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Medical Forum / Diseases and Disorders / Prostate Cancer / June 2006PSA Rise
I'm 47 and in good health. I have been told since 2000 by my doc that my prostate is enlraged, although I don't know to what degree. I do have on and off slight groin and testicular tenderness/pain, which I have attributed to exercise. No first degree relatives with PCa. but an uncle got it at age 67. On 2/2001 I had my first DRE which was negative, and my first PSA which was .9 On 9/2004 my DRE was again negative, and my PSA was .5 Last week, my blood panel showed a PSA of 1.8 (DRE was again negative), The last two tests were done at the same lab. The first one was done somewhere else. I didn't think too much about it until I started reading about the new PSA and PSAV guidelines. Now I'm not so sure it's OK: I'm confused. Seems like the more I read, the more contradictory information I get. Help! As I understand it, a PSA reading <2.5 in my age group is considered normal, but the .75 rise for two years in a row is not. On the other hand, if the PSA is <2, then testing can be done every two years instead of annually. I guess I'll talk to the doc but I wonder if you veterans can give me some insight. I am soon going to relocate overseas and will not have insurance, at least for awhile and I'm a little freaked out by what I've read Thanks! Prostate cancer if found in younger men can be very aggressive and dangerous. There is no way to know if you have prostate cancer except by doing a biopsy. If they find cancerous cells then you have it, if they don't find cancerous cells they may repeat the test again in 6 months or a year. But before you freak out there are several things that can make a difference in the PSA reading. You could have a mild infection or an enlarged prostate, or maybe you spent the night before your test indulging in a little sexual pleasure, or the morning of your test straining to move your bowels. These can all effect (raise) the PSA. If you are seeing a family doctor you might want to consider seeing a urologist. You could also ask about taking a round of antibiotics and then repeat the PSA test. If that PSA is still up then maybe you need a biopsy. Thank goodness you are being tested. Also you are obviously busy trying to educate yourself. The more you know.....! Bev > I'm 47 and in good health. I have been told since 2000 by my doc that > my prostate is enlraged, although I don't know to what degree. I do [quoted text clipped - 30 lines] > > Thanks! > I'm 47 and in good health. I have been told since 2000 by my doc that > my prostate is enlraged, although I don't know to what degree. I do [quoted text clipped - 18 lines] > I'm confused. Seems like the more I read, the more contradictory > information I get. Help! The greater indicator of the possibility of cancer is a PSA that rises significantly three consecutive times. If I understand your situation, your PSAs were 0.9 then 0.5 then 1.8. That 1.8 is unnerving, but honestly, it could be the result of a healthy bowel movement. If your DREs are negative, I would not yet worry about cancer. But, keep up the search, because you might have some other prostate problem. Or not.  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, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum Thank you for your input! The more I read up on the PSA test, the more confusing it seems. And I'm a math teacher. As I understand it, the test provides a continuum of risk, so that the cutoffs are somewhat artificial. Ths is OK with me, but then it appears that the experts still don't know how to interpret the risk; that is, they know that as PSA increases, the risk of PCa rises, but they don't seem to have nailed down the scale, the percentages. There's too much "noise" in the statistical sample. The fact that a low PSA doesn't even rule out an agressive cancer is particularly disturbing. My doc says the DRE should always be done in conjunction with PSA. I had my blood taken at 8AM after the DRE and interestingly my creatinine came back a little high, and the nurse said I might have been dehydrated. I wonder if that might affect the PSA. I also have en enlarged prostate but that still doesn't explain the jump from .5 to 1.8 in two years. I guess the bottom line is that I should monitor my PSA numbers and look for large jumps. If you were in my position, would you go for a biopsy? When would you get your PSA retested? What number would you use as the red flag for biopsy? I will discuss this with my doc but I'd definitely value your opinions. Thanks again for your help. It's great to talk with people who've "been there." I respect you guys a lot. > Thank you for your input! > [quoted text clipped - 26 lines] > Thanks again for your help. It's great to talk with people who've "been > there." I respect you guys a lot. I am