PSA - What in a Number?

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K2
Regular Member


Date Joined Feb 2011
Total Posts : 51
   Posted 2/17/2011 9:09 AM (GMT -6)   

PSA prognosis outcome probability distributions are usually listed as PSA  < 4, PSA <10, PSA >10, sometimes PSA >20  - Yes, of course the g-score is extremely important (I have not yet had a biopsy).

 

Being that PSA is reported with such sensitivity (.01 increments) every PSA whole digit would appear statistically significant for prognosis outcome i.e., PSA 9.5 vs. PSA 10.5. - But then again PSA appears to be fickled at times - low PSA - High Gleason (7s , 8 or 9) - or - High PSA - Low Gleason (3 + 3) but these casses appear to be outliers.

 

I centaintly like the 4 < PSA <10 stats MUCH better and I'm only 2.76 PSA  away from 10 (my PSA is 12.76). But perhaps close only counts with horseshoes and handgrenades?

 

The NCCN uses a three component matrix: Stage, Gleason and PSA for risk - see below.  But PSA does appears to be indicative of statistical outcomes of Stage and Gleason. The higher the PSA the worse Gleason stastically - and being statistics they always allow for exceptions as mention above. But they're just that - exceptions.

 

I haven't seen ANY posts of PSA >10 and Gleason 3 + 3

 

In post treated patients .01 PSA changes appear to be important to many esp. if trending

 

The NCCN Breaks Risk Down Like This:

Very Low:
- Stage T1C; AND
- Gleason score <6; AND
- PSA <10; AND
- Fewer than three biopsy cores positive, <50 percent cancer in each core; AND
- PSA density <0.15.

Low:
- Stage T1 to T2a; AND
- Gleason score <6; AND
- PSA <10.

Intermediate:

- Stage T2b to T2c; OR
- Gleason score 7; OR
- PSA 10-20.

High:
- T3a; OR
- Gleason score 8-10; OR
- PSA >20.

 

 

Any thoughts?

 

K2

PSA 12.76 / DRE Abnormal

Appt Sch w/ local Urologist

Looking into City of Hope Cancer Center

 

 

 


Highwayman
Regular Member


Date Joined Sep 2010
Total Posts : 148
   Posted 2/17/2011 11:07 AM (GMT -6)   
K2,
I had been watching my PSA for years and when it went >10 is when I pulled the plug and the doc pulled my prostate. PSA is <.1 now. And my GG was 3+3.
I hope you caught this just in time. Well what I really hope is you have a case of prostititus or something benign, but you know what I mean. Good luck with your journey.
Mike
Age 48 w/diagnosed
10/06 PSA 3.0
11/06 PSA FREE %13.2
10/07 PSA 3.4
12/07 Biopsy-neg
1/09 PSA 4.6
6/09 psa 5.8
2/10 psa 8.7
7/10 PSA 10.8
8/2010 3rd biopsy GG 3+3=6, one of eight cores -2%
Lap 10/22/10 Dr. Troxel
Path- Neg Margins, Gleason 6, Nerves spared, 85 gm
Jan 20, 1 pad/day psa < 0.1, ed an issue

axle
Regular Member


Date Joined Feb 2011
Total Posts : 35
   Posted 2/17/2011 11:12 AM (GMT -6)   

Although there are many similarities between individuals that have PCa, everyone is different.  Determining an individual's risk of how severe PCa is based upon PSA values or other indicators is really just a statistical indicator created from past studies and historical experience.  Any one individual can fall outside the highest odds situation.

Based upon my personal experience, one needs to cross their own bridges when they get to them.  In other words, since you have the initial indicators that you MAY have PCa, your next bridge is to get the biopsy.  The results of the biopsy will give you another bridge to cross.

Each step of the way provides you the information you need to get to the next step.

The initial indicator that triggered my biopsy was an abnormal DRE.  The biopsy revealed PCa and thus my next step was to choose a treatment. 
 
Since having da Vinci RP, my pathology report revealed pT3b stage.  But since I am only 3 weeks out from surgery I am unsure of what my next bridge may be (if any).  I will cross it when I get to it.  Meanwhile I will get the information I need to see if there are any more bridges in my future. 
 
It is true that the statistical information that assesses the odds of a certain level of risk is interesting, but it is only a part of the information you need to proceed down your individual path.
 
 
Age 58; da Vinci prostatectomy on 1/26/2011
PSA History: 10/2005 = 1.7; 10/2007 = 2.8; 10/2009 = 3.6; 10/2010 = 4.9
Abnormal DRE in 2009; Increasingly abnormal DRE in 2010
Biopsy on 11/23/2010: GS = 3+4 (right side) with 4 of 6 cores positive @ 40%.
Post-OP pathology: GS=3+4; tumor = 35%; pT3b; R. seminal vesicle invasion; Extraprostatic extension into the R. bladder neck; margins uninvolved

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/17/2011 11:30 AM (GMT -6)   
K2....PSA is NOT cancer specific. An elevated PSA doesn't always mean cancer. Thus using just a PSA number alone, there is absolutely no way to determine risk stratifaction. The use of PSA is just ONE of the indicators to plan treatment if needed. A fellow member here that also has his own website ran PSA blood tests for 30 straight days to prove a point. His PSA bounced all over the board. Every day was a different number and not just in in tenths, actually several points difference.

Keep reading and good luck on the biopsy.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months
Clinical Trial - SRT begins 2/21/11

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 2/17/2011 1:13 PM (GMT -6)   
Pre treatment psa is not very specific to less than one whole number. PSA after treatment is specific to .1 as there is no prostate to create psa leaving only prostate cancer cells to generate psa.
PSA is additive' the benigh psa from an entact prostate registures .660 of psa for over cc of prostate tissue and can be affected by infection. There are standard formulas for psa generated by prostate cancer using the size of the tumor and the gleason grade. Higher grades of gleason create less psa. You can find these formulas on the PCRI web site or in Dr Strum''s book "Primer on Prostate Cancer."
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 2/17/2011 9:48 PM (GMT -6)   
K2,

My pre-biopsy PSA was 10.7 and biopsy Gleason 3+3
65 Dx June-2010 PSA: 10.7, biopsy: Adenocarcinoma, 1 core Gleason 6, 3 cores atypia; Clinical stage T2; CT, Bone Scan, MRI all negative

8-23-10 Robotic RP; Pathology: Negative margins; Lymph nodes, Seminal Vesicle clear; PNI present; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason 4+. Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 no incontinence, no ED. 1/2011 PSA: <.1

kbota
Regular Member


Date Joined Aug 2010
Total Posts : 487
   Posted 2/17/2011 9:56 PM (GMT -6)   
and my pre-biopsy psa was 2.9 and biopsy gleason 4+5
Age 57 at Dx
5/09 PSA 2.26
6/2010 PSA 3.07 FPSA 18% DRE +
Biopsy, 7 of 18+, >60%, 4+5=9
7/21/2010 - RRP
Nodes neg, Ves neg
tumor contained, still 4+5=9
pni ext.
9/3, 2010 PSA - 0.04
9/3/2010, I'm 99% continent
10/14/10, PSA still 0.04, and lupron #1, now 99.9% continent
Total ED, 3 caverject failed
10/20/10 OD'd .5cc trimix, after 3hrs, neo synephrine shot
tried .15 & .17 cc neg, next .2

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 2/18/2011 1:02 AM (GMT -6)   
Stop worrying about things you can not do anything about..PSA is always changing, it means different things in different people..You are not 10,000 people, you are one person..As a crystal ball for one person it's almost useless for looking into the future..Wait until you have all your cards before you start placing bets...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0
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