 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / January 2008New PSA test results
DIAGNOSED AUGUST 2007 AND THESE TESTS AND RESULTS ENSUED: Age-59 T1c Gleason score 6 (3+3) PSA 3.17 as of August, 2007 PSA doubled in 22 months Bone Scan-Negative CAT Scan-Negative DRE-Negative Had PSA test on January 9, 2008 PSA is 2.13 No sex for 48 hours prior to test, no bike riding etc.. What is one to "make" of that new PSA value? Thanks, Sy > DIAGNOSED AUGUST 2007 AND THESE TESTS AND RESULTS ENSUED: > [quoted text clipped - 10 lines] > > PSA is 2.13 Lower PSA number on your recent test is good, BUT since you've already had a biopsy done that indicated G3+3, it seemed to me that you've got PCa, albeit slow growing. If I were in your position, I'd do these 3 things: 1. contact another lab to review and confirm the slides 2. contact the JHU researcher that is currently doing a study on PCa marker other than PSA (they claimed 93% accuracy) and see if they are interested in your participation 3. I think there is another Australian research that uses semen to detect PCa (HCA-2), also with high accuracy. In any case your previous rise to 3.17 PSA could be due to sex/ ejaculation/biking, but the bottom line is you had a biopsy that says adenocarcinoma, so now you have to resolve what that means. If you're lucky, the first analysis was in error, then you can continue your watchful waiting. >> DIAGNOSED AUGUST 2007 AND THESE TESTS AND RESULTS ENSUED: >> [quoted text clipped - 10 lines] >> >> PSA is 2.13 Congratulations Sy, on the result of your latest test. > Lower PSA number on your recent test is good, BUT since you've already > had a biopsy done that indicated G3+3, it seemed to me that you've [quoted text clipped - 6 lines] > 3. I think there is another Australian research that uses semen to > detect PCa (HCA-2), also with high accuracy. Sy could do these things and participate in many other less established tests, but why should he? He knows he has cancer. Under generally accepted NCCN practice guidelines his choice not to treat the cancer is considered prudent and the new PSA value only confirms that he made a responsible choice: the cancer may not have any adverse impact the next 20 years, while side effects of any treatment are very likely to occur. > In any case your previous rise to 3.17 PSA could be due to sex/ > ejaculation/biking, but the bottom line is you had a biopsy that says > adenocarcinoma, so now you have to resolve what that means. If > you're lucky, the first analysis was in error, then you can continue > your watchful waiting. As to the significance of free PSA, see http://tinyurl.com/2ve7kp Neither has PSA density been found to be an improved marker over serum PSA. http://www.medscape.com/viewarticle/489253_1 Note that neither Sy's former nor his current PSA value, taken by itself, would lead a doctor to recommend a biopsy in the first place (table II). Note further that most of the ng members that ridiculed Sy's choice, suggesting that he was out of his mind not to get rid of "the beast inside" with his numbers are now remarkably silent. That's considerable progress. [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] Safire, It's way too early for me to gloat, but thanks very much for your supportive comments. Sy > >> DIAGNOSED AUGUST 2007 AND THESE TESTS AND RESULTS ENSUED: > >> [quoted text clipped - 52 lines] > inside" with his numbers are now remarkably silent. That's considerable > progress. >>> DIAGNOSED AUGUST 2007 AND THESE TESTS AND RESULTS ENSUED: >>> [quoted text clipped - 30 lines] > responsible choice: the cancer may not have any adverse impact the next > 20 years, while side effects of any treatment are very likely to occur. What is your basis for concluding that side effects of treatment are very likely to occur? If you mean short term side effects, then you are correct. But if the person who treats him is skilled at the treatment, the likelihood of long term incontinence is extremely low, and at his age, the likelihood of long term impotence is not specially high. It is certainly less than 50 percent. I would not say something is very likely to occur unless its probability were at least 70 percent. My guess is that if he had surgery by a skilled surgeon, his likelihood of long term impotence would be at most 30 percent. >> In any case your previous rise to 3.17 PSA could be due to sex/ >> ejaculation/biking, but the bottom line is you had a biopsy that says [quoted text clipped - 12 lines] > itself, would lead a doctor to recommend a biopsy in the first place > (table II) Given that he knows he has prostate cancer, that is irrelevant. > Note further that most of the ng members that ridiculed Sy's choice, > suggesting that he was out of his mind not to get rid of "the beast > inside" with his numbers are now remarkably silent. That's considerable > progress. I don't think his situation is much different than it was before. He has to get some expert advice from a medical authority who look at him, and decide whether expectant