very very grateful that you are following up on this now. Over a 5 year period my husband went from 2.1 to 26.7. In the 3 years before that, he went from 1.8 to 2.1. So I believe your concern is useful, and I am all for aggressive exploration of anamolies. However, a few comments. A free PSA test (also known as PSAII) can be another indicator. Ask for one of those. I believe that following your PSA doubling time is the most important. Use the tools at www.pcri.org and/or the sloan-kettering one at http://www.mskcc.org/mskcc/html/10088.cfm. Warning: These nomograms are for men who have been diagnosed with cancer through biopsy. You have no indications of prostate cancer. There are may more probable reasons for your 1.8 psa, as others have pointed out. Plus, PSA varies as much as 30% in a day. Plus, a friend of mine came up with an unbelievable PSA and it turns out they had mixed up two people's results. Lab errors happen. http://www.cancer.prostate-help.org/capsaif.htm Condition Manipulation Increase Effect on PSA Level Persists Up To Acute bacterial prostatitis 5-7 fold 6 weeks Acute urinary retention 5-7 fold 6 weeks Digital Rectal Exam (DRE) Variable 3 days Exercise - bicycle 0-3 fold 1 week Prostate biopsy Very Variable 6 weeks Prostate massage Variable 6 weeks Ejaculation Variable 3 days TURP Very Variable 6 weeks As you can see, the DRE could have caused the increased PSA by itself. There are references for the size of the prostate and the amount of normal PSA a prostate puts out (by size). I believe that is on the pcri.org site. So if you had an idea of the size of your prostate, then you would be able to calculate the expected amount of PSA. A urologist might be more experienced and able to guess the PSA size, feel something the GP can't, etc. But even TURPs are not that good for estimating size. A biopsy is not accurate enough to give you a valid reason to stop being concerned. You will have to use other clues until the weight of evidence clearly points to a biopsy. And, as you know, a PSA test is not a cancer test. I think someone said to go to a urologist if you have been going to a GP. Since you are such a good researcher, perhaps you can find a local prostate cancer specialist who can really track down the #s and give you specific information about follow through while you are out of the country. If you could do anything you wanted, an endorectal MRI with spectroscopy would identify areas of concern in the prostate (if there were any) that you could focus on. (My gut feeling is that without more indicators of concern, an annual PSA would be enough.) Best wishes, and thank you for taking this seriously. laurel (snip) > The more I read up on the PSA test, the more confusing it seems. And > I'm a math teacher. As I understand it, the test provides a continuum [quoted text clipped - 4 lines] > percentages. There's too much "noise" in the statistical sample. > The PSA test is not cancer-specific; it is gland-specific. It can tell the patient that there is something abnormal in the gland, but not exactly what it is. I consider it a "heads-up," no more. > The fact that a low PSA doesn't even rule out an agressive cancer is > particularly disturbing. My doc says the DRE should always be done in > conjunction with PSA. > > I had my blood taken at 8AM after the DRE ...... Argh. The PSA blood draw should not be taken sooner than 48 hours after DRE! The DRE stresses the gland, and stress will temporarily increase the expression of PSA. See page 51 of _A Primer on Prostate Cancer_ 2nd ed. by medical oncologist and PCa specialist Stephen B. Strum, MD and Donna Pogliano, PCa warrior. (snip) > If you were in my position, would you go for a biopsy? Not until at least three more *properly-performed* PSA tests. (snip) > What number would you use as the red flag for > biopsy? Consistently in excess of 2.5 ng/mL, or a serial increase over time. > I will discuss this with my doc but I'd definitely value your > opinions. > I would suggest finding a medic who is knowledgeable about PCa testing. Perhaps a urologist would be appropriate at this stage. I would also most earnestly recommend referral to the authoritative and objective website of the Prostate Cancer Research Institute at http://prostate-cancer.org/index.html Specifically, see the "undiagnosed" link at http://prostate-cancer.org/education/education.html#undiagnosed Good luck. Regards, Steve J For Memorial Day: "People sleep peaceably in their beds at night only because rough men stand ready to do violence on their behalf." --George Orwell I have read the various replies to the original post and do hope that this man keeps his wits about him and pays attention to what all of you are telling him. He may not have any problem at all. Or he may have an opportunity to catch a problem before it gets too far along. My Dr had told me in the past that my prostate