I am fairly new at this having had a RP just 6 weeks ago. My PSA level was 4.5 having increased about 3 points over a 4 year period , and I had Gleason 8's and 6's in 8 capsules with prostatic tissue invasion outside the capsule. I see where other members have much higher PSA levels and less cancer. I understand the best PSA is 0.00 but what exactly determines these large increases. Is the amount of cancer on the rise or is it a combination of other circumstances such as infection, tumors or sexual activity. For instance after my first PSA test following surgery; say my PSA comes back 0.60. Three months later it is at 1.2 and six months later it is at 1.6. What does this actually indicate. Many thanks for your informed response. You guys have the best source of uplifting information to be found. Quite frankly my own DR. doesn't explain things as well as you do.
You've already gotten some excellent responses; I hope that my comments bring additional value to the big picture for you. I'm sorry I couldn't really understand your poll, but I'll comment on your posting, and add to some of the postings that followed.
First of all (adding to Goodlife and Alf's postings), the most typical scenario prior to treatment is for PSA and Gleason scores to both go up together (as in Goodlife's "simple formula") in the presence and growth of prostate cancer (above and beyond the base level of PSA a non-cancerous prostate generates given in JohnT's equation).
However, please be aware that in an atypical, smaller percentage of cases of low PSA levels may be seen in the presence of high Gleason scores and high tumor volumes (Alf's comment). Dr Patrick Walsh's book Guide to Surviving Prostate Cancer says it this way:
However, as the tumor grows, it tends to be overrun by more malignant, poorly differentiated cancer cells that have a higher Gleason score. These poorly differentiated cancer cells are different from normal prostate cells, and as a consequence, they make less PSA. In fact, these cancer cells elevate PSA less per gram of tissue than well-differentiated cancer cells--which means that as cancers grow, the PSA level doesn't go up in a directly corresponding way. That'w why PSA levels can be normal even when cancer has spread to the seminal vesicles or pelvic lymph nodes, or it can be higher than expected in men with cancer that's confiineed to the prostate. PSA levels do not accurately estimate the growth of cancer. Thus, the true meaning of a PSA level can't be interpreted without knowing the Gleason Score. [Italics added by Walsh for emphasis.]
This is understanding led scientists to develop the multi-dimensional nomograms which exist today to accurately estimate the extent of PC by correlating the combination of clinical stage, PSA and Gleason score based on the past history of thousands of men. Have you found any of the online nomograms?
Please do also be aware in advance, as An has replied, that as you look ahead to your first post-RP PSA test, there is no such thing as zero PSA in a living, breathing man...with or without a prostate. It seems intuitive, in a simple sense, that without a prostate, the PSA would be "zero". Many men get immediately worried if their post-RP result is not "zero", but if they understand that "zero PSA" (and the "zero club") is a bit of a misnomer
which sometimes causes un-due worry to newcomers, then it's not such a big deal. Here's something I previously posted in another thread which might help:
There is no such thing as zero PSA in a living, breathing man. Most men without a prostate, however, have very low levels of PSA, and in some cases they have such a low level that it is below the most sensitive PSA test's lower detection limit (LDL). The "ultra-sensitive" PSA test has a LDL of 0.01ng/mL (some lesser used ultra-sensitive PSA tests have an even lower LDL). So, <0.01 ng/mL is the test result for an ultra-sensitive PSA test which was below the lower detection limit. The "standard" PSA test, on the other hand, has a LDL of 0.1 ng/mL.
There are sources in the body besides the prostate which produce low levels of PSA, including neurovascular bundles. These sometimes produce small amounts of PSA right around the ultra-sensitive test lower detection limits, so sometimes the results jump around a little right around that low level simply because of the natural variation of the small amounts produced. Of course, if there are remaining cancer cells, they too will produce amounts of PSA which will increase over time.
The notion of "zero PSA" is somewhat of a misnomer which sometimes causes anxiety in men until they learn these facts. Low levels might be considered by some to be essentially "zero", or functionally "zero", but the threshold in one person's opinion might be different than the threshold in another person's opinion. Your example is very illustrative: is "zero" less than 0.01? less than 0.05, which is what you had heard? (this was in reference to an earlier poster's question about "what is 'zero PSA?'"; but, the point is that if you ask 3 different people (non-medical professionals) their "opinion" on the term "zero PSA" you are likely to get 3 different answers) less than 0.1? It can be a confusing term, and you won't likely hear a medical professional or an informed layperson tell you that you have "zero PSA." The best possible result is "undetectable."
So, TTaylor, back to your hypothetical
question "For instance after my first PSA test following surgery; say my PSA comes back 0.60. Three months later it is at 1.2 and six months later it is at 1.6. What does this actually indicate
."...well that would likely indicate that cancer was left behind and rapidly growing.
I hope this information adds value to your learning process. TTaylor, having high Gleasons and extension beyond the capsule, like you had, is indicative that surgery-alone might not be enough to fully cure your prostate cancer. If you don't already have one of the two "bibles" of PC, then I might recommend getting one or both. One was the Walsh book I mentioned above, and the other is A Primer on Prostate Cancer: The Empowered Patient's Guide
by Strum and Pogliano.
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