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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2007PSA Test Reliability
Notwithstanding the nay-sayers, "Prostate-Specific Antigen Improves the Ability of Clinical Stage and Biopsy Gleason Sum to Predict the Pathologic Stage at Radical Prostatectomy in the New Millennium." Chun FK, et al. PubMed ID: 17383807 See, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi .....and search on the ID number. Their conclusion: "In the new millennium, PSA has not lost its ability to accurately predict the pathologic stage in contemporary patients." ---even though they split an infinitive ;-) it seems valid Regards, Steve J "No patient in a civilized society should present with a PSA level that is in double digits. Routine PSA testing on a yearly basis (initially) would virtually eliminate any advanced presentation of prostate cancer, increase the number of patients presenting with true organ confined prostate cancer, increase our ability to cure this disease, decrease health care costs from having to treat more advanced presentations, improve productivity of those men diagnosed with prostate cancer and of course most importantly improve the quality and the duration of life with men diagnosed with this illness." -- Stephen B. Strum, MD IMHO - PSA test is useless in many cases, including mine - mine never went above 3.15 yet I had agressive prostate cancer http://prostate-cancer-log.blogspot.com Joe joec_49@hotmail.com >Notwithstanding the nay-sayers, > [quoted text clipped - 28 lines] >with this illness." >-- Stephen B. Strum, MD JoeC replied to me: > IMHO - PSA test is useless in many cases, including mine - mine never > went above 3.15 yet I had agressive prostate cancer Perhaps Joe has not read the abstract I cited. If he had, he would be aware that it refers to *localized* PCa. I, too, was dxd with aggressive PCa. Such a dx requires aggressive tx. We must take great care when reading abstracts and other such items. Each of us is different; what helps you might harm me, and vice versa. The essential point is: where does each of us fit in the cohort reported on in the abstract? Joe apparently does not fit into the present cohort. Neither do I but that is no reason not to pass along information that just might be helpful to my brothers. Regards, Steve J "No man is an Island, entire of itself; every man is a piece of the Continent, a part of the main; if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friends or of thine own were; any man's death diminishes me, because I am involved in Mankind; And therefore never send to know for whom the bell tolls; It tolls for thee." -- John Donne > http://prostate-cancer-log.blogspot.com > [quoted text clipped - 33 lines] >> with this illness." >> -- Stephen B. Strum, MD Joe I "inadvertently" had a PSA test 10 years ago which was 3.4 - I was told to "watch it" didn't even know what it was! Five years later I had another - again 3.4. Then, this January, I had one which was 13! I went to a hospital here in Hong kong where I live and they took it again - it was 9. Eventually I went to a private ( read - expensive) urologist who gave me a free PSA ratio - came out 15 ( ambiguous). He then put me on anti-biotics and anti-inflamatories for 1 month before giving me another free PSA Ratio - this one was 15 again, but total PSA had dropped to 7.8. Now he says I should have a biopsy ( which I don't want). I honestly believe he just wants the money! I have just seen another urologist in Bangkok - who says he wouldn't give me a biopsy - he would just watch it. Personally I am of the opinion that the medical profession don't know what PSA is telling them - of 1.3 million biopsys in USA less than 15% find cancer - I think that's pretty poor - the urologist in bangkok say the obsession with biopsys is really about "malpractice" law suites in the USA. I'm suprised no-one here is talking about the new EPCA 2 test - which will be here in 18 months. I'm drinking pomegrante juice and am intending to live long enough to have one. I was 58 yesterday. Best wishes Pete Kline ------------------ > JoeC replied to me: > [quoted text clipped - 64 lines] > >> with this illness." > >> -- Stephen B. Strum, MD > Joe > [quoted text clipped - 24 lines] > > I was 58 yesterday. I don't know the status of medicine in Hong Kong since 1999. If the labs are good, the fluctuation seems to indicate BHP -- which still has to be treated, but is not as bad as Cancer. That said, you fPSA looks like Cancer. The only way to find out which is biopsy.... and maybe multiple biopsies if the first comes up negative. Happy birthday! If you want to a lot more, get the biopsy.  