was large, but he did not feel that anything was amiss. Things "felt normal" during the periodic DRE. It was just large for my age of 54. A year later, at age 55 I heard the same thing from both my Dr and my urologist when I went in for a bladder infection. It was just large, that's all. A short time later I went for a general checkup and asked specifically for a psa test. At age 55, with a psa of 55, we found out that yes, there was something very amiss. A couple weeks later my second opinion urologist pretty much knew all he needed to know after putting me through a DRE unlike any I had ever experienced in the past. He knew what he was doing. Knowing what I know today, as little as it may be, I would be leary of a urologist who did a DRE and then immediately took blood for a psa test. I would not even put much faith in the results of the DRE unless I knew that the man doing it knew what he was doing. Like an elderly neighbor lady of mine has said many times, "not every doctor graduated at the head of his class." " . > Perhaps a urologist would be appropriate at this stage. > [quoted text clipped - 16 lines] > stand ready to do violence on their behalf." > --George Orwell >>... >> I had my blood taken at 8AM after the DRE ...... > Argh. The PSA blood draw should not be taken sooner than 48 hours after DRE! The DRE > stresses the gland, and stress will temporarily increase the expression of PSA. See page > 51 of _A Primer on Prostate Cancer_ 2nd ed. by medical oncologist and PCa specialist > Stephen B. Strum, MD and Donna Pogliano, PCa warrior. I had a PSA test taken about 1/2 hour after a DRE and the reading was 2 points higher than at any other time. As Steve says, I think it was just an artificial jump caused by the pressure of the DRE on the prostate. Alan > The more I read up on the PSA test, the more confusing it seems. And > I'm a math teacher. Then search for doubling time of PSA on the Internet. The formula is posted variously. > The fact that a low PSA doesn't even rule out an agressive cancer is > particularly disturbing. My doc says the DRE should always be done in > conjunction with PSA. Absolutely! And that is only to determine if you need a biopsy. > I wonder if that might affect the PSA. I also have en > enlarged prostate but that still doesn't explain the jump from .5 to > 1.8 in two years. It most certainly can! > If you were in my position, would you go for a biopsy? When would you > get your PSA retested? What number would you use as the red flag for > biopsy? I will discuss this with my doc but I'd definitely value your > opinions. Yes, if my doctor suggested it. No, if my doctor didn't. We are usually very careful here to not give medical opinions. 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, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum NO, NO, NO! DRE should be done after the PSA! Not before as it can cause a rise in the PSA. With the next PSA ask for a fPSA to be done, too. The fPSA is more expensive but it gives another indicator. Bev > Thank you for your input! > [quoted text clipped - 26 lines] > Thanks again for your help. It's great to talk with people who've "been > there." I respect you guys a lot. > have on and off slight groin and testicular tenderness/pain, which I > have attributed to exercise. No one replied to this, so I will. I have never heard of anyone who had pain with prostate cancer until it was very very advanced, and then it is usually bone pain. (An enlarged prostate can cause pain, I think, but that is usually around urinary symptoms and not groin.) My impression of this is that you were probably correct about the cause of your groin/testicular pain. Thanks for your feedback. The web pages you sent me are terrific. I think now I'll be knowledgable enough to spar with the doc when I see him. I've seen some of Dr. Strum's work on the net and will definitely pick up his book. I'll ask for a repeat psa test, and get psa tests at 3 to six month intervals and monitor the situation. What do you think of that approach? I've also read the fpsa is not accurate for psa's below 2. Is that true? I also understand that a sudden psa rise from levels below .5 is rare for pca, as exponential psav usually occurs later in the progression of pca. Is that true? Thanks again, as always, for taking the time to speak to my concerns, and fears. Paul > I'll ask for a repeat psa test, and get psa tests at 3 to six month > intervals and monitor the situation. What do you think of that > approach? That sounds rational. Try to get the tests at the same lab. If that is impossible, then at least pay attention to the assay method and get those the same. In the US, the assay method is printed on the results page. I don't know what you'll find overseas (depends a lot on where you're going, I'm sure.) You may have to restart your calculations for a different test