Thu, Sep 28, 2006, 4:35am (CDT+5) From:
tuchasoffentisch@_NO_SPAM_gmail.com (Alex)
(Re-post: mis-sent previously as a reply, not a new thread.)

The discussion earlier about "timing for recurrance" leads me to ask the
group for input on the opposite issue: the significance of downward
changes in PSA over time.
In February of 2005 my PSA was 4.8. A 12-core biopsy found nothing. DRE
was normal. (Foolishly, my last PSA test was in November of 2001, at
1.1)
In July of 2005 the PSA was 6.2. A second biopsy, with 14 cores, found
cancer in 5% of two cores, with a Gleason 3+3 according to Johns
Hopkins, verified by Bostwick. DRE was again normal.
I have a gi-normous 88 gm prostate, with a large median lobe that pushes
into the bladder. That combo pretty much rules out EBRT and/or seeds, so
surgery is my likeliest option if/when I elect active treatment.
In the meantime I've been doing "active surveillance", with PSA readings
every 3 months, color doppler ultrasound (by Dr. Duke Bahn) every six
months, plus health-oriented changes in diet and lots of supplements.
The PSA (all the same lab, all high-precision) held relatively steady at
between 5.81 to 5.25 until this summer, when it dropped to 4.50, then
3.33 at mid-September. An ultrasound this month shows no change in the
(quite visible) area of cancer since diagnosis. My age is 62, and I'm
otherwise in very good health.
In short, I'm currently experiencing a negative doubling time, or a
deceleration of PSA velocity.
I know there are fellows in this NG who are much more knowledgeable than
I about PSA trends, nomograms and the like, and some who are quite
skeptical about watchful waiting. I'd welcome research-backed input from
these and anyone else.
(While I respect the feelings of those who "just want it cut out," or
who believe "the cure is all that matters," I am looking for medical
information, not well-intentioned exhortations to act.)
Alex

=====
hi alex - i don't know if you will find research-backed input to the
question you are asking, but i can give you some insight on your
situation.

first, a 88 gram is right up the road a little bit from the 55 gram that
i had.  

yes, i had the pushing up into the bladder too.

your gleason of 3 + 3 is more along the common numbers and will be slow
growing.  

and the 5% involvement - well - you caught it early on that part.

your variation in psa readings can be for different reasons.

usually, it is mainly due to the prostatitis.  a large prostate usually
has more prostatitis - both chronic as well as acute over time, and this
will make the psa numbers change by itself along and is an independent
factor having nothing to do with the pca that is already there.

as long as you realize that you are playing with your life at this point
in time - i have no problem with what you are doing.

now, what did i mean by that last statement?   very simply this.
prostate cancer never gives back a single cell it takes.   and each day,
the cancer gets stronger.  as long as it is contained inside the
prostate itself, you have a chance for a cure.  you, yourself, have
already ruled out the radiation option, and said that surgery is the
option card that is still on the table.

so, the question goes back to you...... what happens, if the cancer
breaks through the prostate capsule?  then where are your options and
what are chances for a cure?  and only time will time, which is what you
are playing with.

now, you ask about research backed input.  here's the facts.

it takes - on avg - 13 years - for the pca to develop - and to end your
life.  

on avg - it takes 8 years to develop to where it can mest.  and on avg -
5 years to spread throughout the body and develop enough to shut down
one or more  major organs that is needed to sustain life.

it is a known fact, that as a rule - the last three years of your life -
you will be in pain.  this is due to the fact that the pca will invade
the skeleton system and cause the body to collapse on itself - pinching
nerves as well as the nerve themselves.  that is why there are three
different levels of pain management used in the end of life phase.

so, at age 62,  you can do the math.  

right now,  you are eligible for a chance.... for a cure.  right now,
you are healthy enough to get on the operating table, but what happens
if something happens to your health in the next few years and removes
this option.  now what are the treatments that are available left to
you?

i, personally believe, that the reverse in psa, is where the pca - psa
level, really is with the prostatitis factor removed.   (mine dropped
over 1 whole point just from a two week treatment of antibiotics alone)

my advice - do the research and do the math.   the final choice is up to
you and nobody else.

i believe that a person should know the odds and what the type of
disease that they are up against from the very beginning, so that if
they do opt to go down the watchful waiting path, then, they can't say
near the end, "i wish i would have done something"

by the way - those where the words that my dad said when he was in stage
4.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc