When should the RED Flag have gone up?

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Sparrowhawk
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Date Joined Mar 2011
Total Posts : 130
   Posted 4/14/2011 10:33 AM (GMT -6)   
  When should I have been beaten about the head and shoulders by the RED Flag?
PSA levels:  1/11/05 =2.33  7/22/06 =2.19  7/24/07 =2.03  2/21/08  =2.36
                     4/30/09 =2.88  4/26/10 =2.16
  Any thing jump out, are these levels all with-in a "normal" range.  Are the fluctuations in the levels something I should have been concerned about earlier?  I've joined the club so there's no real reason to worry myself with the would have, could have, should have stuff.  Even catching the PC earlier wouldn't have made that much of a difference, right? 
  I need to get a reading a bit more current, it's been close to a year.  Now I'm wondering if there's a significant change???

31 Jan 11 "Cyst" found on prostrate during Colonoscpy.
28 Feb 11 Biopsy of Prostrate; Malignat Neoplasm of Prostrate.
Rt: 30-40% LT: 5% Gleason Score 3+4=7 Both sides.
PSA: 2.16 "Very Stable over time."
15 Mar 11 Bone and Cat Scans completed- Normal
Large Prostrate: 4.9 x 4.0 cm

Steve n Dallas
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Date Joined Mar 2008
Total Posts : 4848
   Posted 4/14/2011 10:41 AM (GMT -6)   
Don't beat yourself up. Your numbers were up and down - up and down.
 
Mine never got over 1.3 but I had nodules.
 
Have a friend that had a PSA of 12 for years - third biopsy finaly found something.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 4/14/2011 11:00 AM (GMT -6)   
No Urologist is going to wave the Red Flag with a PSA in the 2.0-3.0 range and zero PSA velocity and a normal DRE..
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

Sparrowhawk
Regular Member


Date Joined Mar 2011
Total Posts : 130
   Posted 4/14/2011 11:15 AM (GMT -6)   
Steve n Dallas, thank you for your reply. The more I read on PSA testing the more confused I get. I'm leaning on the thought that it's not a sure- proof positive- that PC is there.
31 Jan 11 "Cyst" found on prostrate during Colonoscpy.
28 Feb 11 Biopsy of Prostrate; Malignat Neoplasm of Prostrate.
Rt: 30-40% LT: 5% Gleason Score 3+4=7 Both sides.
PSA: 2.16 "Very Stable over time."
15 Mar 11 Bone and Cat Scans completed- Normal
Large Prostrate: 4.9 x 4.0 cm

Sparrowhawk
Regular Member


Date Joined Mar 2011
Total Posts : 130
   Posted 4/14/2011 11:18 AM (GMT -6)   
Fairwind, thank you for your reply. I wouldn't think it would set off an alarm either. After all the readings were in the acceptable range for normal.
I'm just finding myself in the re-think everything mode. What could I have done, what can I do, what can I tell others, etc...
31 Jan 11 "Cyst" found on prostrate during Colonoscpy.
28 Feb 11 Biopsy of Prostrate; Malignat Neoplasm of Prostrate.
Rt: 30-40% LT: 5% Gleason Score 3+4=7 Both sides.
PSA: 2.16 "Very Stable over time."
15 Mar 11 Bone and Cat Scans completed- Normal
Large Prostrate: 4.9 x 4.0 cm

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7080
   Posted 4/14/2011 11:21 AM (GMT -6)   
Walsh makes the point that you can have a very low PSA (I think most doctors still use 4 as a "normal" range - at least mine does) but have a raging cancer, or have a very high PSA yet have no cancer at all.
 
It is just one indicator. From what you described, there was no red flag in the PSA numbers, as I understand them.
 
Much like my case - first PSA test was 7.4 (out of normal range, but there are those who have numbers in the thousands). That generated a DRE, which was abnormal. The two together were my red flag, and sure enough, I had a G 4+5 and EPE.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 4/14/2011 11:33 AM (GMT -6)   
There are several urine based genetic tests that can spot PC much better than The PSA test can..For whatever reason, they have been VERY slow to reach the market and are rarely used..

I suspect, backstage, there is a big patent battle going on between the 3 or 4 very similar tests that have been announced by labs here and in the U.K.

John T
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Date Joined Nov 2008
Total Posts : 4268
   Posted 4/14/2011 11:36 AM (GMT -6)   
Sparrow,
You were lucky that it was found on a colonostomy. You had no indications that pc was lurking. Just to be on the safeside I would have your biopsy slides checked for unusual tumor markers from either Bostwick Labs or Dr Branhof in Germany. Any time psa doesn't act in a normal fashion it could be a varient variety. A large prostate with a growing G7 tumor should have a higher psa. You need a little more detective work by an experienced pathologist or medical oncologist that understand the biology of PC and it's varients.
Best of luck.
JohnT
66 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, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Herophilus
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Date Joined Sep 2009
Total Posts : 664
   Posted 4/14/2011 11:59 AM (GMT -6)   

what was your age 01/11/05...under 50?