type, which is no big deal since you are looking for a pattern, and can use the new test as your new (temporary) baseline. > I've also read the fpsa is not accurate for psa's below 2. Is that > true? I have seen argument both ways so I'll let someone who's studied it answer. I think Strum addressed that in one of his P2P posts. His posts are often helpful, if you can get past his prediliction for wanting people to go to Denmark for this test, another country for that test... > I also understand that a sudden psa rise from levels below .5 is rare > for pca, as exponential psav usually occurs later in the progression of > pca. Is that true? I do not know. The sources you are researching are probably the same ones I use. It is a matter of making decisions about how valid the sources are. I haven't studied this because we started with a PSA in the 20s and my research was elsewhere. > Thanks again, as always, for taking the time to speak to my concerns, > and fears. > > Paul Good luck, Paul. A PSA < 2 is terrific, so when you choose a monitoring method that makes sense to you, such as looking for a certain doubling time or velocity, I hope you can just let go of the issue the other 364 days of the year. Your approach to take this seriously and learn now what you need to know is wise, and rare. However, you may never get PCa or if you did, it could be decades. So, while it is very important it is not a life-changer at this point. At least if you ever do get it, you will have enough warning to find a treatment and cure. You might research nutritional aspects of prevention. Also, here is a resource you may not have found. They have chats a couple times a week so far, at times designed to be accessible around the world. http://p4.forumforfree.com/prostateaction.html Best wishes, Laurel Thanks for the perspective. I tend to obsess over these things, which is not healthy, I know. I went to the GP today and he offerred to refer me to a urologist but said that he thought that neither the PSA nor the PSAV warranted it. He said I might retest before I go overseas (in a month) to see if the reading was an anomaly but otherwise I should simply monitor my PSA periodically to see if it stays below 2. He feels that unless the value is >2, there's no reason to take any action. Do you think this is too conservative an approach? Am I making too much of this? Should I ask for a referral to a urologist? Thanks for taking the time to help, I know you all are dealing with much more difficult and serious issues. Paul > Good luck, Paul. A PSA < 2 is terrific, so when you choose a > monitoring method that makes sense to you, such as looking for a [quoted text clipped - 14 lines] > > Laurel gabachin asked...I've also read the fpsa is not accurate for psa's below 2. Is that true? Recent studies have shown that fPSA has some measure of significance for tPSA's down to 2.6. I haven't seen any work studying lower levels, so I suspect a fPSA test for PSA's in your range would have no clear validity...ron The Journal of Urology 2002; 168(3):922-925 Robustness of Free Prostate Specific Antigen Measurements to Reduce Unnecessary Biopsies in the 2.6 to 4.0 ng./ml. Range KIMBERLY A. ROEHL; JO ANN V. ANTENOR; WILLIAM J. CATALONA* Conclusions: Percent free PSA provides risk assessment but does not eliminate many unnecessary prostatic biopsies while maintaining a high sensitivity in the narrow total PSA range of 2.6 to 4.0 ng./ml. Thanks for the perspective. I tend to obsess over these things, which is not healthy, I know. I went to the GP today and he offerred to refer me to a urologist but said that he thought that neither the PSA nor the PSAV warranted it. He said I might retest before I go overseas (in a month) to see if the reading was an anomaly but otherwise I should simply monitor my PSA periodically to see if it stays below 2. He feels that unless the value is >2, there's no reason to take any action. Do you think this is too conservative an approach? Am I making too much of this? Should I ask for a referral to a urologist? Thanks for taking the time to help, I know you all are dealing with much more difficult and serious issues. Paul > said I might retest before I go overseas (in a month) to see if the > reading was an anomaly Very good idea. You really can't see a trend in these 3 PSA tests. Too many things affect PSA, it is so low, you KNOW you had a DRE immediately proceeding the last one. Just retest before you go, see what that is, and if it is lower then believe it. Why don't you get your PSA retest in a week or two, so that you have time to mull the results over in your head, so that before you leave for another country you have already become comfortable with your decision? > periodically to see if it stays below 2. He feels that unless the value > is >2, there's no reason to take any action. I don't think PSA by itself is the