PSA< PCA< RP

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Gary Nichols - 25 Jan 2004 12:24 GMT

I haven't been reading or posting to this NG for a while. But I did
before and after my RP in March of 2002. I was constantly reading
about guys with a PSA of 8 or 10 who have cancer. I was biopsied 3
times 1st at PSA 10-nothing detected, 2nd at PSA 17(a few months
later)-nothing detected, then my urologist started me on an oral
medication that was supposed to lower PSA, 3rd biopsy at PSA 26(a few
months later)-cancer detected. He told me the lab results indicated
Stage T1(something), and Gleason of 3+3. I opted for surgery. Since
then my PSA has been 1. 1. 1.2(yikes). Started every three months
Zoladex injections. Since then PSA has been >1. Does a >1 PSA mean
that the cancer has stopped growing (my cancer had spread to my
bladder neck and they didn't get it all with the surgery-negative
lymph nodes and bones)? So I have still have cancer. Does anyone
think that the first two biopsies were botched since when they
biopsied my prostate, after the surgery, my lab results were stage
T2c and gleason of 4 + 4? This was all done at a VA hospital. The
biopsies were done by a resident. After the last one, PSA,
26, my urologist, a doctor with 30 years experience, ordered that
they take 18 samples(first was 9, second was 12) then cancer was
detected. My urologist also did many finger probes and could not
detect any cancer on the outside of my prostate. He did explain that
with a finger probe he could not feel the front of the prostate.

I'm not too worried about my cancer. I am also a diabetic, with good
blood sugar control my A1c has since 1991 hovered around 5.2 (7 is
considered high) but still had to have two amputations-my right foot
in 1990 and my left leg, below the knee, in December of 2002. I am 61
and am able to walk quite easily with my prosthetic legs without even
a cane. I still travel a lot. And my life is pretty much the same as
it has always been except that I am now disabled.

I have never posted anything this long and I sound as if I am
blathering. But answers to my question about PSA >1 and cancer
stopped growing and opinions of my first two biopsies would be
welcome.

Thanks.

Gary "Less Than .One' Nichols :)

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MH - 25 Jan 2004 16:02 GMT

Hi, Gary.....
I've had undetectable PSAs since my surgery in November, 2002.... but
I'm just wondering if your doctor has mentioned radiation therapy to kill
those last cancer cells? Seems that would have been the follow-up after
surgery.

Take care,
MikeH

> I haven't been reading or posting to this NG for a while. But I did
> before and after my RP in March of 2002. I was constantly reading
[quoted text clipped - 35 lines]
>
> Gary "Less Than .One' Nichols :)

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Steve Kramer - 25 Jan 2004 17:16 GMT

> Since then PSA has been >1. Does a >1 PSA mean
> that the cancer has stopped growing (my cancer had spread to my
> bladder neck and they didn't get it all with the surgery-negative
> lymph nodes and bones)?

It almost certainly means that your cancer cells have died off and/or gone
into hibernation. If they detected cancer in the bladder neck, then I
suppose the Zoladex did not kill off all the cells; it rarely does.

Unfortunately, Zoladex (and all currently accepted androgen suppressing
treatments) are not a cure. If and when the PCa becomes refractive, or
androgen independent, your PSA will begin to rise again and other treatments
will be necessary. The hope we all have (and a hope that our predecessors
did not have) is that we will live long enough to see a cure or at least
long enough to see refraction reversed (look up Provenge on the Internet for
one such hopeful treatment).

>Does anyone
> think that the first two biopsies were botched since when they
[quoted text clipped - 6 lines]
> detect any cancer on the outside of my prostate. He did explain that
> with a finger probe he could not feel the front of the prostate.

Considering they did not detect cancer with the DRE AND missed the cancer
that was obviously there when you got the biopsies AND mis-graded the stage
AND Gleason score, I'd say there is a really good chance you received
incompetent treatment. But, that is water under the bridge. You could
never prove it, because each of the screenings are subjective and it will
have no bearing on how you choose your treatment for the rest of your life.

Signature

Prostate Cancer Survivor (so far), not a doctor
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000
PSA .1 .1 .1 .3 .4 .8
EBRT 05-07/2002 @ 47
PSA .3 .2 .2 .2 .3
Erection 05/12/2003 @ 48
HTbegins 07/21/2003 @ 48
PSA .1
Lupron 7/03, 8/03, 12/03

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Alan Meyer - 25 Jan 2004 19:35 GMT

...

> Since
> then my PSA has been 1. 1. 1.2(yikes). Started every three months
> Zoladex injections. Since then PSA has been >1. Does a >1 PSA mean
> that the cancer has stopped growing (my cancer had spread to my
> bladder neck and they didn't get it all with the surgery-negative
> lymph nodes and bones)?

Gary,

Just for clarification, did you mean 1.0 or 0.1? And did you mean
greater than 1.0 (or 0.1) or less than 1.0 (or 0.1)?

Less than 0.1 (usually written as <.1) is a good sign meaning
that the PSA is basically undetectable. Greater than 1.0
(usually written as >1) means that PSA is detectable and is
far higher than it should be for a man whose prostate was removed.

If I were you I would ask for a consultation with a radiation oncologist.
Hopefully, the hormone therapy is holding your cancer in check for
the time being. How long that will last is unknown.