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 "inadvertently" had a PSA test 10 years ago which was 3.4 - I was >told to "watch it" didn't even know what it was! Five years later I [quoted text clipped - 27 lines] >Pete Kline >------------------ Hi Pete. I'm just a lowly PCa patient with no specialist knowledge. From what you write you appear to be a dyed-in-the-wool watchful-waiter. Whatever your suspicions about the medical profession and its arguably indecent haste in pushing folk into having needless biopsies, I'd say 15% is a significant tally of positive outcomes. Yes, of course it would be great to have a procedure both non-invasive AND reliable and I'm sure everyone here is just as excited as you about the EPCA2 test but it's probably not overly discussed because it's not here yet. While PSA may be a less than perfect marker, there's not much else going for us at the moment and the inexactness of PSA and biopsy testing is not a good reason to cast them aside, I believe. Would you perhaps begin to attach some significance if your PSA dynamics were to show a velocity or acceleration? Of course I hope they don't! As to your urologist's mercenary bent - I don't see why that can't happily co-exist with his conscientious efforts to look out for your good health. Good luck. ... But if you are one of the unlucky 15% who have cancer, your statistic is 100%. Remember - there are lies, damned lies, and staticstics. Get the biopsy. (PCa survivor, 7 years clean after RP.) - Larry A. >>I "inadvertently" had a PSA test 10 years ago which was 3.4 - I was >>told to "watch it" didn't even know what it was! Five years later I [quoted text clipped - 45 lines] >conscientious efforts to look out for your good health. >Good luck. > I "inadvertently" had a PSA test 10 years ago which was 3.4 - I was > told to "watch it" didn't even know what it was! Five years later I [quoted text clipped - 9 lines] > Now he says I should have a biopsy ( which I don't want). I honestly > believe he just wants the money! I think your doctor is giving you good advice. He tried to eliminate other factors and he gave you an fPSA test in another effort to avoid the biopsy so he has really done everything that could be expected. Yet even after all that your PSA is high and your fPSA failed to exclude prostate cancer. Based on this online calculator: http://www.compass.fhcrc.org/edrnnci/bin/calculator/main.asp and using Caucasian, 58, 7.8, No, Normal, No as the responses it says you have roughly even odds of having or not having cancer. I answered the questions I did not know, e.g. family history, in a way which favors non-cancer so if I answered them wrong your chances are higher. BTW, this and many other prostate cancer calculators are listed here: http://palpable-prostate.blogspot.com/2007/02/prosate-cancer-calculators.html Note that a biopsy really is not that bad. I found it only mildly uncomfortable and you can always ask for anaesthetic if you have concerns. > I have just seen another urologist in Bangkok - who says he wouldn't > give me a biopsy - he would just watch it. Personally I am of the > opinion that the medical profession don't know what PSA is telling > them - of 1.3 million biopsys in USA less than 15% find cancer - I > think that's pretty poor - the urologist in bangkok say the obsession > with biopsys is really about "malpractice" law suites in the USA. This is a controversial subject but cancer can be best treated if its caught early and I think many people would say its worthwhile to have a number of healthy individuals undergo biopsy in return for catching cancer early in most men who have it. > I'm suprised no-one here is talking about the new EPCA 2 test - which > will be here in 18 months. I'm drinking pomegrante juice and am > intending to live long enough to have one. Hopefully EPCA-2 works well but its not available yet, there are limitations to the generalizations you can make from the study due to its non- representative sample, some of the media reports had significant errors in reporting and anyone who has been around the cancer scene for a while starts getting weary of the numerous "breakthroughs" that never seem to pan out when subjected to greater testing. See the following for some cautions: http://www.cancer.org/aspx/blog/Comments.aspx?id=145 --- The Palpable Prostate http://palpable-prostate.blogspot.com Hello, Pete: Based on your numbers, I really think that the doctor's advice is coming from the right place. You may disagree with the next step being a biopsy, but with what you have presented here -- big change in PSA, free PSA ratio in the ambiguous range -- you are at risk, and should take some measures to find out what you have. You mention the EPCA-2 test. While it will be a big help in the arsenal against PCa, I really do not