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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2008PSA Doubling Time Question
Hi! I am wondering what effect a rather high PSA Doubling Time is on my condition and prognosis. Here's a bit of background: - Was referred to a urologist in October 2007 due to a PSA of 7.5 - Initial biopsy resulted in an indication of PCa - RP set for January 9th, 2008 - Asked for a second opinion on the pathology report. The second opinion from another lab came back inconclusive. - Operation cancelled. - Second biopsy performed - 19 samples taken - pathology report indicated that two had 5% cancer - PSA is now 10.7 which means a Doubling Time of 10 months. - Going for a RP asap. Now, my question: What could the high PSADT mean when it appears that there is minimal cancer in the prostate? Could the cancer have gotten out of the prostate already? Thanks so much for your thoughts!! Ernie Adsett Stats: > PSA 7.5 10/15/2007 @ 55// 10.7 2/20/2008 @ 55// DT = 10 months > Biopsy 1/15/2008 G6 (3+3), T1c > RRP (planned) asap > What could the high PSADT mean when it appears that there is > minimal cancer in the prostate? Could the cancer have gotten out of > the prostate already? The good news is that the PSA difference between 7.5 and 10.7 is not a tremendous one. It will put you into the next set of Partin tables, but 10.7 is closer to 10.0 than 7.5 is to 6.0. And, if you haven't researched Partin Tables, don't worry about it. Partin Tables are used for decision making and your decision regarding surgery is already made. As far as having gotten out of the prostate, sure. Is it likely? No. PCa is very slow growing and if they only found you at 5%, I doubt it got out between January 9 and March 6. It may be out, but if it is, it was probably out in December. That said, you had a Gleason of 6, a Stage of T1c (which means it's not palpable), and a PSA of 10.7 in a range of 1 to 5000. Quit your worrying and get on with your surgery.  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, <0.1 2/12/08 Non Illegitimi Carborundum > Hi! > [quoted text clipped - 29 lines] > > - Show quoted text - Hi Ernie...Assuming that your biopsy samples were accurately read, then with your GS6, 2/19 5% volume PCa, it is unlikely that the PCa has already spread beyond the prostate. I would also venture a guess that the PSA data that you used in your PSA doubling time calculation is being influenced by factors other than the cancer. Some combination of prostatitis, BPH or residual infection/irritation from your two biopsies may be influencing PSA levels. I notice that your second PSA blood draw was taken about 1 month after the second biopsy. Just as a DRE can dramatically increase PSA, so can a biopsy. While the time for PSA to recover from a biopsy is variable, 1-2 months is not unusual, so your 02/20/08 PSA may have been influenced by the biopsy. Also realize that the typical trans-rectal biopsy cannot probe all parts of the prostate, so it is possible that you have a significant tumor in one of these inaccessible areas. Fortunately, tumors in these errors are typically indolent and slow growing, even though they may be large and generate a lot of PSA...ron > > Hi! > [quoted text clipped - 48 lines] > > - Show quoted text - Ernie: PSADT is generally used as a prognistic tool after local treatment (RP, RT etc) not before primary treatment. In the discussions I've had with med onc's PSADT of <= 3 mo's is considered high risk. Here are some articles on doubling time. http://www.prostate-cancer.org/education/preclin/psadbl.html http://www.sciencedaily.com/releases/2007/05/070525074607.htm In my non medical opinion I don't think you should worry just get pursue the primary treatment you feel is appropriate for your situation. Good luck to you. > PSADT is generally used as a prognistic tool after local treatment >(RP, RT etc) not before primary treatment. Both before and after. Where a biopsy suggests the cancer is 'non-aggressive' or has been diagnosed early - and on the face of it Ernie's looks like it might be one of these (2x5% cores out of 19 is not a lot of cancer) - then pre-treatment PSADT is a vital prognostic tool. A report posted here recently suggested a 7 year (or better) doubling time was a reliable marker for avoiding treatment of any kind....other than continued surveillance of course. My amateur take on this: Two PSA results are not enough to establish a trend for the good reasons posted by Ron. The upbeat conclusion would be that either the first reading was falsely low and/or the second falsely high which together could put a much better gloss on (or even vastly alter) the PSADT. The possible downsides are 1) the readings are good in which case PSADT looks to be faster than one would like and/or 2) the biopsy was optimistic and missed some of the cancer. Anything's possible. I would have liked a few more PSA tests to establish a best-fit trend before jumping into surgery but I appreciate the anxiety about this - if 10 months is the true PSADT then I would want treatment soon. Best of luck Ernie. I just want to say "thanks" to everyone for responding. You have all given me good advise and I appreciate it. It certainly appears that my situation is not that serious (when compared to many others here). This group is a great help to many people! Ernie > Hi! > [quoted text clipped - 29 lines] > > - Show quoted text - Normally one needs more than 2 PSA readings in case some of the readings were influenced by one of a number of extraneous factors. See the Factors Affecting PSA section part way down this page: http://palpable-prostate.blogspot.com/2007/05/psa-screening-and-early-detection- part_14.html This 5 part article on PSADT will give you more info on interpreting and calculating PSADT: http://palpable-prostate.blogspot.com/2007/03/psa-doubling-time-psadt-part-1.html Also aside from PSADT you can get prognostics from a number of prostate cancer calculators listed here: http://palpable-prostate.blogspot.com/2007/02/prosate-cancer-calculators.html --- The Palpable Prostate http://www.palpable-prostate.com > Hi! > [quoted text clipped - 27 lines] > > Biopsy 1/15/2008 G6 (3+3), T1c > > RRP (planned) asap Ernie From the dates you gave, first biopsy was in Oct 2007 then you had a second one in Jan 2008 and PSA a month later. I had multiple PSA's after the pre-biopsy one and even 3 months after the biopsy, my PSA was 30% higher than pre-biopsy. Your PSA was probably elevated because your biopsy was the month before - I have not seen any studies that gives a time when the biopsy effect is gone. In my case, it was not gone 3 months after. Keep your peace of mind - it is NOT an accurate doubling time. Lud
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