psadt in miniscular levels of psa?

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logoslidat
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Date Joined Sep 2009
Total Posts : 6079
   Posted 4/11/2011 12:59 AM (GMT -6)   
Do we know for a fact that psadt, determined by very low levels of psa will hold true to the 40 points of doubling, I read from a John T post, it takes to kill you. I mean isn't it possible that the fast doubling time could be from the cells that are killed off and the refractory ones are slower. I mean we make all these decisions using studies, statistics, forum advice, ad infinitum and at certain points they be come "Gospel " but only in certain instances, Usu ally to prove a point in a discussion or worse. Since my diagnosis, I,ve been told you have all the time you need, take it slow when determining treatment, this is tru even at higher gleasons. But with a recurrence hurry up get the srt as soon as possible , the sooner the better. Same with HT, do it be fore it metastasizes, so as to increase the time to metastazation. I realize that ther are studies that push us this way and that. Imo We are individually the captains of our fate, subject to the laws of physics, known laws and those laws not known now but they will be. It will be The Snuffy Meyers, and Milkins that will make these breakthru's. I was watching a movie called Soo, recently and one of the characters said with every ounce of hhis being that he will die when He is ready. Isn't this a worthy goal to say this and believe it. What else do we have to do or think. I glean what I can from this forum, doctors, my personal beliefs etc and then try to tie it all together to promote what I believe is right for me and my loved ones. Anyway down from the soapbox, the thread really deals with the firs sentence. If we think that we have no control over this disease except what others have given us, whats the point!!
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 4/11/2011 6:12 AM (GMT -6)   
Don't have an answer on the PSADT. I hope the answer is no. My PSA went from .07 to .50 in two months. I love Milkin's quote when confronted with his plan to treat is PCa through strict low fat diet -"I don't have the time to wait until it is absolutely proven thatdiet effects PCa". Something like that. Clearly he was note going to let others dictate how long he would live.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 4/11/2011 6:20 AM (GMT -6)   
The more you find out on PCa, the more you we see there are alot half way decent generalizations, but there are enough exclusions and exceptions to the rules...that you cannot define this easily. The rate of progression or change depends more on the genetic factors, ploidy types, variant types....that can even trump Gleason score values. Patients with identical Gleason scores and even volumes of PCa...can have very different results and longevity even, this is written about even in Paact Newsletter recently 'Molecular Pathology' by Dr. Doug Chinn...photos with stains shown along with the commentaries. His conclusion is the disease is more individualized than you might realize. There are many genetic factors that could have caused your PCa...they can now identify alot of them, not all of them yet....some of those Dr. Bonkhoff/Dr. Strum have targeted therapies upon treatments for certain genetic risks or issues and have started the paved road towards this new vista in conquering PCa and they were doing so years ago...ahead of the curve.
 
You can read his info on line at www.paactusa.org   go to pages 9-10-11 for the Chinn article. The whole newsletter is better than ever.  Dr. Bahn has a new guideline for doing Active Survelliance and it is very complete and you probably never knew all the parameters he would say is righteous for A.S.  (worth reading).
 
Logo- there are cases of PCa with no doubling times or small increases and yet could even have mets happening, some PCa's (rarer versions) may not give off much Psa to measure. This is why a wise onco-doc should monitor the patient, other marker tests can catch things the Psa alone can miss.

Post Edited (zufus) : 4/11/2011 5:30:30 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/11/2011 8:37 AM (GMT -6)   
zufus - good post and answer. i think a lot men get frustrated with PC in general, because of all the exceptions, the odd man out cases, the endless variables, the constant division among experts on treatment, etc. many men, and i see some of this in action every day here at HW, feel they have the control, or the need to control - their own PC journeys and even there own fate with cancer. Just doesn't work that way, we don't always have the ability to control a fickled and some times raging enemy like PC. It's not a question of mind over matter, its a question of medical history, personal genetics and DNA and lots of other things. You see it here all the time at HW, 2 guys with virtual identical data, and one reacts one way - to the positive, and the other reacts bizzarely different.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 4/11/2011 9:18 AM (GMT -6)   
logoslidat,

Doubling time calculated with only very small PSA test results will have a large margin of error and be unreliable.

