Re: Why is my PSA Fluctuating?

[Guest guest]

Jim V, I don’t know if you have come

across the term ‘idiopathic’? My

very friendly cardiologist says it is the medical term for “Blowed if I

know.” And it seems the changes in your PSA levels might be regarded as

idiopathic, assuming that they were all done at the same laboratory, using the

same equipment and there were no errors.

I have always been interested in variations

on PSA because it always troubles me that men have a tendency to read too much into

them, so I ran a small experiment almost 10 years ago when I had a PSA test

every day fro 28 days to see what kind of variance I might have. The answer is –

a lot – see here http://www.yananow.org/PSAexperiment.htm

There is no certainty in prostate cancer,

but I reckon with those results that you tabulate your as near as certain that

it isn’t PCa that is causing changes in your PSA levels. After all, PSA

is NOT prostate cancer specific.

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of JimV

Sent: Wednesday, 26 January 2011

3:36 PM

To: ProstateCancerSupport

Subject:

Why is my PSA Fluctuating?

Does anybody have any theories as to why my PSA dances

around? My previous urologist said

he didn't know. The latest swing seems profound. I'm in a new town, and my new

urologist is in too much of a hurry to answer questions. I'm doing watchful

waiting/active surveillance. Apart from prostatitis, what might be the

explanation? Here are my numbers.

1992 PSA 0.58

1996 PSA 1.0

11/2001 PSA 0.83

11/2002 PSA 1.0

11/2003 PSA 2.2

12/2003 Biopsy = High Grade PIN

06/2004 Biopsy = Adenocarcinoma

11/2004 PSA 0.8

01/2005 PSA 0.8

04/2006 PSA 1.7

10/2006 PSA 2.8

10/2006 Biopsy = All sites were benign

03/2007 PSA 1.2

11/2007 PSA 1.0

03/2008 PSA 1.2

11/2008 PSA 1.0

04/2009 PSA 1.11

10/2009 PSA 2.06

02/2010 PSA 1.33

08/2010 PSA 7.86

09/2010 Biopsy = High Grade PIN

01/2011 PSA 1.35

[Guest guest]

JimV wrote:

> Does anybody have any theories as to why my PSA dances around?

> My previous urologist said he didn't know. The latest swing

> seems profound. I'm in a new town, and my new urologist is in

> too much of a hurry to answer questions. I'm doing watchful

> waiting/active surveillance. Apart from prostatitis, what

> might be the explanation? Here are my numbers.

> 1992 PSA 0.58

> 1996 PSA 1.0

> 11/2001 PSA 0.83

> 11/2002 PSA 1.0

> 11/2003 PSA 2.2

> 12/2003 Biopsy = High Grade PIN

> 06/2004 Biopsy = Adenocarcinoma

> 11/2004 PSA 0.8

> 01/2005 PSA 0.8

> 04/2006 PSA 1.7

> 10/2006 PSA 2.8

> 10/2006 Biopsy = All sites were benign

> 03/2007 PSA 1.2

> 11/2007 PSA 1.0

> 03/2008 PSA 1.2

> 11/2008 PSA 1.0

> 04/2009 PSA 1.11

> 10/2009 PSA 2.06

> 02/2010 PSA 1.33

> 08/2010 PSA 7.86

> 09/2010 Biopsy = High Grade PIN

> 01/2011 PSA 1.35

Prostatitis sure sounds like the right explanation to me for the

08/2010 reading.

The 06/2004 biopsy result also needs explanation. Either the

biopsy happened to sample some bit of tissue with cancer in it

that didn't happen to get sampled in the two subsequent biopsies,

or else the pathologist was just dead wrong - something that has

happened to others in the past.

You may want to send your recent biopsy slides to an expert lab

for a second opinion. Steve Jordan has posted a list of the top

labs which you'll find in the archives, and has noted that

insurance will usually cover the cost of the second opinion.

Good luck.

Alan

[Guest guest]

JimV wrote:

> Does anybody have any theories as to why my PSA dances around?

> My previous urologist said he didn't know. The latest swing

> seems profound. I'm in a new town, and my new urologist is in

> too much of a hurry to answer questions. I'm doing watchful

> waiting/active surveillance. Apart from prostatitis, what

> might be the explanation? Here are my numbers.