Hero


Sparrowhawk
Regular Member


Date Joined Mar 2011
Total Posts : 130
   Posted 4/14/2011 12:25 PM (GMT -6)   
Herophilus said...

what was your age 01/11/05...under 50?

Hero

I was 44 at the time.


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7080
   Posted 4/14/2011 12:32 PM (GMT -6)   
At age 44, unless there are some significant contributing factors not mentioned, I am surprised that your doctor would even do a PSA.
My insurance would certainly not have paid for the test unless it was a special case - they start at 50.
 
 

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 4/14/2011 12:34 PM (GMT -6)   
Frankly, those PSA numbers look totally benign. No red flag whatsoever
 
Mel

Sparrowhawk
Regular Member


Date Joined Mar 2011
Total Posts : 130
   Posted 4/14/2011 1:22 PM (GMT -6)   
142 said...
At age 44, unless there are some significant contributing factors not mentioned, I am surprised that your doctor would even do a PSA.
My insurance would certainly not have paid for the test unless it was a special case - they start at 50.
 
 
  Up until the time of my being  diagnosed I was getting my health care from the Veterans Administration.  I don't know if they do PSA testing as a matter of course or what age they start it.  In my case early testing didn't seem to matter much.  I was not aware that there was an age restriction on being PSA tested.
  Possible contributing factors?  Mildly high blood pressure, high cholesterol?  No family history of PC. 
 

Sparrowhawk
Regular Member


Date Joined Mar 2011
Total Posts : 130
   Posted 4/14/2011 1:24 PM (GMT -6)   
John T said...
Sparrow,
You were lucky that it was found on a colonostomy. You had no indications that pc was lurking. Just to be on the safeside I would have your biopsy slides checked for unusual tumor markers from either Bostwick Labs or Dr Branhof in Germany. Any time psa doesn't act in a normal fashion it could be a varient variety. A large prostate with a growing G7 tumor should have a higher psa. You need a little more detective work by an experienced pathologist or medical oncologist that understand the biology of PC and it's varients.
Best of luck.
JohnT
John T, I've been thinking about what you have written.  Why would I want further biopsy testing?  Does it matter what type of PC I have?  Should I be concerned that this maybe only the start of a battle with other cancers??

Ed C. (Old67)
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Date Joined Jan 2009
Total Posts : 2460
   Posted 4/14/2011 1:27 PM (GMT -6)   
At the age of 44 my PSA was just above 1. My boys are in their low to mid 40s and their PSA is barely above 1. I think at your age our PSA should have been below 2.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18, 21 months) undetectable
Latest PSA test (2 years) <.008 ?

Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 4/14/2011 1:38 PM (GMT -6)   

I only ask because Age Adjusted PSA Norms were being considered as far back as 2004.  You can Google “age adjusted PSA… charts/norms/whatever” and depending on race and age, a PSA over 2 could have been a Red flag.  S0 at age 44 a 2.33 PSA most likely would have been under the radar, but under specific circumstances or under the management of conservative practitioners that endorsed the age adjusted model, it could have indicated the need for concern.  I do not want to open a can of worms (over treatment) but even today the medical community is not 100% in agreement on where to draw the line.  As an individual armed with the knowledge that 4.0 is normal and given a completely stable run of numbers I would (I), again I, would never had blinked an eye at those results.

I would think that it would be much more likely to be considered a significant finding in today’s climate.  

PSA…….Positive to Start an Argument

Hero


Age 51 PSA 6.8
Bxy 10 of 12 Cores positive for Gleason 6. up to 75%
Robotic surg 11-02-09
Post op path. 20% neoplasm;4+3=7 Gleason
All nodes (14) and other related tissue negative for cancer
No EPE
Post op PSA x 3, all <0.01
walkbobwithjack.blogspot.com

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/14/2011 1:40 PM (GMT -6)   
sparrow,

i agree with johnt's thinking on your numbers. at face value, your numbers look benign, but you have positive proof of a Gleason 7 case, both sides. In theory, your psa should be rising, and its not, and there are more dangerous variants out there that would produce less psa. any gleason 7 has the potential to be agressive, i am in that situation, having failed both surgry and SRT, and now seem to have a run away PSA situation. due to your unique situation, a higher level look at that biopsy would be in order, to be on the safe side. gleason 7's can also be very unpredictable, and many are treated as if they were at a higher gleason grade. if it were me, i would want that second opinion, so that you are not lulled into thinking you were safe, when perhaps you are not.

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,
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