exponential rise in psa

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Freepsa
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Date Joined May 2011
Total Posts : 15
   Posted 5/26/2011 4:12 PM (GMT -6)   
I had psa March 20,2011 23.44
 May 17 25.44 (free psa 2.26)
May 23 34.41(!)
Bx may24
May 25 post bx PSA 51.0 free psa 3.94
Bone scan/CRP ESR negative with "perhaps"small nodule on DRE r lobe. Intraoperative Doppler susicous 2cm mass r lobe
 
I understand that surgery is delayed after biopsy, but in a case such as mine with an exponential rise in the psa (even if the last psa post biospsy is discounted) shouldn't the surgery be performed asap. I presume the Gleeson will be at lesast 3+3 since I understand pathologist don't like to give scores lower than 3
 
Is Da Vinci an option?
 
It is my understanding that with this high a psa the tumor has metastasized regardless of the Gleeson scores and so surgery alone can not be curative
 
TIA

clocknut
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Date Joined Sep 2010
Total Posts : 2680
   Posted 5/26/2011 4:30 PM (GMT -6)   
Am I understanding that you had a PSA test the day after your biopsy? Also, that you haven't yet received the pathology report from the biopsy? I'm not sure that your questions can be answered until the biopsy results are obtained and reviewed. I also wouldn't jump to the conclusion that the tumor has gotten beyond the capsule. I'm sure others will soon be offering their opinions, but I'm not sure that there's enough information here to answer your questions until the results of the biopsy are known. Has an infection been ruled out?

I can sense your worry, and my thoughts are with you.
Age 65
Dx in June 2010.
PSA gradually rising for 3 years to 6.2
Biopsy confirmed cancer in 6 of 12 cores, all on left side
Gleason 7 (3 + 4)
Bone scan, CT scan, rib x-rays negative.
DaVinci 8/20/10
Negative margins; negative seminal vesicles
5 brothers, ages 52-67 ; I'm the only one with PCa
Continence OK after 7 weeks. ED continues.
PSA 1/3/10: 0.01

142
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Date Joined Jan 2010
Total Posts : 7084
   Posted 5/26/2011 4:34 PM (GMT -6)   
Freepsa,
 
Welcome to HW - sorry you find psa numbers that send you here.
 
On the biopsy, if you have less than a Gleason 3, they would likely report is as suspicious, or some other "maybe" term. In general, no one seems to give 2's any more. There is no reason to presume you will get a 3 just because you had a biopsy. It could come back with no cancer found in the samples taken.
 
Did they run you through a round of anti-biotics? Sometimes infections will cause high psa numbers.
 
Surgery is usually delayed after the biopsy to allow the rectum and the tissue between the rectum and the prostate to heal. My surgeon wants 6-8 weeks minimum after a 12-core biopsy, longer with more. ASAP has to be considered in context, and may be 8 weeks.
 
You would be doing yourself a disservice to assume you have metastasis. Walsh will tell you that a high psa may not be cancer, and cancer can be present with very low psa levels.
 
You will need to find a good surgeon, and a good radiation oncologist, and get opinions from both. Then find another set and get second opinions for both approaches. If you have a positive biopsy, use these 6-8 weeks wisely. Research and consultations will fill that time easily.
 
DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Freepsa
New Member


Date Joined May 2011
Total Posts : 15
   Posted 5/26/2011 4:37 PM (GMT -6)   
wIth all due respect, with a free psa ratio of 9% and 8% it can be said that all non malignant causes have been ruled out. Statistically a psa > 30 prior to treatment does not correlate with a surgical cure. I would be happy if someone can prove me wrong with the literature.

Freepsa
New Member


Date Joined May 2011
Total Posts : 15
   Posted 5/26/2011 4:44 PM (GMT -6)   
I really appreciate everyone's concern. However, I have to be realistic untill someone can show me even one case where a psa > 30 with a free psa ratio of 8% was not cancer. Furthermore psa that high suggests that there will be a recurrence after surgery alone. Since the primary tumor would be removed that implies that there are metastases that cause the recurrence

142
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Date Joined Jan 2010
Total Posts : 7084
   Posted 5/26/2011 4:59 PM (GMT -6)   
OK, I'll give you credit for considering the worst case possible, but get the biopsy results before you start planning surgery.
 