While there is no universal standard for PSADT calculation, several "practical rules" have been published. These include:
* threshold values for initiating PSADT calculation, especially in cases of PSA relapse after RP; low values are unreliable and can vary the final calculation widely  (for example, the free online MSK PSADT tool LINK accepts only values above 0.1 ng/mL)
* use measurements taken at least 3-weeks apart, and/or at least 15% different than prior values
* use same lab & same assay
 
 
 
 
 
 
edit:  added LINK

Post Edited (Casey59) : 4/11/2011 8:31:13 AM (GMT-6)


logoslidat
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Date Joined Sep 2009
Total Posts : 6079
   Posted 4/11/2011 11:21 AM (GMT -6)   
Casey59 ,zufus, BB, Purgatory, thanks for the responses they are in fact, much appreciated. David , I respectfully disagree with one of your points. Of course I want to be in control of my body and what it does and what happens to it. Thats why when I wake up and my body{ matter] says stay in bed, my mind over rides it and dictates to the body what the mind wants to do. IMO this is a good thing. And when Im 90 or so and suffering the SE's of a long life, I will be using, those rubber bands to keep this control in tact. Where would we be without this self-control. I realize that I could get eaten by a shark this morning when I go surfing, but that possibility in no way, in my mind, and thats the only one that matters. Again don't you love words and the play they represent at times. Er, as I was saying no way
does that change the veracity of never accepting matter as my master. Dont you ever wonder when you see nomograms that show a gleason10 with only a 5% chance of making it to 10 years, who those 5% are and what are they doing or not doing to still be alive. I,m sorry , I refuse to believe life is a crap shoot. All the things you mentioned, have a huge role in outcome, but by jiminy, there is more to it than that. Im one who who believes that believing is seeing, not the obverse. Much Aloha to all of youse and yours. Logo
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 4/11/2011 3:47 PM (GMT -6)   
Logo,

Don't know if you saw my post last week, but I have been watching my PSA slide from <..01 to .03. I went to one the nomogram authors at Cleveland Clinic. He didn't give rip about doubling time, bur how long after surgery I had stayed BCR free. According to him, .06 is his warning bell, so we will see in 3 months if I sound the gong or not.

He went to his nomogram and pointed out to me that .03 at 2 years gave me 65 % chance at a cure rate. So, I have put SRT on hold for another few months.

Goodlife

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 4/11/2011 4:35 PM (GMT -6)   
Goodlife that's the first I've heard of .06 as BCR. I thought it was .1, with SRT begun at around .2 or .3. Is your doctor rounding .06 up to .1? Guess it doesn't matter with a standard single digit PSA, since the lab would probably report at .06 as .1
Age: 66
Pre-surgery PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Post-surgery PSA one year of zeros.
Continent right away.
Viagra and other pills only gave me headache
Trimix working great!

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 4/11/2011 5:16 PM (GMT -6)   
Reachout, actually Sloan kettering center considers .05 as recurrence, those are the guys with the nomagrams, which I'm sure use .05. So if you like those MSK nomagrams, and who doesn't, i guess you have to like there BCR #, I Don't. The American Cancer society uses 3 consecutive .2's as there trigger, I like that. But if the psa is rising it is rising, just not sure that we have to rush into anything, guess thats why I do the std psa, its also my surgeons choice, Not sure if hawaii has ultra, it must, its got every ting else. goodlife,couldn't that be "noise ", whatever that means . I seen the term all the time re. ultra tests
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 4/11/2011 7:22 PM (GMT -6)   
Well, I've been under .1 for 18 months but once a year I go for a VA physical and they use a three digit PSA. Last year I was under .014, their limit, and tomorrow I get the new number. .2 is a lot less worry than .05, so I'll soon know if I make the MSK threshold.
Age: 66
Pre-surgery PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Post-surgery PSA one year of zeros.
Continent right away.
Viagra and other pills only gave me headache
Trimix working great!

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 4/11/2011 10:16 PM (GMT -6)   
Roche Labs, the maker of the electochemicaluminesence PSA test also prints .05 on the hard copy of test report as abnormal.

My doctor from Cleveland Clinic was a developer of the MSK nomograms.

Goodlife
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
15 month PSA <.01

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/12/2011 11:03 AM (GMT -6)   
logoslidat said...
Reachout, actually Sloan kettering center considers .05 as recurrence...
 
logoslidat, would you please provide a link to the MSK nomogram site which says this?
 
