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Medical Forum / Diseases and Disorders / Prostate Cancer / June 2005PSA Rollercoaster Ride
PSA 8/2003 = 1.24 PSA 10/2004 = 12.4 PSA 11/2004 = 15.7 LRP 1/24/2005. Cancer confirmed and confined, 2 tumors, Gleason 5, cure prognosis excellent. PSA 4/24/2005 = 0.24 scheduled EBRT to begin 5/31/2005. scheduled another PSA for 5/25. PSA came back as <0.1 Nobody knows why. Postponed EBRT. Scheduled another PSA for 6/14. PSA came back as 0.12 Not sure what to do and am all ears (and PSA)! Of course I'll talk to the urologist and oncologist. I'm concerned about not taking immediate action mostly because of my 2003/2004 PSA readings. IMHO an order of magnitude jump indicates an aggressive strain. Anybody out there versed in PSA acceleration statistics and indications? Up and down, up and down. Hard to keep a good attitude. Hi Pops...My thoughts are to begin ultrasensitive testing, and hold until a rising pattern appears, if one ever does. Maybe you could bounce that off your doc, if it makes sense to you. It appears that your most recent PSA tests are bouncing around 0.1. An ultrasensitive test will give you better visiblity to what's occurring in this region, than the standard test. Two things to keep in mind, 1) PSA varies quite a bit over the course of a month, so some PSA variation is normal when PSA can be measured, and 2) the study below suggests that about 9% of the men who recur after surgery do not show PSA or clinical progression. Hang in there!..Best wishes and good health, Ron Urology 2003 Feb;61(2):380-5 Biochemical recurrence without PSA progression characterizes a subset of patients after radical prostatectomy. Prostate-specific antigen. Shinghal R, Yemoto C, McNeal JE, Brooks JD Department of Urology, Stanford University Medical Center, Stanford, California 94305-5118, USA. OBJECTIVES: To characterize a subset of patients with biochemical recurrence after radical prostatectomy but with little, if any, subsequent rise in serum prostate-specific antigen (PSA) and no clinical progression during long-term follow-up. METHODS: Of a series of 600 patients, 158 with biochemical recurrence after radical prostatectomy were examined. We identified a subset with measurable serum PSA levels during long-term follow-up, but with very low PSA velocity and no clinical recurrence. Serum PSA was measured with the ultrasensitive TOSOH assay with a PSA recurrence defined as a serum PSA of 0.07 ng/mL or greater. RESULTS: We identified 14 patients (8.8% of biochemical recurrences) with a detectable serum PSA level after radical prostatectomy yet without clinical or PSA progression at a mean follow-up after radical prostatectomy of 10.3 years. The mean time to PSA recurrence was 5.8 years, and the mean PSA velocity after recurrence was 0.028 ng/mL/yr. No clinical or pathologic features were found that could be used to identify this subset of patients. CONCLUSIONS: A subset of patients with biochemical recurrence after radical prostatectomy will not exhibit a progressive rise in serum PSA or clinical progression at 10 years follow-up. This suggests that serum PSA kinetics should be observed after biochemical recurrence before adjuvant hormonal therapy or radiotherapy. Ron Thanks for the info! I guess it boils down, in my stupid head, to two questions. 1) Does measureable recurrent PSA mean there are cancer cells remaining (e.g. I still have cancer) or is it just that prostate cells are present and may or may not be cancerous? 2) Is my understanding correct that EBRT has a cure potential while hormone thearpy simply slows down the growth? My point is that if it is certain that I still have cancer (no matter how little) and if there is a cure potential, then I will not hesistate to take that path unless the therapy invollved incurs higher risks than watchful waiting. Hi Pops...I've been away for a few days, my answers are posted below...Best wishes and good health, Ron > Ron > Thanks for the info! [quoted text clipped - 4 lines] > (e.g. I still have cancer) or is it just that prostate cells are > present and may or may not be cancerous? The latter is correct (prostate cells are present and may or may not be cancerous). > 2) Is my understanding correct that EBRT has a cure potential while > hormone thearpy simply slows down the growth? EBRT has a cure potential if the PCa is still localized in the prostate area. HT does kill prostate cancer cells. There is some evidence suggesting that if started early enough (e.g. before the immune system is overwhelmed and before hormonal balance is lost) HT may be curative. I have not seen any evidence that HT can be curative upon recurrence. > My point is that if it is certain that I still have cancer (no matter > how little) and if there is a cure potential, then I will not hesistate > to take that path unless the therapy invollved incurs higher risks than > watchful waiting. That makes sense to me. Hope your next PSA comes in at 0.1 or lower, Pops. The waiting is the tough part...Good luck, Ron > EBRT has a cure potential if the PCa is still localized in the prostate > area. HT does kill prostate cancer cells. There is some evidence > suggesting that if started early enough (e.g. before the immune system > is overwhelmed and before hormonal balance is lost) HT may be curative. > I have not seen any evidence that HT can be curative upon recurrence. Concur. Not one of my readings has indicated that there is even a remote chance that HT can be curative. The only time I've heard the words uttered were by my uro who basically said it's extremely rare, but possible for those who have an extremely low amount of PCa in their system and/or only those types of PCa cells that are responsive to HT. He made it sound like it's a possibility, but not to make any decisions based on the possibility.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum Pops, You're being put through a psychological stress test. Cancer. Cancer cured. Cancer not cure. No sign of cancer. Ever so slight rise in PSA. Geesh!! Were I you, I'd go back to the basics. The definition of recurrent cancer is three straight rises in PSA. .24, .10 and .12 are all within acceptable (although worrisome) standards and they do not represent three increases. So, I would relax and wait for the next PSA or two. You can certainly not have any confidence in being cured. However, you have to admit there is no absolute indication that your cancer has recurred. In the end, if your PSA goes up, EBRT is there and it represents a possible cure. If it doesn't go up, then no treatment is necessary. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > PSA 8/2003 = 1.24 > [quoted text clipped - 28 lines] > > Up and down, up and down. Hard to keep a good attitude. |
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