 and their findings reveal important data on the course of prostate cancer.

The prostate-specific antigen (PSA) test measures an enzyme produced almost exclusively by the glandular cells of the prostate. It is secreted during ejaculation into the prostatic ducts that empty into the urethra. PSA liquefies semen after ejaculation, promoting the release of sperm.

Normally, only very small amounts of PSA are present in the blood. But an abnormality of the prostate can disrupt the normal architecture of the gland and create an opening for PSA to pass into the bloodstream. Thus, high blood levels of PSA can indicate prostate problems, including cancer.

Now research reported in BMC Medicine (Volume 6, page 6), indicates that a man's prostate-specific antigen (PSA) level at or before age 50 can predict his risk of developing advanced prostate cancer 25 years later.

Researchers analyzed data from blood samples collected from about 21,000 men between 1974 and 1986 as part of the Malmö [Sweden] Preventive Medicine Study. By 1999, 498 of the men had developed prostate cancer. Because not all elevated PSA levels indicate a clinically relevant cancer, the researchers focused only on the risk of developing locally advanced or metastatic prostate cancer. This was defined as the presence of metastases or as clinical stage T3 or higher at the time of diagnosis. By this definition, 161 of the men had potentially life-threatening disease.

Bottom line: The researchers found that a man's PSA level around age 50 was a strong predictor of the development of advanced prostate cancer later in life. Even a modestly increased PSA level of 1.01 to 2.0 ng/mL increased the odds of developing advanced prostate cancer by several percentage points. These results suggest that PSA level in middle age might be used to determine which men need more intensive prostate cancer screening and which can be screened less frequently.

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.


Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 4/28/2010 7:15 AM (GMT -6)   
Sonny, I would believe Hopkins over the ACA any day...just proves the point that many of us have made over these past months about the importance of PSA testing.

How are you and your dear wife Lynn doing?
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


Sonny3
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Date Joined Aug 2009
Total Posts : 2448
   Posted 4/28/2010 7:29 AM (GMT -6)   
Sephie,

Thanks for asking. We are holding our own.

Lynn enjoyed our trip to Sanibel this last weekend. It was her first overnight trip in the RV and she said she now understands why so many people love the lifestyle. She is ready for more trips and told me to start the planning.

We look to be on the road as soon as my son's college baseball season ends.

The best to you and John,

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 4/28/2010 8:58 AM (GMT -6)   
Glad to hear Lynn enjoyed the RV and Sanibel...and that she's eager for the next trip.

John and I are doing just fine. His 60th birthday is coming up and we have a cruise to Bermuda planned to celebrate this milestone and to detox from this past year. Figure we've earned this one and plan on enjoying every minute of being wined and dined. Both of us have lost some weight 'cause we know we're going to come back with a few pounds of extra baggage.

Be well, dear friend...regards to Lynn from

Sephie & John
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 4/28/2010 9:45 AM (GMT -6)   
I am trying to figure out what is new about this Hopkins report. The work of Dr. Hans G. Lilja showed this years ago, including that approximately 50% of advanced prostate cancers occurred in people who had baseline PSAs within the top 10% for their age (PSA of 1.2 ng/mL or higher before age 50). Seems what JHU has done is simply some sort of re-working of the Lilja data. But maybe there's more to it and I simply don't fully understand.
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/28/2010 11:27 AM (GMT -6)   
medved said...
I am trying to figure out what is new about this Hopkins report...
 
Agreed.  No new news here.  Johns Hopkins online reports are not the place to get breaking news.
 
 
These findings certainly went into the body of knowledge which resulted in organizations like American Cancer Society recommending that men discuss PSA testing with their physicians at an early age...ACS recommends starting as early as age 40 for men with PC in direct family.
 
 
 

Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 4/28/2010 12:30 PM (GMT -6)   
It's a great reminder to those that don't believe the value in PSA testing. Thanks for sharing Sonny!
Father's Age DX 62 (now 64)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Oct. 9, 09 PSA <.01 Last Lupron Shot
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 4/28/2010 6:16 PM (GMT -6)   
Sonny, thanks for the report, as a father of three boys all in their low to mid forties I have been very aggressive in getting them to have PSA tests annually. So far, thank God, all three are under 1.0.
I'm glad you and Lynn are enjoying the RV.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
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 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 4/28/2010 9:20 PM (GMT -6)   
Am I understanding this study as saying that men who have an elevated PSA at 50 have a greater chance of an elevated PSA/PC later ?  Is this kind of just common sense ?
 
I 'm not bright enough to see the scientific breakthrough on this .
Goodlife
 
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 injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 4/28/2010 10:01 PM (GMT -6)   
Goodlife -- I dont know if it is intuitive or not, but as I noted above the Lilja data showed this years ago.  Those data are well known to people who study this disease.   There must be something new that JHU is reporting -- they presumably would not just be reporting ten year old news.  But I can't figure out what they are saying now that Lilja did not. 
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/28/2010 10:03 PM (GMT -6)   
Hey, Sonny's just reporting what he read and sharing it. No need to over analyze it to death. It will still be "news" to some of our newer brothers. Thanks for posting it Sonny.

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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in

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