management or some variation of that is a viable choice. He shouldn't rely on advice obtained on the internet. It is possible that some people ridiculed his choice, but I think most people said essentially what I just said. > What is your basis for concluding that side effects of treatment are > very likely to occur? If you mean short term side effects, then you are [quoted text clipped - 5 lines] > guess is that if he had surgery by a skilled surgeon, his likelihood of > long term impotence would be at most 30 percent. Leonard, there are no objective criteria to determine how skilled a urologist is; moreover, the urologists that advertise their high success ratio in avoiding long term side effects may be selective when they accept patients for treatment. According to http://www.nccn.org/patients/patient_gls/_english/_prostate/5_side-effects.asp from NCCN, according to some people in this ng "just a website", but in my opinion a source with authority: - during the first 3 to 18 months after RP, most men will have erectile dysfunction - nearly all men who have a RP should expect some permanent decrease in their ability to have an erection, though younger men may expect to retain more of their ability. If the surgeon does not remove the nerves on either side of the prostate during prostatectomy, the impotence rate is between 25% and 30% for men under 60. But it occurs in 70% to 80% of men over 70, even if nerves on both sides are not removed. (I remember some other study reporting that at age 60 the risk is over 50%, and that unilateral or bilateral nerve sparing, if possible, doesn't make much difference (a few percentage points only) - about 30% to 70% of men who receive external beam radiation develop impotence. Impotence usually does not occur right after radiation therapy, but gradually develops over one or more years. So in general, the risk that side effects will occur is more likely than not. >>> In any case your previous rise to 3.17 PSA could be due to sex/ >>> ejaculation/biking, but the bottom line is you had a biopsy that says [quoted text clipped - 15 lines] > > Given that he knows he has prostate cancer, that is irrelevant. That is entirely correct. That's why I wrote "taken by itself". But, in general, if PCa is overtreated, it's in part because biopsies are taken even when not indicated. >> Note further that most of the ng members that ridiculed Sy's choice, >> suggesting that he was out of his mind not to get rid of "the beast [quoted text clipped - 5 lines] > and decide whether expectant management or some variation of that is a > viable choice. He shouldn't rely on advice obtained on the internet. I don't think he ever relied just on advice obtained on the internet. > It is possible that some people ridiculed his choice, but I think most > people said essentially what I just said. As a scientist you have based your opinion on facts. I referred to people that ridiculed Sy's decision but were not at all interested in the facts (among them: Beverly and Steve Kramer). They attacked Sy's rational approach and, based on purely emotions, ridiculed his choice. Kramer called Sy a "gambler" and asked him whether he expected to crash in an airplane. Beverly, opined that "all cancers in otherwise healthy men should be treated" and that Sy should just accept the side effects. >> What is your basis for concluding that side effects of treatment are >> very likely to occur? If you mean short term side effects, then you [quoted text clipped - 10 lines] > ratio in avoiding long term side effects may be selective when they > accept patients for treatment. Of course that may be true. But hospitals sometimes follow up and keep track of results. For example, I enrooled, at the suggestion of my surgeon, in such a study which followed me for at least two years. That would seem to put a break on a surgeon inflating his statistics. Also, hmos and insurance companies sometimes keep track of such matters. Increasingly, Medicare is doing it. So physicians don't find it quite so easy to mislead in such matters. Perhaps I was fortunate, but I believe my surgeon at least was pretty honest with me about my prospects were he to do the surgery. Surgeons should be selective. For example, they should not do surgery for patients that have a high risk of metastatic prostate cancer, and they should not do surgery for men who don't have an expected lifetime of at least 10 years. That is written into the practice guidelines of the American Urological Association. Of course, some physicians are dishonest, but I think it is a big mistake to assume they all are or even that many are. > According to > http://www.nccn.org/patients/patient_gls/_english/_prostate/5_side-effects.asp > > from NCCN, according to some people in this ng "just a website", but in > my opinion a source with authority: I didn't thoroughly study that web page, but I found nothing to dispute what I said. > - during the first 3 to 18 months after RP, most men will have erectile > dysfunction Note that i