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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2007Now I'm really scared
Everything has been going so well for me. Now I just received the call that my 6 week post -surgical PSA is 1. They want me to wait 6 more weeks (a total of 3 months) before we check it again. Has anyone else had this same experience and is it possible my PSA will continue to drop after 6 weeks? Thank you. Mike 11/2006 Diagnosed with PCa at age 55 PSA 13.8 Gleason 6 (3+3) T1c Asymptomatic No incontinence or ED da Vinci RLRP performed Feb 20 2007 Queen's Medical Center O'ahu Hawaii Two separate, bilateral foci present Less than 5% prostate involvement Gleason 6 (3+3) All margins clear Multiple foci high grade PIN present Both nerves spared Minimal incontinence/no ED post-op 4/3/07 PSA 1 5/15/07 PSA... > Everything has been going so well for me. Now I just received the call > that my 6 week post -surgical PSA is 1. They want me to wait 6 more > weeks (a total of 3 months) before we check it again. Has anyone else > had this same experience and is it possible my PSA will continue to > drop after 6 weeks? As I understand it, the purpose of excising the prostate in almost every case is to excise the cancer completely from your system. As such, the expectation is a PSA of < 0.1 in one assay or <0.04 in a more sensitive assay. But, unless I miss my guess, that is an expectation at three months post surgery. You went into the surgery with at least a 13.8 PSA. Unless someone more knowledgeable about it than I (Leonard, ron, Steve, and many more) says otherwise, I would not worry until the 3-month mark. Furthermore, I would call and ask for verification as to 1.00 or 0.10. Is it possible she said "point one"? I only ask because that seems to be a common issue with new cancer patients.  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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05 Non Illegitimi Carborundum > As I understand it, the purpose of excising the prostate in almost every > case is to excise the cancer completely from your system. As such, the > expectation is a PSA of < 0.1 in one assay or <0.04 in a more sensitive > assay. But, unless I miss my guess, that is an expectation at three months > post surgery. Are you saying that it can take a few months for the PSA to flush out of his system? -kh >> As I understand it, the purpose of excising the prostate in almost every >> case is to excise the cancer completely from your system. As such, the [quoted text clipped - 5 lines] > Are you saying that it can take a few months for the PSA to flush out > of his system? It makes sense that it has to flush out of your system. When you are tested for PSA, it is your blood that is tested. Even when all the cancer is contained within the prostate, the PSA registers. It is counterintuitive to believe that the day your prostate is removed, suddenly all the PSA that was in your blood disappears. Ergo, it takes some amount of time. I'm only guessing at the three months because a lot of docs aren't testing before three months... including mine. 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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05 Non Illegitimi Carborundum ... > I'm only guessing at the three months because a lot of docs aren't testing > before three months... including mine. Makes sense. I appreciate RalphV's details too. Doesn't some other organ produce PSA? Seems I read that somewhere. Also, how much variation is there in the rate that it flushes out? Could it be that some guys take much longer than others, that's why there's a 3 month convention? an update, hospital called and said that anesthesia kept me asleep and that's why I pee'ed in bed. -kh >As I understand it, the purpose of excising the prostate in almost every >case is to excise the cancer completely from your system. As such, the >expectation is a PSA of < 0.1 in one assay or <0.04 in a more sensitive >assay. But, unless I miss my guess, that is an expectation at three months >post surgery. I think that's right. I met my surgeon at one month to check the pathology results and a "how are you feeling". The first PSA check was at 3 months and no suggestion that this might have been earlier. I think someone here mentioned the decline of existing PSA in the blood and that this would presumably be expected to take a while to disperse needing an entire body blood-change - maybe 3 months is a safer margin. "no ED post-op " Mike, are you be serious? You can get a spontaneous erection w/o Viagra or stimulation? That would be a medical first in my memory. Good for you! Bill Denton RP 2/12/02 PSA 1.6 Memphis Hello Mike, PSA has an half-life elimination rate of 2 to 3 days. Based on your PSA pre-surgery (13.8 ng/ml) your PSA 6 weeks after surgery should be undetectable. That said, do not wait another 6 weeks and simply have the first result rechecked to validate the result. Should the PSA result of 1.0 ng/ml be validated there is a high probability that the cancer has not been eradicated (in spite of a pristine pathology report). You have reason to be worried. Act now to