Besides PSA, how can PC be monitored.

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Jerry L.
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Date Joined Feb 2010
Total Posts : 3072
   Posted 4/15/2011 7:22 AM (GMT -6)   
With a PSA of .09 and hot spot on scan, it's fairly obvious that my PSA is a bad spokesperson for my PC.

I realize scans can monitor specific areas, but is there any other ways to monitor the level of all of the PC globally?

How am I to judge if therapies are working?
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05
March, 2011 .09

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/15/2011 8:36 AM (GMT -6)   
The ultra sensitive PSA testing you have been doing, is still the best and most sensitive way of monitoring you PC activity especially, since like me, you have already used up your curative hope cards of both surgery and radiation.
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 margin
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, 4/11 3.81
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

JNF
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Date Joined Dec 2010
Total Posts : 3880
   Posted 4/15/2011 9:34 AM (GMT -6)   
As I understand, the problem is that some strains of PCa give off little, if any, PSA while others give off a lot, but from the same overall tumor load. The rare small cell strain does this as well as strains that become so differentiated that they can't be identiified as PCa.

We see situations like yours where your PSA signals little if any cancer, but you know you have it in the mets. Others have indicated relatively high PSA even above 20 with little, if any, known mets. This goes back to Zufus' theory of the PCa Twightight Zone.

There are some new blood tests that are nearly ready to be used that show the blood born cancer presence that may be an improvement for people whose PCa has stopped giving off PSA.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010, HDR Brachytherapy 12-6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.

compiler
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Date Joined Nov 2009
Total Posts : 7269
   Posted 4/15/2011 9:38 AM (GMT -6)   
That's a very good question.
 
I don't think your PSA is a good surrogate for your PC activity. I understand some strains are like that.
 
Wish I had an answer.
 
I imagine scans will show progress either good or bad on those hot spots. As long as the scans don't get worse, you are probably okay.
 
Mel

BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 4/15/2011 9:41 AM (GMT -6)   
I understand that new MRI's have been developed that can identify micro mets (I think that there is a Facility in Florida that does these scans). My medical oncologist told me that if my PSA returns after SRT, he will restage me with one of these MRIs.
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 RP March 2009
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes - tumor volume 9%, nerves spared, no negitive side effects.
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT .01, < .01

English Alf
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Date Joined Oct 2009
Total Posts : 2217
   Posted 4/15/2011 10:29 AM (GMT -6)   
Sorry if this is a stupid question.
I can understand how a PCa cell on a microscope slide can be correctly identified, but what identifies a hotspot on a bone scan as PCa related and not due to some other condition? (ie especially in a case like this where the PSA is low,)
Alf

John T
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Date Joined Nov 2008
Total Posts : 4268
   Posted 4/15/2011 11:26 AM (GMT -6)   
Alf,
Not at all a stupid question. The only thing a scan can do, any scan, is to point out an abnormality. It is up to a trained radiologist to interpret what this means. location is very important and some locations favor PC and others joint or bone injuries. Also other of the patient's stats are taken into account, for example, a low psa G6 with an abnormal bone scan to the arm is most likely nothing. A high Gleason, high psa, with a mass to the pelvic area is more than likely looking at PC mets.
JT
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.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/15/2011 11:30 AM (GMT -6)   
Other tests the leading onco-docs usually are doing:
Page 35 Dr. Strum's book 'A Primer on Prostate Cancer':

Lab tests: PAP, CGA, NSE, CEA (biomarkers for more aggressive disease)=uro docs are clueless on this stuff, they look mostly at PSA (lol)

Complete blood count (CBC)
Pyrilinks-D or other similar bone breakdown markers (urine testings for bone breakdown can be done and should be, my onco does them, this establishes know mets is the idea)

Chemistry panel that evaluates, kidney, liver, bone and electroyte status (if failing normal then clues I presume)

Other tests on Page 35 have to do with physical exam, pathology evaluations, radiology exams including Dexa (quantitative CT scan-QCT) for bone density

It is not simple PSA tests only.
Dx-2002 total urinary blockage from PCa emergency room, bPsa 46.6,
12/12 biopsies all 80-95% vol., Gleasons found 7,8,9's, scans appeared clear, ADT3 prior to Neutron & Photon radiations, DES since 2004-5.

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 4/15/2011 11:37 AM (GMT -6)   
Jerry,
 
I'll add-on to zufus' recent post on the set of tests Strum recommends for higher risk (higher Gleason) patients like yourself by providing this LINK.  This link explains the benefit and purpose of each test (PAP, CGA, CEA and NSE biomarkers).

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 4/15/2011 11:41 AM (GMT -6)   
BB-Fan That scan is by Dr. Bravo at Sand Lakes, Florida I believe it is called USPIO it is compared to the Combidex scan in Holland, but according to Dr. Strum and Dr. Barrantz (Holland), whom have seen the comparison scans (film) between the two machines technology...Dr. Strum told me in an email that it is not as good as Combidex and Barrantz concurrs on that, however it is superior it appears to any USA scan method we know of..as to picking up less amounts of PCa to be 'seen' or found. Maybe not micro mets...of course that has variance within how do you size them????

So yeah it is worth going to get in some instances.
Dx-2002 total urinary blockage from PCa emergency room, bPsa 46.6,
12/12 biopsies all 80-95% vol., Gleasons found 7,8,9's, scans appeared clear, ADT3 prior to Neutron & Photon radiations, DES since 2004-5.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 4/15/2011 1:25 PM (GMT -6)   
Zufus:
 
Interesting. Are these all blood tests?
 
I haven't read the link, but I thought some of these tests were helpful in gauging the severity/aggressiveness of the PC. I didn't know they could be used in monitoring the situation.
 
Mel

BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 4/15/2011 1:37 PM (GMT -6)   
Zufus, Thanks for the info. BB

ralfinaz
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Date Joined Jan 2011
Total Posts : 735
   Posted 4/15/2011 1:51 PM (GMT -6)   
Jerry L. said...
With a PSA of .09 and hot spot on scan, it's fairly obvious that my PSA is a bad spokesperson for my PC.

I realize scans can monitor specific areas, but is there any other ways to monitor the level of all of the PC globally?

How am I to judge if therapies are working?


Jerry,
PSA will be still the main test to monitor. Others have mention tests that indicate if the cancer has a neuroendocrine character (such PCa tumors might make little PSA while progressing). A baseline of both neuron-specific enolase (NSE) and chromogranin A (CGA) could help to avoid that situation.

Other important markers to follow are prostate acid phosphatase (PAP) and Alkaline Phosphatase (AlkP). These tests measure potential bone involvement which is a common met site.

Continue relying on PSA as your primary marker. Relying on a super-sensitive PSA test can have some benefit for surgical patients and those who had salvage therapy.

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 4/15/2011 2:02 PM (GMT -6)   
There are urine based genetic tests available that are FAR more sensitive than PSA when it comes to spotting cancer..At least one of these tests have received FDA approval (Four Gene Signature Urine Test) but there seems to be a big backstage brouhaha going on over procedures and patent rights as several very similar tests have been announced both in the U.S. and U.K.
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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