think that it's going to replace biopsies as a part of the diagnostic process. In order to decide the best treatment for the newly diagnosed, the Gleason score of the tumor cells will still need to be known, and if I'm reading the JHU report correctly, the EPCA-2 will not do that. And it won't be available for 18 months. While PCa is usually slow- growing, giving it such a head start does not seem to be wise. You did not mention a DRE, so I'm assuming that it was negative for irregularities. Is that correct? --charlie Thanks for all your very reasonable replies guys. I still need to do some serious thinking - if I'm still "watching and waiting" any suggestions as to when I should get another PSA test - 3 months, 6 months, 1 year? best wishes to you all Pete ========== > Hello, Pete: > [quoted text clipped - 18 lines] > > --charlie >Thanks for all your very reasonable replies guys. I still need to do >some serious thinking - if I'm still "watching and waiting" any >suggestions as to when I should get another PSA test - 3 months, 6 >months, 1 year? > >best wishes to you all in your shoes I would opt for a biopsy as soon as is convenient (make sure you get the anesthetic shot then it's really no biggy). If that proves negative - GREAT! - but keep doing the PSAs 3-monthly because the biopsy can miss the cancer, if present, and you need to see if there's any change in your numbers. If the biopsy shows an early cancer, typically T1 gleason (3+3) or better, you could still opt for WW while monitoring your continued 3-monthly PSAs for any change, but make sure you read up thoroughly on the implications of WW and have your future strategy mapped out well ahead. If you decide against a biopsy - then I suspect you'd be advised to check your PSA 3-monthly for changes. (I'm not a doc!) > Thanks for all your very reasonable replies guys. I still need to do > some serious thinking - if I'm still "watching and waiting" any > suggestions as to when I should get another PSA test - 3 months, 6 > months, 1 year? Determining probability of cancer just by PSA is a foolish quest. However, if that's what you end up doing, quarterly PSA tests seem to be the norm for your circumstances (in my unprofessional opinion). I don't believe I have heard you mention a digital rectal exam. Have you had one? If so, what is normal or abnormal? If normal, you have about a 28% chance of having cancer according to the formula you've already been introduced to. If abnormal, I think it was 51%. If you haven't had a DRE, I think that is your next step and should be done as soon as possible. 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 Steve I have ended up having so many DREs the doctor is sending me valentine cards! : ) Apart from enlarged I'm told no hard lumps etc(normal?) . sincere thanks for your advice. I will have another PSA in 3 months and then take it from there. wishing you luck and good health Pete =========== > > Thanks for all your very reasonable replies guys. I still need to do > > some serious thinking - if I'm still "watching and waiting" any [quoted text clipped - 25 lines] > PSA <0.04, <0.05 > Non Illegitimi Carborundum : Steve : [quoted text clipped - 8 lines] : Pete : =========== <Remainder snipped> Pete, if you trust your doctor (and I sense this is an issue with you) and he recommends a biopsy, I'd go for it. It's not the most pleasant experience you'll ever have, nor is it the worst. My urologist, really a very kind man, performed my biopsy, 13 cores, without even suggesting anesthetic and I survived it, and it revealed more than the finger or the PSA. No one, especially men, I believe, want probes up into places where no probes are supposed to go, but it's sometimes necessary to learn what's taking place "in there." A colonoscopy is no fun, either. Ken Bland > Steve > [quoted text clipped - 7 lines] > > Pete Okay, Pete. I wish you luck. There is a 100% certainty that I have cancer and, without a medical breakthrough, I will die of it. With a PSA of 15 and a 'normal' prostate, there is a 50% chance you have cancer. Don't wait until you catch up with me. 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 have ended up having so many DREs the doctor is sending me valentine > cards! : ) Apart from enlarged I'm told no hard lumps etc(normal?) . Abnormal is when its "palpable". That means either the doctor can feel nodules or else the overall feel is hard. Such hardness is also called induration. Its somewhat subjective although an experienced doctor would have felt more prostates and therefore would presumably be in a better position to know the normal range of hardness. --- The Palpable Prostate http://palpable-prostate.blogspot.com |
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