validate the result and use the information to ease your mind. In case of proven surgical failure, use this time to plan your strategy, but no need for immediate action. There is always the possibility that benign tissue was left behind and in such case PSA could remain high but stable. Wish you and family the very best outcome. RalphV, KT7P pcainaz.org/phpbb > Everything has been going so well for me. Now I just received the call > that my 6 week post -surgical PSA is 1. They want me to wait 6 more [quoted text clipped - 19 lines] > 4/3/07 PSA 1 > 5/15/07 PSA... > Hello Mike, > PSA has an half-life elimination rate of 2 to 3 days. Based on your > PSA pre-surgery (13.8 ng/ml) your PSA 6 weeks after surgery should be > undetectable. Well, that blows that theory out of the water. 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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05 Non Illegitimi Carborundum >PSA has an half-life elimination rate of 2 to 3 days. Ahh! - thanks for that, in my shocking ignorance I thought it was just something that faded away. > ...is it possible my PSA will continue to > drop after 6 weeks? I surely hope so. However, I'm pretty sure that I read that six weeks was the length of time it took to flush out the PSA -- but I can't find it here in my office. I have Scardino's book here, but he only mentions that it should be all gone in a 'few weeks', whatever that means -- probably not twelve. Mike, are you sure that the number was 1 and not 0.1? That just seems incredibly high. If yours was 13.8 before removal, and if PSA is proportional to the size of the prostate tissue, then a PSA of 1 would mean either that they missed about 7% of the prostate tissue (7% ~ 1/13.8) or that you have a lot of metastates. Neither of those sound very likely. The other thing about that number is that PSA results are usually reported as "emm-point-enn" -- like 1.7 or 3.2 or something like that. "1" without a point after it sounds odd. You should give the uro a call and verify that result. And please let us know. You and I are in the same cohort, so I'm rooting for you. --charlie >> ...is it possible my PSA will continue to >> drop after 6 weeks? [quoted text clipped - 4 lines] > mentions that it should be all gone in a 'few weeks', whatever that > means -- probably not twelve. I think where the time frame comes from, is something I learned during Diabetes classes of why Hemoglobin A1c (HbA1c or H1Ac), also called glycated hemoglobin, is measured periodically, usually 3 months. to determine the average blood-sugar level over the life span of the red blood cell, which is about 8 to 10 weeks. It may have something to do the life span of the red blood cells being flushed and a fresh PSA reading obtained. If I recollect , my first post-op Psa was at the 3 month mark.. Just my way of thinking , Thanks for listening. Radical RPer (lurker) portland, me RRP 5-6-03 PSA since <.04 now Diabetic type 2 I'm not a doctor, but here are some speculations regarding the timing of the PSA testing. Testing much before 6 weeks is too early because it does take some time for the PSA to flush. Using Ralph's number of a PSA half-life of around 3 days, in six weeks (42 days), the PSA should drop by a factor of 2 to the 14th power, or 16,384. His initial PSA of 13.8 should decline to less than .001, which would make it undetectable, if all prostate tissue were removed. So, assuming this was a good test and Mike's PSA sample wasn't contaminated, confused with someone else, inaccurately reported, or otherwise incompetently handled, he still has a significant amount of prostate tissue in his body. That's an important data point. But it's too early to begin treatment. First of all, the surgical trauma needs to heal before radiation can be attempted. Second of all, it would be very useful to get at least two readings so that we can see a trend. It would probably be a mistake to begin either radiation or hormone therapy before knowing whether the PSA is rising rapidly, slowly, or not at all. Alan Alan, The point I was trying to make is that Mike should have a retest ASAP to validate that the result is not an analytical error. These are common and before getting worried or scarred this possibility should be eliminated. I have seen this happen often enough to alert people to have the test rechecked. At his diagnosis PSA level, it all should be gone by now. His pathology report is pristine and he had a non- aggressive GS. All these point to an analytical error. Like you said, even if the PSA is correct, at this point he first has to heal from the surgical procedure before any salvage treatment could be instituted. Let's hope this is one more human error and Mike's prognosis is as good as his other results have been from his surgical treatment. RalphV pcainaz.org/phpbb > I'm not a doctor, but here are some speculations regarding > the timing of the PSA testing. [quoted text clipped - 21 lines] > > Alan On Apr 5, 6:29 pm, PCAi...