And consider that getting blood drawn for a psa the day after a biopsy is probably not going to give valid results - they will certainly be artifically elevated to some degree by the biopsy.

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 5/26/2011 5:04 PM (GMT -6)   
Freepsa,
You are correct, but there may be some rare exceptions. Depending on your Gleason grade you can estimate the tumor size as psa, gleason and volume are correlated. The PCRI web site has a tumor size calculator. Only a transition zone tumor can generate that much psa and still be contained. Tumor volume is directly correlated to extracapsular extension. You are also correct in your assumption that surgery has a low probability of being curable. Once you get your Gleason score you can go to the Partin Tables and better assess your risks. The rapid rise and high psa also are an indication of systemic spread and not just coming from a contained tumor. As soon as you get your biopsy results you should get a 2nd opinion from a medical oncologist that specializes in Prostate Cancer.
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.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 5/26/2011 5:42 PM (GMT -6)   
Freepsa- welcome and glad to see you know alot already up front, hope your pathology is decent, my was bad and badder...the good news still ok at year 9+ thus far, but took some different roads in so doing. Dx-2002 psa 46.6 12/12 biopises all 80-95% and Gleasons 7,8,9's ct and bone scan looked clear but I know there are (no warranties in PCa ever)!

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 5/26/2011 7:43 PM (GMT -6)   
FreePSA,
Keep reading while you await an active therapy. You need to heal the biopsy stuff because it will improve your chances to avoid infection during the therapy phase. Additionally, I have seen some cases where the PSA were as high as yours but they had excellent disease control with surgery. My PSA was not quite as high as yours but I am four and a half years out with advanced prostate cancer still in remission. It is true that your PSA will likely have positive margins, but PM's are not an indicator of prostate cancer specific mortality. And relapses are not either. If you need more time to decide and the PSA continues to climb at the current rate you may want to see an oncologist and consider a temporary round of hormonal therapy. If your PSA while on that round does not get back to zero or near zero then a local therapy will likely be less successful.

You have a great chance right now to get the varying opinions from your medical options. Take advantage of it. But note that no matter what they say you can likely find someone that will tell you differently ~ and both sides can be right.

Welcome to our board. Good luck in the coming days!

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3993
   Posted 5/26/2011 8:56 PM (GMT -6)   
>> If your PSA while on that round does not get back to zero or near zero then a local therapy will likely be less successful. <<<
 
Tony -- could you give me a quick explanation?  thanx.
 
ed
 

 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/26/2011 9:34 PM (GMT -6)   
Ed,
When applying HT the PSA should drop out pretty much completely. If it does not then there is a reason. When applying early HT before a primary treatment therapy it is called neo-adjuvant hormonal therapy. You can get good search results in google when searching it and also with the MSK nomograms:

www.mskcc.org/mskcc/html/10088.cfm

The issue is that there is minimal data available on prostate cancer specific survival in these nomograms. But I just plugged in Freepsa's numbers and checked the neo-adjuvant hormones in and got 10 and 15 year results showing 96% and 90% respectively on the survival stats in the pretreatment calculator. What is not defined is in what combination of treatment therapies. This can be a tough road of various therapies, including surgery with radiation or brachytherapy with radiation as primary treatment options, and various hormonal approaches at some point during these time periods. of course he could also have surgery or radiation mono-therapies and get great results altogether without a combination approach although it's less likely.

That's good news for Freepsa!

Tony

Post Edited (TC-LasVegas) : 5/26/2011 9:35:29 PM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/26/2011 9:38 PM (GMT -6)   
Freepsa,
Don't make any assumptions based on PSA or freepsa. These can only be used to estimate probabilities. There is nothing set in stone with prostate cancer. With the numbers I had back then it was more controversial then than it is today for me to have surgery. Of course I am one of a good statistics thus far. But today the available data shows I chose a good option for my case.