was discussing long term erectile dysfunction. I agree that almost all men will be impotent for some such period after RP. but the site says also that only 25-30 percent of men under 60---Sy is 59 I believe---will be permanently impotent. That is pretty much what I said. Of course, as men age, more will be impotent after RP. Of course, many men will become impotent as they age without surgery. I will also agree that many men, although not impotent will experience some degree of decrease of erectile function. But the relevant question is whether men in general after RP can maintain a satisfying sex life. For some men, particularly younger men, there is little difference before and after. For others, like myself, it is possible to continue is a manner satisfying to the man and his partner, albeit not quite the same as before surgery. Even men who are essentially totally impotent, so that even Viagra doesn't help, can often continue using a pump, injections, or an implant. For example, i was impotent for 18 months following surgery and during that time I used a pump. My wife and I resumed our sex life about six weeks after surgery and continued it about at the same frequency as before surgery. The possible range of losses in erectile function have to be balanced against the benefit from possibly curing the disease. Remember in this context that the consequences of not treating prostate cancer may also be quite serious and include impotence as well as a complete lack of interest in sex because of ADT. It is not a matter of black and white; there are many shades of gray in between. > - nearly all men who have a RP should expect some permanent decrease in > their ability to have an erection, though younger men may expect to [quoted text clipped - 12 lines] > So in general, the risk that side effects will occur is more likely than > not. From the very figures you quote, the risk of permanent long term impotence is not greater than 50 percent for a man of age 59. Perhaps you don't understand the meaning of "more likely than not". Also, note that for older men, you have to look at the increase in the risk of impotence due to treating prostate cancer over what it would have been anyway. >>> What is your basis for concluding that side effects of treatment are >>> very likely to occur? If you mean short term side effects, then you [quoted text clipped - 19 lines] > Increasingly, Medicare is doing it. So physicians don't find it quite > so easy to mislead in such matters. Are you aware of any published list rating surgeon's skills with respect to prostatectomies, i.e. a list that a prospective patient could rely on to find that skilled practitioner, assuming he would travel a long distance, possibly overseas, to reduce the risk of side effects? How does a patient know if a surgeon is skilled, if he doesn't want to rely just on the surgeon's own claims? If radiation is elected, are skills as relevant in avoiding SE? >>>> What is your basis for concluding that side effects of treatment are >>>> very likely to occur? If you mean short term side effects, then you [quoted text clipped - 26 lines] > does a patient know if a surgeon is skilled, if he doesn't want to rely > just on the surgeon's own claims? There are some tools available for that, but I agree they aren't sufficient and many men would not know how to use them. At the very least, you can check a surgeon's training and make sure he/she is Board Certified. That information may be available online, but it can also be found in a standard reference book which should be at any reasonable public library. Generally graduation from a good medical school and training at an established medical center ensuresa minimum level of competence. You can also ask your surgeon how many such surgeries he has done and how many in the past year or so. If he only does them occasionally, he can't be considered skilled. Finally, you can call one of the medical centers which specialize in treating prostate cancer and ask for a local surgeon. Walsh's office, for example, at one time was happy to make recommendations. Of course most likely they will recommend someone they trained, but that is worth something. There are also various agencies which rate doctors. Something called Checkbook has a listing of the best doctors in the Chicago area in each specialty. they compile such lists by asking other physicians where they would send members of their own families, and those that get several such recommendation appear in the list. It included my surgeon, but I didn't find that out until after I had had my surgery. > If radiation is elected, are skills as relevant in avoiding SE? I've read in several places, including Walsh's book, that such is the case. The results of radiation therapy are less dependent on the physician, though of course you are better off with a high skilled practitioner who is familiar with the procedure. > Had PSA test on January 9, 2008 > > PSA is 2.13 > > What is one to "make" of that new PSA value? Your PSAD (if including your 2005 PSA) seems to be 4½ years. If so, it would appear that you have bought yourself another few months of Watchful Waiting, should that be your desire -- and I assume it is. As we have discussed before, it makes no sense at all that PSA would go down in an untreated man diagnoses with prostate cancer by biopsy. But, for some reason, it sometimes happens. The first that jumps to mind is Alex. He also is working on WW. He might be of some help to you in this. There have been seven others who tried WW, but none have been back in years so I don't know their fates. I knew two who ended up getting treatment, but I don't know what happened after that.  