@gmail.com wrote: > The point I was trying to make is that Mike should have a retest ASAP > to validate that the result is not an analytical error. ... A good point. I agree with it. Alan > I'm not a doctor, but here are some speculations regarding > the timing of the PSA testing. [quoted text clipped - 19 lines] > a mistake to begin either radiation or hormone therapy before > knowing whether the PSA is rising rapidly, slowly, or not at all. This 1996 article, Gleave et al indicates that inflammation as well as half-life are determining factors when to test. They say "The half-life of serum PSA was determined by Stamey et al. [31] using the Yang assay to be 2.2 +/- 0.8 days, and by Oesterling et al. [39] using the Hybritech assay to be 3.2 +/- 0.1 days. These determinations of PSA clearance were made from data obtained from patients in the postoperative period after radical prostatectomy. Clearance of PSA from the serum follows an exponential decay pattern characteristic of first-order elimination kinetics, as indicated by the straight line obtained when the natural logs of serum PSA values are plotted as a function of time. Because of the relatively long half-life of PSA, coupled with slow resolution of inflammation following biopsy or prostatitis, it may take several months for serum PSA to reach its baseline after transurethral prostatic resection (TURP), biopsy, or infection. This is particularly important in assessing elevated PSA levels in patients with resolving prostatitis or after surgery, where reevaluation of serum PSA levels is generally performed after 3 months." http://web.archive.org/web/20050402143500/http://www.prostatepointers.org/brucho vsky/np4/paper.html In a 2003 article, Swanson says there are widely varying estimates on PSA half life in the literature: "The need for proper, albeit simple, quantitative modeling can be illustrated by the example of trying to determine the half-life of PSA following radical prostatectomy. A search on MEDLINE reveals at least a dozen articles on the topic (eg, Bjork et al,6 Haab et al,7 Lein et al,8 Partin et al,9 Ravery et al,10 Richardson et al,11 Semjonow et al,12 and van Straalen et al13). In these articles, we find that the calculated half-life of PSA can range from minutes to days. Clearly, this range cannot reflect the same process. Closer examination of these articles reveals that each group of investigators fits the serum dynamics of PSA after surgery to a different curve." http://www.amath.washington.edu/~swanson/ajcp.pdf --- The Palpable Prostate http://palpable-prostate.blogspot.com > > I'm not a doctor, but here are some speculations regarding > > the timing of the PSA testing. [quoted text clipped - 65 lines] > > - Show quoted text - I haven't read all of those references, but in both of the papers noted below, the authors point out that post-RP PSA decay is "biphasic". This means that the kinetics change during the PSA decay process. For the first few hours the PSA elimination half-life is measured in hours. After this phase, a longer half-life, on the order of days takes over. Partin also notes an initial infusion of PSA during the first hour post-op, so your PSA may initially increase a bit over the pre-op baseline before it begins to decay...Best wishes and good health, ron Urology. 1999 Apr;53(4):722-30; Serum half-life time determination of free and total prostate-specific antigen following radical prostatectomy--a critical assessment; Brandle E, Hautmann O, Bachem M, Kleinschmidt K, Gottfried HW, Grunert A, Hautmann RE. Prostate Suppl. 1996;7:35-9; Clearance rate of serum-free and total PSA following radical retropubic prostatectomy; Partin AW, Piantadosi S, Subong EN, Kelly CA, Hortopan S, Chan DW, Wolfert RL, Rittenhouse HG, Carter HB. > ... > This 1996 article, Gleave et al indicates that inflammation [quoted text clipped - 15 lines] > transurethral prostatic resection (TURP), biopsy, or > infection. ... Sometimes I read things like this and think, Whoa, wait a minute, is that right? And I read it again, and then again. In this particular case, no matter how often I read it I can't seem to get it stand up straight. The author shows a worst case PSA half life of 3.3 days. Then he says that there is an "exponential decay pattern characterisitic of first-order elimination kinetics". I take that to mean that half the PSA disappears in the first 3.3 day period, then half again in the next, and so on. This gives us the "straight line obtained when the natural logs ... are plotted as a function of time." Okay. I've got that part standing up straight. But then comes the wiggly part: it "may take several months for serum PSA to reach its baseline..." How can that be? If several means, say, three, or around 90 days, then there are 27 3.3 day half-life periods in that time. PSA should drop to less than 1/1000th of it's pre- treatment level in only 33 days. Am I missing something? Alan > ... PSA should drop to less than 1/1000th of it's pre- > treatment level in only 33 days. I didn't phrase that quite right. If the treatment is a radical prostatectomy PSA should drop to 1/1000th of the pre-treatment level in 33 days. If the treatment is something else that cures some other condition - infection, inflammation, etc., then the PSA due to that condition should drop to 