Some education, some luck...

If you want to search about neo-adjuvant therapy I did for you here...

www.google.com/search?client=safari&rls=en&q=neoadjuvant+therapy+prostate+cancer&ie=UTF-8&oe=UTF-8

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Post Edited (TC-LasVegas) : 5/26/2011 8:41:50 PM (GMT-6)


F8
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Date Joined Feb 2010
Total Posts : 3993
   Posted 5/26/2011 10:00 PM (GMT -6)   
>>That's good news for Freepsa!<<
 
i hear that.  thanx for the info.
 
ed

age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3742
   Posted 5/26/2011 10:59 PM (GMT -6)   
FreePSA

You have done your homework. But If you had the PSA after the biopsy, feel free to kick the doc in the nuts for me. See how much his PSA rises. Don't trust that 51.

My very first, routine PSA was 17.8. I started antibiotics and had it checked again: 22+. Then again. 23+ The Uro ordered a Free PSA but the lab could not report a number with such a high PSA. I am surprised you got one.

The Biopsy results were 7/12 up to 70% I didn't need a free PSA to tell me.
My surgery was scheduled VERY quickly -just shy of 6 weeks post biopsy.
I had daVinci surgery. At ~18 months I'm sitting here with a PSA of <0.01. I'll take those numbers. I hope you are as lucky.
Jeff
Age: 58, Mar 35 yrs, 56 dx, PSA: 4/09 17.8 6/09 23.2
Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg
DaVinci RP: 7/09, U of Roch Med Ctr
Path Rpt: Glsn 3+4, pT3aNOMx, 56g, Tumor 2.5x1.8 cm both lobes and apex
EPE present, PNI extensive, Sem Ves, Vas def clear, Lymph 0/13
Incont: 200ml/day ED: Trimix
Post Surg PSA: 10/09 .04, 4/10 .04, 7/10 <0.01, 12/10 <0.01
AdVance Sling 1/10/11 Dry

Freepsa
New Member


Date Joined May 2011
Total Posts : 15
   Posted 5/27/2011 2:24 AM (GMT -6)   
Thank u all.
Even if the post bx of 51 is ignored, who can explain psa rise of 1.5 in 2 months and then a 9 point rise in 6 days? Hard to believe that a DRE could cause that. anyone with data or references?
I am inclined against RT presurgery since it makes surgery more difficult.
The hormnonal therapy presurgery sounds like a good option
Am considering SKMCC or ColumbiaPresbyterian in NYC for second opinion.
 
Anyone have any experience with MD Anderson?

az4peaks
Regular Member


Date Joined Feb 2011
Total Posts : 112
   Posted 5/27/2011 3:31 AM (GMT -6)   
Hi FreePSA, - You are making a lot of assumptions based upon totally unreliable information. The reason you had a Biopsy is because it is the ONLY widely accepted method of diagnosing Prostate Cancer (PCa). Without it, you have no meaningful information on which to make an INFORMED treatment choice since you don't know for certain that you have PCa.

Further, if it is determined that you do have PCa, you need to know the Biopsy results to determine a clinical Gleason Score, clinical Staging and a RELIABLE PSA. FREE PSA is only approved for use with Total PSA (it must be run on the same blood sample and with assay from the same manufacturer) readings between 4 and 10 ng/ml. Some Studies have found it to be reasonably reliable down to 2 to 2.5 ng/ml Total PSA results, but to my knowledge there are not comparable Studies that have been done on elevated results that are 2 to 5 times the approved PSA range. As a result, many responsible Laboratories will not perform Free PSA tests on such extremely elevated Total PSA blood samples. - John@newPCa.org (aka) az4peaks

Freepsa
New Member


Date Joined May 2011
Total Posts : 15
   Posted 5/27/2011 3:59 AM (GMT -6)   
the free psa's were indeed run on the same day and I believe they are irrefutable evidence of PCA

Post Edited (Freepsa) : 5/27/2011 3:06:53 AM (GMT-6)


Worried Guy
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Date Joined Jul 2009
Total Posts : 3742
   Posted 5/27/2011 6:08 AM (GMT -6)   
FreePSA,
I'm not disagreeing with you. If I had to bet I'd give you 20:1 odds you have PCA. Join the club.