> 1992 PSA 0.58

> 1996 PSA 1.0

> 11/2001 PSA 0.83

> 11/2002 PSA 1.0

> 11/2003 PSA 2.2

> 12/2003 Biopsy = High Grade PIN

> 06/2004 Biopsy = Adenocarcinoma

> 11/2004 PSA 0.8

> 01/2005 PSA 0.8

> 04/2006 PSA 1.7

> 10/2006 PSA 2.8

> 10/2006 Biopsy = All sites were benign

> 03/2007 PSA 1.2

> 11/2007 PSA 1.0

> 03/2008 PSA 1.2

> 11/2008 PSA 1.0

> 04/2009 PSA 1.11

> 10/2009 PSA 2.06

> 02/2010 PSA 1.33

> 08/2010 PSA 7.86

> 09/2010 Biopsy = High Grade PIN

> 01/2011 PSA 1.35

Prostatitis sure sounds like the right explanation to me for the

08/2010 reading.

The 06/2004 biopsy result also needs explanation. Either the

biopsy happened to sample some bit of tissue with cancer in it

that didn't happen to get sampled in the two subsequent biopsies,

or else the pathologist was just dead wrong - something that has

happened to others in the past.

You may want to send your recent biopsy slides to an expert lab

for a second opinion. Steve Jordan has posted a list of the top

labs which you'll find in the archives, and has noted that

insurance will usually cover the cost of the second opinion.

Good luck.

Alan

[Guest guest]

(su-nip)

> You may want to send your recent biopsy slides to an expert lab

> for a second opinion. Steve Jordan has posted a list of the top

> labs which you'll find in the archives, and has noted that

> insurance will usually cover the cost of the second opinion.

Here's the list:

Bostwick Laboratories [800] 214-6628

Dianon Laboratories [800] 328-2666 (select 5 for client services)

Jon Epstein (s Hopkins) [410] 955-5043 or [410] 955-2162

Jon Oppenheimer (Tennessee) [800] 881-0470

Lucia (303)724-3470

Regards,

Steve J

[Guest guest]

Jim:

I have had the same problem and prostatitis may be the culprit. My PSA has ranged from 4.4 to 19.3 over a nine year period I have been tested. To make matters more confusing in two test that were back to back with a biopsy in between, my results were 19.3 and 0.1. My doctors were confused by these results. My nutritionist said it was possible since my cancer cells were so small that the cancer could have been "pulled out" with the biopsy. My urologist would have none of that saying "lab error". A retest came back at 12.6.

In September 2010 it was 15.4, a steady rise from 12.1 the previous year. Today in the results I just received showed 14.6.

In conclusion I have to think You shouldn't put a too much weight in this test. I have another doctor who is also a seventh generation herbalist who tells me not to take PSA test because they are inaccurate and the person reading the results can interpret differently.

Also I should add that my first biopsy (out of 3) was botched up. I believe that a bad biopsy which caused me a lot of problems for a year or more could have caused long term prostatitis causing my PSA to flucuate.

Subject: Why is my PSA Fluctuating?To: ProstateCancerSupport Date: Tuesday, January 25, 2011, 10:35 PM

Does anybody have any theories as to why my PSA dances around? My previous urologist said he didn't know. The latest swing seems profound. I'm in a new town, and my new urologist is in too much of a hurry to answer questions. I'm doing watchful waiting/active surveillance. Apart from prostatitis, what might be the explanation? Here are my numbers.1992 PSA 0.581996 PSA 1.011/2001 PSA 0.8311/2002 PSA 1.011/2003 PSA 2.212/2003 Biopsy = High Grade PIN06/2004 Biopsy = Adenocarcinoma11/2004 PSA 0.801/2005 PSA 0.804/2006 PSA 1.710/2006 PSA 2.810/2006 Biopsy = All sites were benign03/2007 PSA 1.211/2007 PSA 1.003/2008 PSA 1.211/2008 PSA 1.004/2009 PSA 1.1110/2009 PSA 2.0602/2010 PSA 1.3308/2010 PSA 7.8609/2010 Biopsy = High Grade PIN01/2011 PSA 1.35

[Guest guest]

FRANK KIRKALDY wrote:

> ... To make matters more confusing in two test that were back

> to back with a biopsy in between, my results were 19.3 and 0.1.