1/1000th of the pre-treatment level in 33 days, if the condition is 100% cured. PSA should return to baseline + 1/1000th of the increase caused by the condition. I shouldn't criticize others for sloppy writing! Alan > > ... > > This 1996 article, Gleave et al indicates that inflammation [quoted text clipped - 41 lines] > > Am I missing something? The part about "slow resolution of inflammation". --- The Palpable Prostate http://palpable-prostate.blogspot.com >> Am I missing something? > > The part about "slow resolution of inflammation". Ah yes. Got it. Thanks. Alan Alan, I think the quote is missing "after transurethral prostatic resection (TURP), biopsy, or infection." The PSA kinetics are different after radical prostatectomy. Looked at all the references cited by Swanson (the ones I could find) and over all with the exception of the Haab F et al citation all report a half-life that would render Mike's PSA to be UD after 6 weeks. Haab reported a half-life of almost 14 days which could fit Mike's results. A range of 1.2 days to almost 14 days seems extreme... I don't know if Mike is reading this thread, but a retest is in order ASAP to eliminate the possibility of an analytical error. RalphV pcainaz>org/phpbb Source: Bjork T et al. Removal of the prostate resulted in a rapid, biexponential elimination of PSA-F from serum, corresponding to a mean initial (alpha) half-life of 0.81 hours and a mean terminal (beta) half-life of 13.9 hours. Serum PSA-ACT concentrations decreased by 20% to 40% immediately after removal of the gland; the elimination after surgery was slow and nonexponential, corresponding to a mean rate of 0.8 ng/mL/day. Haab F et al After radical prostatectomy: 11/18 patients (61%) showed a one- component exponential decrease in PSA with a half-life of 2.5 +/- 1.33 days (range 0.97-4.6 days), and 7/18 showed a two-component exponential decrease with a first half-life of 0.94 +/- 0.8 days and a second of 7.62 +/- 6.35 days); 100% of the patients reached undetectable serum PSA by day 28 in the first group compared to 14.2% of the patients with a two component exponential decrease (P < 0.01). There was no difference between these groups as far as preoperative PSA levels and specimen pathology were concerned. Lein M et al Could not find at Pubmed Partin AW et al Serum free and total PSA are cleared from the circulation following a "two-compartment" model with an initial constant "infusion." The constant "infusion" is most likely a consequence of surgical manipulation. The initial half-life estimates are < 2 hr for both free and total PSA, and later increase to 22 and 33 hr, respectively. Ravery V et al RESULTS: Group I-the mean half-life was 1.416 +/- 0.723 days for free PSA and 2.43 +/- 0.688 days for total PSA. After prostate removal, free PSA showed a marked increase. Group II-the mean half-life of free PSA was 2.157 +/- 1.792 days and 3.391 +/- 2.337 days for total PSA Richardson TD et al, CONCLUSIONS: Unlike PSA, which has a half life of 2-3 days, the half- life of serum free PSA is 110 minutes (1.83 hours). Rathert P et al When PSA serum half-life was calculated solely in potentially cured patients, we found a half-life of 1.6 days, which is considerably shorter than in previous reports based on patient populations regardless of the outcome of disease in the follow-up. To elucidate the route of PSA elimination, serial urine PSA levels were determined before and after radical prostatectomy, revealing strong evidence for the assumption that PSA is not eliminated by the kidneys in its unchanged form. de Reijke TM et al Could not find at PubMed > > ... > > This 1996 article, Gleave et al indicates that inflammation [quoted text clipped - 43 lines] > > Alan > Haab reported a half-life of almost 14 days which could fit >Mike's results. A range of 1.2 days to almost 14 days seems extreme... If the half-life can vary to this extent then nothing can be taken for granted at the 6 week stage - in which case it might be wiser for Mike to relax and wait until the seemingly conventional 3 month period is up before even considering another, possibly affirming, and possibly premature, result is obtained - particularly if it's also too early to consider SRT. Chasjac also makes a good point about PSA results normally providing at least 1 decimal place of accuracy - and so it needs to be established that this wasn't a communication error, i.e. "1" was actually "0.1". >I don't know if Mike is reading this thread, but a retest is in order >ASAP to eliminate the possibility of an analytical error. On Apr 6, 2:17 pm, PCAi...