Radiation after surgery _sometimes_ completely cures the cancer.
I don't know what your chances are for a cure, but even if they're only
25%, it might be worth doing since, at age 61, you could develop full
blown symptoms of the disease before you died of other causes.

A radiation oncologist looking at your last lab and pathology reports
might be able to suggest a radiation treatment that could give you a
cure (or might not - he'd know more about it than I would).

If radiation is recommended, it's a very bearable experience. I got
some hemorrhoids, some sensitive skin, some blood in the semen,
and some difficulty urinating from it. But none of the symptoms
were debillitating and, I'm told, they should mostly or completely go
away in few months.

Impotence is another possible outcome of radiation. That one is
apparently something that can develop years afterword as blood
vessels damaged by radiation get weaker.

At any rate, it can't hurt to talk to an expert.

Good luck.

Alan

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Gary Nichols - 26 Jan 2004 14:34 GMT

>...
>> Since
[quoted text clipped - 13 lines]
>(usually written as >1) means that PSA is detectable and is
>far higher than it should be for a man whose prostate was removed.

The first post op was 1.0, then 1.0 then 1.2. After Zoladex (6
months) it was <.1 and has been since. Sorry I had things a little
backward.

>If I were you I would ask for a consultation with a radiation oncologist.
>Hopefully, the hormone therapy is holding your cancer in check for
>the time being. How long that will last is unknown.

I plan on doing that when I see the radiation oncologist next week to
set up radiation for skin cancer at the tip of my nose (The
Dermatologist said it is 'the good kind' :) It's just a little red
dot but she suspected cancer, because I had cancer removed from my
temple, and had it biopsied and it is. It's odd though, now that I
think of it that my oncologist hasn't mentioned radiation. Actually,
just before my urologist retired, he did say that he wouldn't have his
dog radiated at this (VA) hospital. I put that down to an ongoing
feud between surgeons and radiationists (?).

>Radiation after surgery _sometimes_ completely cures the cancer.
>I don't know what your chances are for a cure, but even if they're only
[quoted text clipped - 20 lines]
>
> Alan

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ron - 25 Jan 2004 20:07 GMT

Hi Gary...You've found a good place to ask questions and get answers.
Most of the people in this newsgroup have "been there, done that", so
I suspect you'll get a lot of useful responses. BTW, you're asking
good questions. I've inserted my thoughts below...Best wishes and
good health, Ron

> I haven't been reading or posting to this NG for a while. But I did
> before and after my RP in March of 2002. I was constantly reading
[quoted text clipped - 5 lines]
> Stage T1(something), and Gleason of 3+3. I opted for surgery. Since
> then my PSA has been 1. 1. 1.2(yikes).

These values are high for post-surgery and indicate, as you've noted
that they didn't get it all. Your PCa may have already escaped the
prostate and become systemic prior to surgery.

> Started every three months
> Zoladex injections. Since then PSA has been >1.

Since you're Gary "Less Than .One' Nichols, I'm assuming that you
meant to write this as <0.1

> Does a >1 PSA mean
> that the cancer has stopped growing (my cancer had spread to my
> bladder neck and they didn't get it all with the surgery-negative
> lymph nodes and bones)?

Less than 0.1 is a good sign when you're on hormone therapy. If you
have you're PSA measured using an ultra-sensitive PSA test you can
track even lower values like 0.01. The advantage to the
ultrasensitive test is that it allows you to see if the PSA is
increasing before it hits 0.1. Then you have more time to start
considering options with your oncologist and you'll also have a handle
on the PSA doubling time which is important to know. So it's hard to
say if your PCa is growing with the data you have, all you know is
that your PSA is in a good range. BTW it sounds like you're just
taking Zoladex. You might want to read up on IADT3 (do a google
search and talk to your onc).

> So I have still have cancer. Does anyone
> think that the first two biopsies were botched

I don't think the biopsies were botched. It is relatively difficult
for a pathologist to find and grade PCa. There's not one big solid
tumor to examine; rather PCa is typically a diffuse, multifocal tumor.
It becomes even more difficult when all you have to examine are small
biopsy fragments. That's one of the reasons that an expert PCa
pathologist (there are roughly a dozen or so around the US, see
http://www.prostate-help.org/cagleex.htm for a listing) should examine
PCa biopsy slides. Because many people don't have their Gleason Score
determined by one of these experts, there is a documented
"under-grading" of Gleason scores from PCa biopsy specimens (to be
accurate, I should say that there is both over- and under-grading,
but, on average, there is more under-grading). Said differently, the
GS from the pathologic specimen obtained after RP frequently comes in
higher than the GS determined from the biopsy specimen, as occurred in
your case. This means that sometimes people pick the wrong treatment
method because their tumor GS was under-graded.

I've seen quite a few posts were it takes guys 2 or 3 biopsies to find
the PCa even though their PSA is rising. It's probably a good idea if
you have rising PSA, especially if its over 10, and they don't find
PCa on the first biopsy to see Drs. Lee or Bahn and have them run a
color doppler, that almost always finds it.

> since when they
> biopsied my prostate, after the surgery, my lab results were stage
[quoted text clipped - 22 lines]
>
> Gary "Less Than .One' Nichols :)

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