best criteria. There are men who have had metastatic PCa with PSAs under 2. This is rare rare rare but I would choose a method other than straight PSA like PSADT or PSAV, read until you can figure out the point where the velocity or DT is becoming risky (I never did understand the difference between velocity and DT-can you explain it?) and then use that point as your trigger. NOT that I'm a doctor. I do think that whatever you do, you should choose a criteria (even, say, PSA 2.) and then stick with it. Forget the whole problem except when you do your PSA test, and then remember it only long enough to check against that criteria. You have no 1st degree relatives. If you did, that would probably be the only thing I saw to indicate any concern at this early age. All men must have cousins or uncles with it; PCa is too prevalent for that to mean anything. There is no reason to think that you have prostate cancer AT ALL. It is just a good thing that you are aware of it and will catch it early if it ever shows up. Be conscientious about no sex, no DRE, no bicycles before the next PSA. If your PSA was still high (well, still below 2), then by far the most likely explanation would be a DIFFERENT problem with the prostate, like prostatitis. IF there is a problem at all. Did you calculate expected PSA by prostate volume? He said yours was large, so choose a # like 70 grams, maybe, and calculate what your PSA would be with a 70G prostate. > Do you think this is too conservative an approach? Am I making too much > of this? Should I ask for a referral to a urologist? Who knows? It is scary to be sick alone, or, say, sick in a foreign country with no support system (hook up with the online groups like this one and some of the chats). So for peace of mind, it might be worth it to consult with a uro. However, if you end up with a run-of-the-mill uro who is too laid back for you, then you may feel even more frustrated and scared rather than reassured. So probably the only uro that would satisfy you is one of the masters of prostate cancer. Do you have one of those available? From what I can tell, he would kindly reassure you and go on to the next patient that has a real issue. Your doc is probably right. But whatever it takes to feel comfortable. Unless you are thinking of a biopsy at this time. That would be idiotic, I would think. Paul, I encourage you to look for reasons you don't have cancer. I have a feeling that the #s you look at that don't cause worry, you disregard, or at least assign less weight. And anything that might be worth a 2nd look, you give more weight to, even when they should have LESS weight. For instance that PSA of 1.8. Since it followed a DRE, it is probably the least valuable data point you have. It is not good to weight your data based on your fears. You could get an ulcer, it'll perforate, you'll bleed to death on a street corner from worrying about a cancer that you don't have. lf > I don't think PSA by itself is the best criteria. There are men who > have had metastatic PCa with PSAs under 2. This is rare rare rare but > I would choose a method other than straight PSA like PSADT or PSAV, > read until you can figure out the point where the velocity or DT is > becoming risky (I never did understand the difference between velocity > and DT-can you explain it?) PSAV is the change in PSA over time. In my case, it's 1.8-.5 divided by 1.7 beacuse the readings were taken 1.7 years apart. The value is .76 If you have more than two points, you use a 'linear regression' which just measures the 'best straight line between all the points you have. DT is just the time it will take for the PSA to be twice what it is now. Since it is a prediction, it's called a growth model. There are many growth models, the two basic ones being linear (straight line, constant growth) or exponential (accelerated, red flag for cancer). If you use the exponential model, it turns out that the DT never changes. If your DT is 2 years, then theoretically, in 1, 2, 3, 4, 5 years, it still will still be 2 years. This constancy of DT is what makes the number an easy thing to use in diagnostics. It's like the half life in a radiooactive process. The half life of uranium is 5280 years, (I think). Whether or not you have 1, 10, or 100 grams, it takes 5280 years for it to be reduced to half of what it was (which, by the way, is why radiation is so nasty. It takes a looong time to go away). >From what I've been reading, there's a lot of shoddy science being done out there, IMHO. Lots of flawed statistical analysis which makes the cutoffs almost maeningless. When it comes to PSA, there's just too much variability, not to mention the methodological errors in the studies. As you and others here have pointed out, two or even three readings probably don't say too much. But...they might. So I get to activate my neurosis and start worrying. >and