@gmail.com wrote: > Alan, > I think the quote is missing "after transurethral prostatic resection > (TURP), biopsy, or infection." The PSA kinetics are different after > radical prostatectomy. Gleave et al say in the next sentence: "This is particularly important in assessing elevated PSA levels in patients with resolving prostatitis or after surgery, where reevaluation of serum PSA levels is generally performed after 3 months" Granted its not at all clear as their wording is ambiguous as to what kind of surgery they were referring to but since (1) PSA testing after RP is normally at 3 months (2) the article as a whole is about prostate cancer, (3) if simply poking a needle in a prostate can elicit inflammation I would think removing it could also result in infllamation so I think they intended their comments to including prostatectomy. By the way, Swanson attributes the large variation in half life to different investigators using different models in support of his thesis that models should have a biological basis and not simply be empirical. Interestingly enough, he does not attribute it to the data itself. --- The Palpable Prostate http://palpable-prostate.blogspot.com > It may have something to do the life span of the red blood cells being > flushed and a fresh PSA reading obtained. If I recollect , my first [quoted text clipped - 5 lines] > PSA since <.04 > now Diabetic type 2 Good to hear from you again, Owen. Great PSA!!! Sorry about that diabetes crap. You've had enough to fight. 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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05 Non Illegitimi Carborundum > ... my 6 week post -surgical PSA is 1. They want me to wait 6 more > weeks (a total of 3 months) before we check it again. ... Rats! That's not what anyone likes to hear. As others have said, 1 is too high. It is my understanding that radiation should not be performed until several months after surgery because the tissues won't heal properly from the surgery if they are radiated too soon. The fact that the margins were clear is also a little disturbing. It might mean that the remaining prostate tissue is elsewhere in the body. This is something to ask about. The best hope at this time may be that the surgeon didn't do a great job and left some prostate tissue behind in the prostate itself. It happens quite often I think. If that happened, then there is a decent chance that radiation will kill it. I think it is a good idea to start now to line up a radiation oncologist and get in the schedule for treatment. If it takes a month or two to schedule it, then you might be able to start the process now and abort it if something happens to change your mind (a drop in PSA or definite evidence of metastasis.) Maybe you can ask for advanced testing, like the PET scans that people are saying can detect metastatic cancer before a bone scan can. I know that this is frightening as hell, but no matter what happens or how badly it turns out, you've still got a bunch of years ahead of you, and there are still a bunch of treatment options, even for metastatic cancer, that might give you a bunch more, and the number of treatment options seems to increase every year or so. Best of luck. Alan "Maybe you can ask for advanced testing, like the PET scans that people are saying can detect metastatic cancer before a bone scan can." Does anyone have any experience w/ these? I am going to a new med-onc at Dana Farber in a few weeks and he wanted a bone scan and CT, which I had Tues. I happened to be touring the hospital last week and asked a radiologist about the 18F Flouride PET/CT scan. He conferred w/ "the guru" and said a bone scan was sufficient. Looking at the scan and talking w/ the tech, it looked like there had been no change in the last 3 years when my PSA went from .37 to 1.6. I hate to think it was just another worthless test when something better was available. Bill Denton RP 2/12/02 PSA 1.6 Memphis > "Maybe you can ask for advanced testing, like the PET scans that > people are saying can detect metastatic cancer before a bone scan > can." > > Does anyone have any experience w/ these? As my PSA rose from 6.4 to 21, I had a PET-scan and Prostascint, these did not pick up anything. At PSA 21, I had a bone scan, it pickup up what the MRI revealed to be a slight compression fracture of a vertebra. My opinion is that these tests can be good but are far from perfect. The PET-scan was at a local commercial imaging center. Johns Hopkins did the Prostascint; they're top notch. Inova's nuclear medicine department did the bone scan. I think these tests are pushing the physical limits of the technology. -kh > "Maybe you can ask for advanced testing, like the PET scans that > people are saying can detect metastatic cancer before a bone scan [quoted text clipped - 13 lines] > PSA 1.6 > Memphis Hi Bill...Here is a reference that compares the various scan techniques for detecting bone mets. J Nucl Med. 2006 Feb;47(2):287-297; Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I.; The Detection of Bone Metastases in Patients with High-Risk Prostate Cancer: 99mTc-MDP Planar Bone Scintigraphy, Single- and Multi-Field-of-View SPECT, 18F-Fluoride PET, and 18F-Fluoride PET/CT. Here is a table that summarizes their findings... sensitivity specificity positive pv negative pv planar BS 70% 57% 64% 55%, spect BS 92% 82% 86% 90%, 18F PET 100% 62% 74% 100% 18F PET/CT 100% 100% 100% 100% Here is a summary of what the various terms mean... Test Positive Test Negative Disease Present True Positive (TP) False Negative (FN) Disease Absent False Positive (FP) True Negative (TN) SENSITIVITY: The Sensitivity of a test is the percentage of all patients