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, <0.04, <0.04 10/11/07 Non Illegitimi Carborundum [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] Hi Steve, I just spoke to my Internist who believes that what may have happened is that when I had the PSA done in August (3.17) I may have had an inflammation which has since subsided and going for the biopsy and being diagnosed with Pca was a serendipitous event based upon that PSA reading. Was wondering how you figured my PSAD ? Thanks for your feedback. Sy > > Had PSA test on January 9, 2008 > > [quoted text clipped - 14 lines] > so I don't know their fates. I knew two who ended up getting treatment, but > I don't know what happened after that. > [[ This message was both posted and mailed: see > the "To," "Cc," and "Newsgroups" headers for details. ]] [quoted text clipped - 12 lines] > > Sy Sy...Your docs theory is reasonable. In my mind, the question now becomes were these normal cancerous cells that harbored the infection. If cancerous, and you appear to have a small amount of these, then it may suggest that the cancerous cells are close to the surface of the prostate (e.g. in order for a small volume of cells to have a significant effect, they may be located closer to surface), a less desirable location. I think AS is a reasonable choice for many men, but as the name implies increased vigilance is part of the game. Have you already had your slides reread by an expert (search "artist" in this NG, or check out the listing ar the PCRI website). If you really have Gleason 7, that may alter your thinking. Also a color doppler ultrasound, by an artist, should be able to determine the location of your tumor(s). Again, if close to the surface or margin of the prostate, this may alter your decisions...ron >> [[ This message was both posted and mailed: see >> the "To," "Cc," and "Newsgroups" headers for details. ]] [quoted text clipped - 29 lines] > Again, if close to the surface or margin of the prostate, this may > alter your decisions...ron Ron's advice is quite relevant. There is quite a big difference between Gleason 6 and Gleason 7. I doubt if many medical experts would recommend expectant management for a Gleason 7 cancer. > [[ This message was both posted and mailed: see > the "To," "Cc," and "Newsgroups" headers for details. ]] [quoted text clipped - 6 lines] > being diagnosed with Pca was a serendipitous event based upon that PSA > reading. That was my guess about what had happened. > Was wondering how you figured my PSAD ? I don't know how Steve did it, but I came up with a little over 5 years for the PSAD. I will be glad to explain what I did. From your figures, I assumed that you started at 3.17/2 ~ 1.59 about 26 months ago. If we ignore the August reading, that means the ratio for the increase over 26 months was 2.13/1.59 ~ 1.34. Assuming exponential increase of the form C e^{kt}, that gives us a time constant k = ln(1.34)/26 ~ 0.0113. Then the doubling time would be ln(2)/k ~ 61.6 months. Of course, making this calculation with just two data points is meaningless, and you shouldn't put much faith in my calculation. Certainly don't make any decisions based on it. There is quite a bit of error in PSA measurements. My urologist said it could normally vary by as much as 0.5. And we can't even be sure the PSA is growing exponentially. To get a more accurate picture, you need to have more measurements. Your doctors can presumably advise you about how often you should do that, given that you know you have prostate cancer. By the way. how consistent were your previous PSA measurements 26 months ago, and are you fairly confident they weren't elevated for extraneous reasons? Good luck. > Thanks for your feedback. > [quoted text clipped - 17 lines] >> so I don't know their fates. I knew two who ended up getting treatment, but >> I don't know what happened after that. >> Was wondering how you figured my PSAD ? > > I don't know how Steve did it, but I came up with a little over 5 years > for the PSAD. I had a slight advantage. I had his PSAs back to 2005. Though he was not yet diagnosed in 2005, we know it's a long-progressing disease, so I thought it fair to use it. So, his data points were: 1.8 (2005), 2.7 (2006), 3.7 (8/2007), and 2.13 (1/2008). I assumed June 1 for 2005 and 2006. SRK |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.