post-biopsy psa 8.47, up from 2.73 in April

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mountainguy1958 - 13 Sep 2006 00:02 GMT

On June 28th I had a biopsy in which 12 tissue samples were taken, one
of which was cancerous.

When I recently called Memorial Sloan-Kettering to schedule a
consultation with a surgeon, I was told that they wouldn't put me on
the calendar without copies of biopsy and scan reports, etc., as well
as a recent PSA. My most recent pre-biopsy PSA was from April when it
was 2.73, which the admission coordinator at Sloan told me wasn't
recent enough.

04/13/2006 - 2.73 (DRE & glucose normal)
04/06/2005 - 2.04 (DRE & glucose normal)
10/13/2004 - 3.09 (DRE & glucose normal)
05/12/2004 - 3.30 - recommendation for biopsy withdrawn by same same
MD (DRE & glucose normal)
04/28/2004 - 4.51 - biopsy recommended (DRE & glucose normal)
08/06/2003 - 2.73 - (DRE & glucose normal)

In order to provide the documents that Sloan-Kettering requires for the
surgical consultation, on September 8th I went to the the urgent care
clinic at the large group practice where I receive moth of my
heatlhcare and requested a blood draw for a PSA.

I got the report back today and the PSA level was 8.47 -- almost 2x as
high as it's ever been before. It seems possible to me that this spike
could be solely, or at least largely, due to the biopsy.

Is it reasonable to attribute that much of an increase to having had a
biopsy 11 days earlier? Or is this elevated level more likely a sign of
spreading disease?

Tom

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mountainguy1958 - 13 Sep 2006 00:14 GMT

Correction: The biopsy was on August 28th.

> On June 28th I had a biopsy in which 12 tissue samples were taken, one
> of which was cancerous.
[quoted text clipped - 28 lines]
>
> Tom

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Richbro - 13 Sep 2006 00:32 GMT

Tom, there are differences that can occur with the method used at a
particular lab versus another lab. I believe I understood that this was
a different lab for the 8.47 versus the 2.73. There are also
inaccuracies in the test itself. Still, I wouldn't delay in double
checking. Here is a web reference that might help.
http://www.cancer.gov/cancertopics/factsheet/Detection/PSA.

Good luck.

Richard

> Correction: The biopsy was on August 28th.
>
[quoted text clipped - 30 lines]
> >
> > Tom

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ron - 13 Sep 2006 01:04 GMT

mountainguy1958 wrotesnip...

> Correction: The biopsy was on August 28th.
> > Is it reasonable to attribute that much of an increase to having had a
> > biopsy 11 days earlier? Or is this elevated level more likely a sign of
> > spreading disease?
> >
> > Tom

Hi Tom...There's a table over on Don Cooley's PHML website at

http://diagnosis.prostate-help.org/pcpsaid.htm

It shows how long various things can affect PSA levels. For a biopsy
it suggests that biopsy affects on PSA can persist for 6-8 weeks. You
are well within that range. The table indicates that prostatitis, for
example, can have a 5-7 fold affect on PSA. While no range is given
for a biopsy, I would guess that, given the "violence" that a biopsy
does to a prostate and that blood and fluids flow out directly from the
prostate, it could easily explain the 2-3x affect you've
observed...Best wishes and good health, ron

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Steve Kramer - 13 Sep 2006 00:31 GMT

> I got the report back today and the PSA level was 8.47 -- almost 2x as
> high as it's ever been before. It seems possible to me that this spike
[quoted text clipped - 3 lines]
> biopsy 11 days earlier? Or is this elevated level more likely a sign of
> spreading disease?

Damn, Tom!

From my perspective, it makes no sense at all. Yes, a biopsy is going to
spike your PSA. But, I don't think for more than a week. And, maybe 10%;
not 100%!

It's so incredible, I think there's a greater chance that they mixed you
sample with another or are reporting on a different scale.

If it IS 8.47, your choices would seem to have narrowed to one; with a slap
to the face kicker!

Signature

PSA 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, 6/06
PSA .07 .05 .06 .09 .08 .132 .145
Casodex added daily 07/06
Non Illegitimi Carborundum

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Steve Jordan - 13 Sep 2006 01:06 GMT

On September 12, Tom wrote:

(snip)

> In order to provide the documents that Sloan-Kettering requires for the
> surgical consultation, on September 8th I went to the the urgent care
[quoted text clipped - 9 lines]
> spreading disease?
>

The biopsy just 11 days before is a likely culprit.

But it could very well be a lab error. It's not unknown by any means, as
I understand it. FWIW, my anecdotal experience is this: in May 2005,
after several months of scoring 0.01, I scored 4.87! Scared the devil
out of me. My onc wanted me to report forthwith for Taxotere. I said
whoa, this is beyond the realm of possible; let's do another PSA.
Result: 0.01. The lab had made an error. Question is: who was the poor
guy who got a 0.01 report when it should have been 4.87? The lab claimed
that they would run it down, but I wouldn't bet my life on it.

Bottom line: do it over.

Regards,

Steve J

"Digressions, objections, delight in mockery, carefree mistrust are
signs of health; everything unconditional belongs in pathology."
--Friedrich Nietzsche

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JohnHace - 13 Sep 2006 16:50 GMT

Tom,

Five weeks after my biopsy, my PSA was way up. Eight weeks after, it
was back.

> Bottom line: do it over.

I agree, but wait until eight weeks have elapsed.

Just calm down. You've got time.

John

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DrYew.com - 14 Sep 2006 06:15 GMT

That is just plain stupid of MSK. You have a biopsy that shows cancer
and plenty of PSA velocity data. It's likely up from your biopsy. Using
logic, what do you think is more reliable? A biopsy? or the post-biopsy
PSA? What was the Gleason and %core?

> On June 28th I had a biopsy in which 12 tissue samples were taken, one
> of which was cancerous.
[quoted text clipped - 28 lines]
>
> Tom

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mountainguy1958 - 14 Sep 2006 11:27 GMT

Dr. Yew,

The list of required documents came from an administrative employee,
not a healthcare worker. She wasn't suggesting that I do or don't have
cancer; just telling me that I need to have all my papers in order to
see the man, including a recent PSA. Used to dealing with bureaucrats,
as the request didn't seem like a big deal, I complied.

As I mentioned, I got the test by going to the urgent care clinic where
I get most of my general healthcare. My PCP was on vacation, so an
internist whom I've never met and who didn't see me ordered the labwork
at my request. The printout was handed to my by my ENT when I went for
a scheduled sinus check-up. He said he could give it to me, but he
couldn't offer any interpretation since it was out of his specialty.
Hence my initial concern that led to the posting of this thread.

"BIOPSY SUMMARY: Location: left lateral base (core 1/1). Diagnosis:
3+3=6. Core Length (mm): 16. Tumor length (mm): 0.8. % Tumor: 5%. Tumor
Position From Inked Margin: Not inked."

I met with two oncologists yesterday for previously planned
informational consults. Both told me the 8.47 PSA was meaningless under
the cirucumstance, but encouraged me to go ahead and include it in my
packet to MSK in order to get scheduled. I had already drafted a cover
letter which questioned the validity of the PSA level taken 11 days
post biopsy. But if the admissions lady wants it, there it is. I'll fax
it in today and hopefully get a date.

Thanks.

Tom

> That is just plain stupid of MSK. You have a biopsy that shows cancer
> and plenty of PSA velocity data. It's likely up from your biopsy. Using
> logic, what do you think is more reliable? A biopsy? or the post-biopsy
> PSA? What was the Gleason and %core?

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