then use that point as your trigger. > NOT that I'm a doctor. I do think that whatever you do, you should > choose a criteria (even, say, PSA 2.) and then stick with it. Forget > the whole problem except when you do your PSA test, and then remember > it only long enough to check against that criteria. Yes, you're right. Absolutely. I am working on it. > Did you calculate expected PSA by prostate volume? He said yours was > large, so choose a # like 70 grams, maybe, and calculate what your PSA > would be with a 70G prostate. If one uses 30 cc as a lower limit for BHP , the formula gives 1.98 as the PSA value. On the other hand, I wonder if a prostate volume could induce a rise from .5 to 1.8 in 20 months due to BPH. I don't have really bad symptoms, just frequent bathroon runs and a somewhat weakened stream. > > Do you think this is too conservative an approach? Am I making too much > > of this? Should I ask for a referral to a urologist? > > Who knows? It is scary to be sick alone, or, say, sick in a foreign > country with no support system (hook up with the online groups like > this one and some of the chats). You guys have been great. My major worry is my family. I have a wife and a 4 year old who need me. Sounds corny I guess. I worry about not having the resources to deal with this, if it becomes an issue as my health benefits in Mexico will not be great. > Do you have one of those available? From what I can tell, he > would kindly reassure you and go on to the next patient that has a real > issue. Your doc is probably right. But whatever it takes to feel > comfortable. Unless you are thinking of a biopsy at this time. That > would be idiotic, I would think. I need to relax and do three PSA's over the next 9 months or so and take it form there. But I have this major league fear of my PSA rising to 10 in a year. > Paul, I encourage you to look for reasons you don't have cancer. I > have a feeling that the #s you look at that don't cause worry, you > disregard, or at least assign less weight. And anything that might be > worth a 2nd look, you give more weight to, even when they should have > LESS weight. For instance that PSA of 1.8. Since it followed a DRE, > it is probably the least valuable data point you have. Also, I had some severe testicular/groin pain about 6 months ago which lasted for about three weeks, then subsided but it still bothers me a little. The GP said is probably has nothing to do with the prostate, since prostate pain usually occurs in the perineum. But maybe that's a factor. Who knows. > It is not good to weight your data based on your fears. You could get > an ulcer, it'll perforate, you'll bleed to death on a street corner > from worrying about a cancer that you don't have. Yeah, I know. My therapist tells me the same thing. My BP bounces around more than my PSA. Thank you so much for your time and kindness. I've never felt such gratitude for members of a club I'm loath to join... > lf Paul, I have a couple of questions. They may be in the form of statements but I am really asking. I know I could study it but I could spend hours and, if you don't mind the time to reply, I think I'll understand direct answers better. > PSAV is the change in PSA over time. In my case, it's 1.8-.5 divided by > 1.7 beacuse the readings were taken 1.7 years apart. The value is .76 > If you have more than two points, you use a 'linear regression' which > just measures the 'best straight line between all the points you have. And what is a worrisome PSAV? You have 3 points, now, but the last one was a jump, so linear regression is not too helpful. But when you get another point, and it doesn't continue up, then it will smooth the bump? > DT is just the time it will take for the PSA to be twice what it is > now. Since it is a prediction, it's called a growth model. There are [quoted text clipped - 4 lines] > still will still be 2 years. This constancy of DT is what makes the > number an easy thing to use in diagnostics. It's like the half life in Why isn't PSAV also a prediction? It sounds like you can create a line with it, so then one could continue the line.... Are these growth models for DT created by someone? Then you would choose the one you want to use? If so, why would you use the exponential model? DT *does* change over time. (at least in some models :) Or is the correct model somehow inherent in the numbers? > >From what I've been reading, there's a lot of shoddy science being done > out there, IMHO. Lots of flawed statistical analysis which makes the > cutoffs almost maeningless. When it comes to PSA, there's just too much > variability, not to mention the methodological errors > in the studies. As you and others here have pointed out, two or even > three readings probably don't say too much. But...they might. Yes, I am sure you know what you are talking about. It is a frustration