> My doctors were confused by these results. My nutritionist

> said it was possible since my cancer cells were so small that

> the cancer could have been " pulled out " with the biopsy. My

> urologist would have none of that saying " lab error " . A retest

> came back at 12.6. ...

,

I think your urologist was definitely right on that one. A

normal prostate produces some PSA, even if the needles pulled out

all the cancer (incredibly unlikely) and there is no cancer at

all. It sounds to me like the lab sent some other guy's results

to you, If they sent your results to him, they probably scared

the hell out of him.

> In conclusion I have to think You shouldn't put a too much

> weight in this test. I have another doctor who is also a

> seventh generation herbalist who tells me not to take PSA test

> because they are inaccurate and the person reading the results

> can interpret differently.

It is possible that an herbalist knows something about PSA and

prostate cancer, but I'd much prefer to get advice on prostate

cancer from a doctor that was trained in urology and/or oncology

than from someone who has studied herbs.

PSA tests do require interpretation. An elevated PSA can be

caused by infection, inflammation, enlarged prostate, or cancer.

Unless the PSA is way high, it's not easy to tell without more

tests, mainly a biopsy. But I'm not convinced that means we

shouldn't get PSA tests. The same can be said of most medical

tests. The give us measures of " biomarkers " that don't always,

by themselves, tell us why those biomarkers are out of line with

the averages.

> Also I should add that my first biopsy (out of 3) was botched

> up. I believe that a bad biopsy which caused me a lot of

> problems for a year or more could have caused long term

> prostatitis causing my PSA to fluctuate.

I too had a couple of years of prostatitis during and after my

treatment. I wondered if the biopsy, digital rectal exams,

endo-rectal MRIs, radiation, and other assaults on the prostate

were the cause, but I guess I'll never know.

Good luck.

Alan

[Guest guest]

Hi Jim:

Except for the 7.86 my numbers over the years have been a

lot like yours: a lot of bouncing around (I blame it on

prostatitis) and a slow drift upwards. I've been on AS

for about as long as you and my biopsies have have

consistently shown one core with cancer. I'm old enough

now that I think something else will get me first. My

uneducated feeling is you should stay calm and keep

checking the numbers every three to six months. And you

might consider looking for a more friendly urologist!

Good luck.

Crawford

p.s. They say you should compare PSA's from the same lab

and not within two days of sex or strenuous bicycle riding

or a digital exam.

On Wed, 26 Jan 2011 04:35:42 -0000

" JimV " wrote:

> Does anybody have any theories as to why my PSA dances

>around? My previous urologist said he didn't know. The

>latest swing seems profound. I'm in a new town, and my

>new urologist is in too much of a hurry to answer

>questions. I'm doing watchful waiting/active

>surveillance. Apart from prostatitis, what might be the

>explanation? Here are my numbers.

>

> 1992 PSA 0.58

> 1996 PSA 1.0

> 11/2001 PSA 0.83

> 11/2002 PSA 1.0

> 11/2003 PSA 2.2

> 12/2003 Biopsy = High Grade PIN

> 06/2004 Biopsy = Adenocarcinoma

> 11/2004 PSA 0.8

> 01/2005 PSA 0.8

> 04/2006 PSA 1.7

> 10/2006 PSA 2.8

> 10/2006 Biopsy = All sites were benign

> 03/2007 PSA 1.2

> 11/2007 PSA 1.0

> 03/2008 PSA 1.2

> 11/2008 PSA 1.0

> 04/2009 PSA 1.11

> 10/2009 PSA 2.06

> 02/2010 PSA 1.33

> 08/2010 PSA 7.86

> 09/2010 Biopsy = High Grade PIN

> 01/2011 PSA 1.35

>

>

>

[Guest guest]

As Terry noted, PSA can vary and a daily variation range of +/_20% is not

unreasonable. When charting my PSA, I normalize the results by averaging the

most recent three samples then plotting the values. Graphing is useful to

monitor PSA velocity, that is, rate of change.