with disease present who have a positive test. __TP___ = Sensitivity TP + FN SPECIFICITY: The Specificity of a test is the percentage of all patients without disease who have a negative test. __TN___ = Specificity FP + TN PREDICTIVE VALUE: The predictive value of a test is a measure of the times that the value (positive or negative) is the true value, e.g. the percent of all positive tests that are true positives is the Positive Predictive Value. __TP___ = Positive Predictive Value TP + FP __TN___ = Negative Predictive Value FN + TN ...Best wishes and good health, ron Thanks, Ron; that report is the reason I asked the radiologist about it, and when I went in to get my scans Tues. I left a copy for him. It's really frustrating to constantly be more up on developments than doctors in practice. Of course, they don't have this forum or the time to monitor it. Bill Denton RP 2/12/02 PSA 1.6 Memphis > Thanks, Ron; that report is the reason I asked the radiologist about > it, and when I went in to get my scans Tues. I left a copy for him. > It's really frustrating to constantly be more up on developments than > doctors in practice. Of course, they don't have this forum or the time > to monitor it. Because they *do* have access to this forum but most of them poo-poo the internet and any other source of data we offer including research literature, I attribute their reticence to accept contrary patient input to arrogance, find a different doctor, and, if blatant, report their uppity a.ses. I've even seen their attitudes put them in personal, physical danger in street situations where their MD degree and experience meant zilch (think their scrubs mean squat to an angry redneck in the woods?). I.P. > ... > Here is a table that summarizes their findings... > sensitivity specificity positive pv negative > ... > 18F PET/CT 100% 100% 100% 100% That's amazing! If I understand it correctly, it's saying that 18F-Fluoride PET/CT scans are 100% accurate at detecting bone mets. Did I understand it correctly? Shouldn't everyone be using this technique? Alan On Apr 6, 10:52 am, "Alan Meyer" <amey...@yahoo.com> wrote...snip... > Shouldn't everyone be using this technique? Hi Alan...Yes, but my understanding is that it is relatively new and not widely available. Dr. Strum still reccomends travel to Israel to have it performed by the authors of the study I cited. I've also heard that it is now available at The Dattoli Cancer Center & Brachytherapy Research Institute, 2803 Fruitville Road, Sarasota, Florida 34237, 1-877-328-8654 www.dattoli.com and Oregon Advanced Imaging (OAI) located in Medford, Oregon ...Best wishes and good healtth, ron > Does anyone have any experience w/ these? I am going to a new med-onc > at Dana Farber in a few weeks and he wanted a bone scan and CT, which [quoted text clipped - 4 lines] > last 3 years when my PSA went from .37 to 1.6. I hate to think it was > just another worthless test when something better was available. Paul Williams, M.D. just stopped by a day or two ago. It would be great if he saw your question. If not, his email is N268ME@gmail.com. Otherwise, I have seen several opinions about the PET when combined with CT with specific reference to our disease (maybe one from Dr. Williams). If I can recall correctly, the average opinion was that it is a fantastic technology, to be sure, and that in the right hands, may be of some value. There seems to be an expectation that it will become even better as operators gather experience and feed it back to the manufacturers. > > Does anyone have any experience w/ these? I am going to a new med-onc > > at Dana Farber in a few weeks and he wanted a bone scan and CT, which [quoted text clipped - 4 lines] > > last 3 years when my PSA went from .37 to 1.6. I hate to think it was > > just another worthless test when something better was available. Good friend of mine is a young radiologist. Iasked him about PET scans for Pca and this is his response. Fred PET scans for Prostate cancer are not often done, and as far as I know are not generally approved by Medicare and 3rd party payers (insurance companies). 1 of the major reasons is that to detect local recurrence you need to be able to see the pelvis well. FDG (the radioactive agent used in PET scanning) is excreted by the kidneys and therefore collects in the urinary bladder. This makes evaluation of things in the pelvis dicey at best. Another problem is that PET scans detect elevated metabolic activity (which most cancers show), but Prostate Cancer metastasis generally have low metabolic activity and are slow growing. This decreases detectability. The primary site for Prostate mets is the bone, and standard whole body bone scans are very good at detection of these. There have been reported cases in the literature of PET scans detecting spread to nodes before they can be anatomically detected on a standard CT scan, but the research for this is ongoing as far as I know. There is another nuclear medicine agent called Prostascint, which is more specifc to cells of prostate origin, but I have no experience in using it. |
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