for all of us, even the ignorant, to have conflicting and unclear and meaningless (but who knows) information. Some of the threads that have heated up have been over just this issue--someone questioning the basis for something, someone else getting upset about that. > If one uses 30 cc as a lower limit for BHP , the formula gives 1.98 as > the PSA value. On the other hand, I wonder if a prostate volume could > induce a rise from .5 to 1.8 in 20 months due to BPH. I don't have > really bad symptoms, just frequent bathroon runs and a somewhat > weakened stream. Really? You should ask the guys. I think 30 cc is a small prostate, it wouldn't have BPH. I think that maybe 50 would be a lower limit for BPH. But that is just a feeling, from numbers I've read in passing. Well, I think we are all assuming that the 1.8 has far more to do with the DRE than anything else. Not that I expect you to assume that; it is your life. Reminds me of some reason of a recent post when someone asked "how much difference can there BE in urethras?" Good question. I can see how there is a lot of variation in prostates, but urethras? I guess so.... > You guys have been great. My major worry is my family. I have a wife > and a 4 year old who need me. Sounds corny I guess. I worry about not > having the resources to deal with this, if it becomes an issue as my > health benefits in Mexico will not be great. Well, from purely anectdotal evidence, it seems that when a man gets prostate cancer at a young age, it does tend to be aggressive and more deadly. Purely anectdotal, as far as I know. So even though the #s don't fit a profile, its worth checking out thoroughly. And it seems like (personal experience here) you only get one chance with prostate cancer, over and over. Everything is so life-changing. Let me find our numbers, just for your information. It will be scary, I suspect. 3/97 PSA 1.1 8/00 PSA 2.3 12/05 PSA 20.1 12/05 PSA 26.7 1/06 PSA 22.15 1/06 biopsy 2/10 pos cores <1% & <5% cancer, G7 2/06 PSA 27.5 2/06 PSA 21.2 3/06 RRP extensive cancer throughout, pos bladder neck margin, 1/2 pos lymph nodes, Gleason 9 Biopsies are not the best tool, I am convinced. Actually, the best diagnostic tool is an RP. lol. So continue your search for good indicators. Also if you create a spreadsheet that calculates stuff for you, and you want to share it, let me know. I'll publish it on the web so people can use it. > I need to relax and do three PSA's over the next 9 months or so and > take it form there. But I have this major league fear of my PSA rising > to 10 in a year. This has happened to men, I am sure. I tend to think that if someone has a strong feeling like you do, maybe they know something unconsciously from their body that no one else can even tell. Of course I don't know you at all; if you were a hypochrondiac (no evidence for that, just an example) then you could *still* have PCa even if you worried about everything. Like they say, "just because I am paranoid doesn't mean they're not out to get me." (How reassuring I am, huh?) > Thank you so much for your time and kindness. I've never felt such > gratitude for members of a club I'm loath to join... Yeah, well, once this question resolves, do come back every year and give us an update so we have a real, live non-PCa experience to share. :) A lot of times people get cured and you don't hear about them. But a lot of men just drop in and post their zeros. I think this is mostly because they know Steve Kramer is tracking these things. Steve's data is pretty cool. Every so often he answers someone's question with a "X from this NG over the past Y years had Z". We know its not a clinical study but it is a bridge between the 1:1 experience and the clinical data out there in the stratosphere. Best wishes Paul. > And what is a worrisome PSAV? As I understand it, a PSAV of more than .75 /yr is considered worrisome. On the other hand, having read one of Strum's referenced articles, PSAV is not a reliable indicator for PSA levels below 2. >You have 3 points, now, but the last one > was a jump, so linear regression is not too helpful. But when you get > another point, and it doesn't continue up, then it will smooth the > bump? Yes, exactly. But the problem is that a regression will always give "the best straight line" through the data points, even if the trend is not linear. With only three points, it's hard to interpret the meaning of the data. In any case, the first PSA is suspect, because it was done in Mexico and I don't know what assay they used. I'm also recalling the number from memory, and don't have it on paper. > Why isn't PSAV also a prediction? It sounds like you can create a line > with it, so then one could continue the line.... PSAV is a predictor because if you have enough points, it will distinguish linear (usually non cancerous) growth from exponential (maybe cancerous) growth. If