Also keep in mind that grading tissue samples is a judgment items based on

illustrative samples. As in any such grading there will be marginal variations

that the evaluator must judge one way or the other.

Also, you show at least one result with PIN,in your case listed as High Grade.

LG and HGPIN express much higher levels of PSA and other markers used to date at

far higher levels than benign tissue. That is one reason for the loss of

popularity of PCA3 as a marker for prostate cancer among other issues.

There is increasing evidence that cancerous cells such as those found in the

prostate and the breast may come and go.

Finally, ejaculations and massage of the prostate (eg bicycle seat) can impact

PSA expression significantly.

Rich Luxton

Green Bay, WI

PS My biopsies did not hurt per se but rather felt more like someone was trying

to park a Mack truck up my rectum. It is an unnatural feeling to relax as

someone pushes a dildo equivalent up there. The cores themselves felt like bee

stings, if at all.

>

> Does anybody have any theories as to why my PSA dances around? My previous

urologist said he didn't know. The latest swing seems profound. I'm in a new

town, and my new urologist is in too much of a hurry to answer questions. I'm

doing watchful waiting/active surveillance. Apart from prostatitis, what might

be the explanation? Here are my numbers.

>

> 1992 PSA 0.58

> 1996 PSA 1.0

> 11/2001 PSA 0.83

> 11/2002 PSA 1.0

> 11/2003 PSA 2.2

> 12/2003 Biopsy = High Grade PIN

> 06/2004 Biopsy = Adenocarcinoma

> 11/2004 PSA 0.8

> 01/2005 PSA 0.8

> 04/2006 PSA 1.7

> 10/2006 PSA 2.8

> 10/2006 Biopsy = All sites were benign

> 03/2007 PSA 1.2

> 11/2007 PSA 1.0

> 03/2008 PSA 1.2

> 11/2008 PSA 1.0

> 04/2009 PSA 1.11

> 10/2009 PSA 2.06

> 02/2010 PSA 1.33

> 08/2010 PSA 7.86

> 09/2010 Biopsy = High Grade PIN

> 01/2011 PSA 1.35

>

[Guest guest]

My thanks to everybody who addressed my question about my fluctuating PSA

numbers. My tissue sample of cancerous cells was only 1 mm long, and that was

in 2004. My urologist at the time said he had another patient who never again

showed cancer after the first biopsy, and he speculated that he may have gotten

it all with the biopsy. But he cautioned that this was very unlikely and not

something I should hope for. I am aware that sex and bicycle riding can distort

the PSA and refrained from both for 72 hours prior to the test. I hadn't given

much thought to lab or pathologist error, so I appreciate the insight. I would

like to re-examine the 2004 sample, but I'm sure it's too late for that. As for

the 2010 sample, the discussion by Dianon labs give me some confidence that it

was scrupulously examined. In fact, it was the subject of a conference or so

the report said. I will certainly insist on more PSA tests before I jump right

into another biopsy. Thanks again to you all.

>

> Does anybody have any theories as to why my PSA dances around? My previous

urologist said he didn't know. The latest swing seems profound. I'm in a new

town, and my new urologist is in too much of a hurry to answer questions. I'm

doing watchful waiting/active surveillance. Apart from prostatitis, what might

be the explanation? Here are my numbers.

>

> 1992 PSA 0.58

> 1996 PSA 1.0

> 11/2001 PSA 0.83

> 11/2002 PSA 1.0

> 11/2003 PSA 2.2

> 12/2003 Biopsy = High Grade PIN

> 06/2004 Biopsy = Adenocarcinoma

> 11/2004 PSA 0.8

> 01/2005 PSA 0.8

> 04/2006 PSA 1.7

> 10/2006 PSA 2.8

> 10/2006 Biopsy = All sites were benign

> 03/2007 PSA 1.2

> 11/2007 PSA 1.0

> 03/2008 PSA 1.2

> 11/2008 PSA 1.0

> 04/2009 PSA 1.11

> 10/2009 PSA 2.06

> 02/2010 PSA 1.33

> 08/2010 PSA 7.86

> 09/2010 Biopsy = High Grade PIN

> 01/2011 PSA 1.35

>