In discussion of "x trumps y" we should probably consider whether we are talking about
two pieces of data that are both prior to surgery or we are talking about
a pre-surgery statistic of PSA or Gleason compared to the post surgery pathology report.
In my case, my PSA jumped 2 ng in the 3 months just prior to surgery, however, the path report came back clean. The docs I spoke with said that although the jump in PSA is generally of concern, that the favorable pathology trumps the high pre-op PSAV.
The research Kbota found said...
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.
This research was followed up by another study which said that the high PSAV was predictive of poor pathology (EPE+, SM+ etc.) but NOT of early mortality once these pathology features were taken into account.
"Among the 852 consecutive patients in our series2 (1989 to 2002; median follow-up, 3.4 years [range, 0.4 to 14.6]) and who met the eligibility criteria of D'Amico et al., a PSA velocity of more than 2.0 ng per milliliter per year was associated with more advanced clinical and pathological stages, but not with recurrence of cancer or a reduction in overall survival. The probability of death from any cause at seven years was 7 percent (95 percent confidence interval, 5 to 9 percent) among those with a PSA velocity of 2.0 ng per milliliter per year or less and 7 percent (95 percent confidence interval, 2 to 13 percent) among those with a PSA velocity of more than 2.0 ng per milliliter per year.” Source: Bianco, Kattan, Scardino in JAMA www.nejm.org/doi/full/10.1056/NEJM200410213511723
and...Pretreatment Prostate-Speciﬁc Antigen (PSA) Velocity and Doubling Time Are Associated With Outcome but Neither
Improves Prediction of Outcome Beyond Pretreatment PSA Alone in Patients TreatedWith Radical Prostatectomy
Matthew Frank O’Brien, Angel M. Cronin, Paul A. Fearn, Brandon Smith, Jason Stasi, Bertrand Guillonneau,
Peter T. Scardino, James A. Eastham, Andrew J. Vickers, and Hans Lilja
Urology. 2007 May;69(5):931-5. Assessment of prostate-specific antigen doubling time in prediction of prostate cancer on needle biopsy. Spurgeon SE, Mongoue-Tchokote S, Collins L, Priest R, Hsieh YC, Peters LM, Beer TM, Mori M, Garzotto M. which found: "In contrast to its prognostic value after the diagnosis of prostate cancer has been established, PSA kinetics offer little to clinical decision making as predictors of cancer or high-grade cancer in men with a PSA level of 10 ng/mL or less."