the growth is linear, the PSAV will be constant, and if the growth is exponential, the PSAV will be increasing over time. In theory, PSA in the presence of PCa follows a truly exponential function, while benign processes tend to be linear. For exponential functions the DT will be constant, and the higher the value, the steeper the exponential curve is, and the more rapid the progression of the PCa. > Well, I think we are all assuming that the 1.8 has far more to do with > the DRE than anything else. Not that I expect you to assume that; it > is your life. Well, it turns out that I forgot that I had to do the blood test over on a different day because the sample was 'damaged' at the lab. So, no DRE influence. > Well, from purely anectdotal evidence, it seems that when a man gets > prostate cancer at a young age, it does tend to be aggressive and more [quoted text clipped - 3 lines] > cancer, over and over. Everything is so life-changing. Let me find > our numbers, just for your information. It will be scary, I suspect. Thanks for sharing. > 3/97 PSA 1.1 > 8/00 PSA 2.3 [quoted text clipped - 6 lines] > 3/06 RRP extensive cancer throughout, pos bladder neck margin, 1/2 pos > lymph nodes, Gleason 9 Oh, what a rough diagnosis. How is he doing now? I hope he's OK. > Also if you create a spreadsheet that calculates stuff for you, and you > want to share it, let me know. I'll publish it on the web so people > can use it. I definitely will. I plan to test every 3 to 6 months. I saw a urologist yeaterday and he told me that my PSA rise was not a problem yet, that a good cutoff is 2.5 and that I should retest in a year. He also said that PSAV is not valid for two data points, and in any case, is unreliable for PSA levels below 2. He did a DRE and told me my PSA was "consistent with the size of my prostate, as far as I can tell." No BPH, so maybe my urinary symptoms are "a touch of prostatits." He said a biopsy was not indicated, although he offered to do it if I insisted. In fact, he said, tongue in cheek, "I make my living doing biopsies" and I don't think you need one. I wonder if the uro is being to conservative. >Of course I don't know you at all; if you were a > hypochrondiac (no evidence for that, just an example) then you could > *still* have PCa even if you worried about everything. Right. I'm not a hypochondriac, at least, I don't think so. I do, however, take an active interest in my health. Monitor my cholesterol, glucose and so forth. > Like they say, > "just because I am paranoid doesn't mean they're not out to get me." > (How reassuring I am, huh?) LOL > Yeah, well, once this question resolves, do come back every year and > give us an update so we have a real, live non-PCa experience to share. > :) What a nice thing to say. >A lot of times people get cured and you don't hear about them. in fact, what got me going on this forum was a guy who posted a thread about his rise from .4 to 1.8 which I found uncanny...just like my numbers. He was going to get retested in 2 months but then never reported back. wonder what happened to him. > But > a lot of men just drop in and post their zeros. I think this is mostly [quoted text clipped - 5 lines] > > Best wishes Paul. Thank you so much. You've been so supportive, informative, nice! > Do you think this is too conservative an approach? Am I making too much > of this? Should I ask for a referral to a urologist? Oops I thought of one reason to see a uro. There was a recent thread about the quality of DRE results from uros because they do so many and because the get feedback also, from surgeries and such. But if you do, get your PSA test before the uro's DRE because I guarantee it will go way up. Paul...Drs. Fred Lee and Duke Bahn are the best prostate ultrasonographers in the US (MN and CA respectively). If they imaged my prostate and didn't see anything suspicious, I'd feel comfortable that nothings amiss and that routine PSA and DRE checks could be used to follow-up...ron Thanks, Ron. Unfortunately, my insurance limits my access to specialists. I did see a urologist yeasterday. He told me that my PSA rise was nothing to worry about yet, and that I should retest in a year. He also said that PSAV is not valid for two data points, and in any case, is unreliable for PSA levels below 2. He did a DRE and told me my PSA was "consistent with the size of my prostate, as far as I can tell." He said a biopsy was not indicated, although he offered to do it if I insisted. I wonder if the uro is being to conservative. > Paul...Drs. Fred Lee and Duke Bahn are the best prostate > ultrasonographers in the US (MN and CA respectively). If they imaged > my prostate and didn't see anything suspicious, I'd feel comfortable > that nothings amiss and that routine PSA and DRE checks could be used > to follow-up...ron |
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