Sonny is going to MD Anderson early next month.
I'm betting other guys will chime in shortly.

Jeff
Age: 58, Mar 35 yrs, 56 dx, PSA: 4/09 17.8 6/09 23.2
Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg
DaVinci RP: 7/09, U of Roch Med Ctr
Path Rpt: Glsn 3+4, pT3aNOMx, 56g, Tumor 2.5x1.8 cm both lobes and apex
EPE present, PNI extensive, Sem Ves, Vas def clear, Lymph 0/13
Incont: 200ml/day ED: Trimix
Post Surg PSA: 10/09 .04, 4/10 .04, 7/10 <0.01, 12/10 <0.01
AdVance Sling 1/10/11 Dry

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 5/27/2011 6:43 AM (GMT -6)   
An elevated PSA and a correspondingly low free PSA percentage can be caused by prostatitis, which is a benign rather than a malignant condition. If prostatitis symptoms are noted and/or if expressed prostatic secretions are consistent with prostatitis, four to six weeks of Cipro® or similar antibiotic should be prescribed prior to recommending a biopsy. At the end of the Cipro therapy, a repeat PSA determination should be made. If there is significant lowering of the PSA, an element of prostatitis is likely to be present
 
This was on Dr Strums website..............I'm not suggesting that you don't have PCa, but I have read in several places that a low fpsa and a high psa is also just as likely Prostatitis.........many here suggest that a low free psa is always a sign of PCa,not true..........................Cooper  wink

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/27/2011 7:12 AM (GMT -6)   
I would bet that you have a 90% cancer of having PC at this point. But hoping you don't. This may be a fun club, but it;s membership comes at a high price
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

Freepsa
New Member


Date Joined May 2011
Total Posts : 15
   Posted 5/27/2011 9:27 AM (GMT -6)   
cooper 360:

I don't believe there is ANY instance of a PSA>30 with a free PSA of 8% which was not PCa.

But taking cipro post biopsy won't hurt since I have to take it anyway

I am hoping u can prove me wrong witrh something other than an erroneous post on someone's website. every other website I have seen totally contradicts that misinformation. That's the whole purpose of getting the freePSA

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 5/27/2011 9:55 AM (GMT -6)   
You could have prostatitus and PCa at the same time and even through in bph too.
Like mentioned the fPsa test tends to be called inaccurate at psa's above 10, but we shall see. Not alot of rules in PCa that are set in stone....except for high priced treatments (-: and even that has a few exceptions.

Freepsa
New Member


Date Joined May 2011
Total Posts : 15
   Posted 5/27/2011 10:18 AM (GMT -6)   
Facts just the facts. Show me them, otherwise these are just words.

These results are consistent with only one thing, no one has yet to show me even one exception to PSA > 30 and a free PSA ratio of 8% being anything other than PCa. I am still waiting for documentation not just someone's unsubstantiated opinion

You mean the free PSA might be 10% instead of 8%? Remember at this level a slight inaccuracy is irrelevant. Also remember these results have been repeated and are consistent.

BTW, I am ofering my extra free PSA tgo anyone who wants it, but this is a one day offer only. So act now!!!

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 5/27/2011 3:02 PM (GMT -6)   
"I am hoping u can prove me wrong with something other than an erroneous post on someone's website"........................renowned Medical Oncologist Stephen B. Strum, not just anyone and not just an erroneous website!!!!......................It looks like you've already been mishandled by a doctor who would take a psa test so soon after biopsy...........I hope the cipro takes the psa down........get a color doppler if possible.............Cooper

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/27/2011 3:57 PM (GMT -6)   
'I am still waiting for documentation not just someone's unsubstantiated opinion"

Freespa, doesn't your remark sound a bit on the rude side? Folks here are answering you the best way they can. This is not a doctor site, this is a patient to patient site.

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 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
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