If I could politely say so, I think that we might have a slight terminology mix-up...    My hunch is that MSK is not saying 0.05ng/mL is their threshold for declaring biochemical recurrence, because that would be an unusually low level for BCR...much lower than the American Urological Association level which has defined BCR this way (LINK, see page 38):

"The AUA defines biochemical recurrence as an initial PSA value 0.2 ng/mL followed by a subsequent confirmatory PSA value 0.2 ng/mL."

What appears more likely to me is that MSK has set some sort of watch-point at 0.05 ng/mL, but if you can provide the link we can clear this up easily, I'm sure.  I looked on the MSA nomogram site, and could not find anything indicating your comment above.
 
thanks
 

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 4/12/2011 3:22 PM (GMT -6)   
Longo,
The 40 doubling times is a rule of thumb for all cancers. The start point is a single cell and the end point is where the cancer affects the organs and shuts the body down.
PSAD is not useful in very low numbers, but in most cases does give a good approximation of how fast the cancer is growing. There are many exceptions, especially with varients that don't generate any psa.
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.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 4/12/2011 7:37 PM (GMT -6)   
Casey59, To be honest , I don't even know how to do a link. But I do read alot about PCA and well not very organized, I normally preface information that I,m not sure of with I think or something to that effect. I guess the reason I didn,t this time is that in a few different posts in the last weeks, Iv,e mentioned this point with the I thinks etc. I recieved no definitive answers, and I ass u med, that this was std information. I "think" that answers the unasked question of my intent. I have always thought you were polite any time, so when you prefaced it with the word polite, a flag arose in my mind, probably wrongly, that there was this unasked question. Any way to the main point. That number has been rolling around my mind for a long time in connection with MSK, cause ther'e a big deal and that is so low, so it concerned me that maybe I should do an ultra. Ok , I know , along time coming, but am 90% sure I read it in peter scardinos book. If he isn't from MSK, I'm doomed. Im pretty sure on this but am going to town today and will find the book at borders, if they still have it , going out of business sale is on. Thats the best I can do at this juncture. In the future, unless I am sure that it is " common " knowledge I will qualify it as I normally do. I,m really curious at this point. Thanks and if some one diffenitively know , help us out. My wife says I'm over analytical , I'll get back to that after I.......
















































that answers the unasked question of intent
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 4/12/2011 7:38 PM (GMT -6)   
Have no idea what happened there!
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 4/12/2011 7:40 PM (GMT -6)   
John T thanks for that, thats actually some what encouraging for an older guy. you know anything about this .05 thing
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 4/12/2011 8:16 PM (GMT -6)   
Well, today I found out I'm at .05 and it's getting me depressed. I was at <.014 a year ago and had three other <.1 readings but now it looks like something is growing again.
Age: 66
Pre-surgery PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Post-surgery PSA one year of zeros.
Continent right away.
Viagra and other pills only gave me headache
Trimix working great!

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 4/12/2011 10:59 PM (GMT -6)   
Ok here it is, I was wrong and apolgise for any negative effects it has or may have. Page394 big paperback Dr Scardino 2nd paragraph, .05 is referred to as MSK 's lab"s threshold of detectability. Somehow in my mind the dedectability threshold, the point at which, their lab will detect psa , became BCR. BCR I 'think" is a # agreed to by whomever to say that the cancer has returned. Detectability threshold is a# that definitively says there is psa in the blood at least at that #. PSA= Prostate specific antigen, not prostate cancer specific antigen. A side note, as I was reading this, a few pages on, Dr. Scardino mentions that a study said that 1/2 of men who reach the "basic " std of .2 for BCR, in fact never went on to a full BCR. Now that's encouraging. I probably won't ask for his reference, lol.

Whew, I stay tired awready!!
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 4/13/2011 7:02 AM (GMT -6)   
logo, thanks for the clarification. So I don't have BCR yet, I have a derectable PSA. I think that's what my doctor said also. Still, as your doc said, it's a red flag I need to watch.
Age: 66
Pre-surgery PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Post-surgery PSA one year of zeros.
Continent right away.
Viagra and other pills only gave me headache
Trimix working great!

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/13/2011 10:20 AM (GMT -6)   
Thanks, logoslidat, for the update/correction.

The 0.2 ng/mL is fairly universal for defining BCR (although it it not 100.0% universal).

Your point that many reach 0.2 and never progress to full recurrence is also worth re-stating...

No hidden intent in my use of the word "polite"; just wanted to be sure I left the door open to the possibility that I, too, could have been wrong.

best wishes...
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