FW: Re: Question on doubling time

[Guest guest]

It is extremely problematic to base any assessment of PSA kinetics, whether

doubling time or PSA velocity (just the rate of increase in PSA per year) on a

few PSA readings, especially in comparing just a pair of readings. PSAs can

vary by as much as 25% or more just from normal day-to-day changes in a mans

biology and lab variance. If one has episodes of prostate inflamation, there

can be what appear to be dramatic changes between two PSA readings from the

inflamation.

In my own history, between two subsequent PSA readings from 2 to 3 months apart,

I have had apparent PSA velocities over 2 ng/ml per year, both positive

(increasing PSA) and negative (decreasing PSA).

The general advice is that PSA doubling times should be based on at least 3

readings at least 6 months apart. Preferably, at 6 or more readings spaced over

at least 2 years.

The vast majority of prostate cancers in early stages will not present a

dramatic change in either doubling time or velociy in a space of a few months.

Exceptions usually involve Gleason sums of 8 or more.

In Lynn's husbands case, I agree that the Gleason 4+3 is a focus of concern.

Hence the advice to get a second opinion on the pathology from an expert on

prostate cancer pathology. Also, if the biopsy used the older 6-core sampling,

I would have a repeat biopsy of at least 12 cores.

The PAP test is a good one to suggest whether or not cancer has escaped the

prostate. For early cancers it is a better diagnostic than the much more

expensive bone scan.

The Best to You and Yours!

Jon in Nevada

, May 30, 2011 5:20 PM

> To: ProstateCancerSupport ; adopt4u@...

> Subject: RE: Re: Question on doubling time

>

> I guess a case could be made for Lynn's husband that with the prostate gland

> still intact, concern should be evidenced when PSA velocity is greater than

> 0.75 ng/mL within a year (which certainly is his case). It would also be

> reasonable to consider a PAP (Prostatic Acid Phosphatase) blood serum test

> to make sure that PC confined to the prostate is not approaching a critical

> PAP threshold of 3.0 or higher which confers a poorer prognosis in the face

> of RP, or any form of RT. What concerns me most with this man is that

> Gleason Score 4 + 3 cancers are associated with a three-fold increase in

> lethal prostate cancer compared with 3 + 4 cancers. I hope something

> motivates him to action.

>

>

>

> Chuck

>

>

[Guest guest]

Thank you all for your replies. It is very reassuring that we can ask questions,

and know that there are people out there who care.

To answer a little about my husband, he will turn 65 in a couple of months. He

was staged T1c. He has VA benefits currently, so we are a limited on what tests

we can order. We have already been told that the doctor doesn't want to make

another appointment until my husband has treatment. He can't do that, but the

sentiment was sincere. He really wants my husband to get treatment now and not

later. But it makes it more difficult to get another PSA in a couple of months

because to them it is unncessary. I know ordering one at a different facility

has the issue that we wont know what assay the company is using. So the results

could be useless to us.

So, we are looking at test scores and trying to decide if this PSA reading means

nothing or everything and where to go from here.

I appreciate your insights and best wishes.

Thanks again,

Lynn

>

> It is extremely problematic to base any assessment of PSA kinetics, whether

doubling time or PSA velocity (just the rate of increase in PSA per year) on a

few PSA readings, especially in comparing just a pair of readings. PSAs can

vary by as much as 25% or more just from normal day-to-day changes in a mans

biology and lab variance. If one has episodes of prostate inflamation, there

can be what appear to be dramatic changes between two PSA readings from the

inflamation.

>

> In my own history, between two subsequent PSA readings from 2 to 3 months

apart, I have had apparent PSA velocities over 2 ng/ml per year, both positive

(increasing PSA) and negative (decreasing PSA).

>

> The general advice is that PSA doubling times should be based on at least 3

readings at least 6 months apart. Preferably, at 6 or more readings spaced over

at least 2 years.

>

> The vast majority of prostate cancers in early stages will not present a

dramatic change in either doubling time or velociy in a space of a few months.

Exceptions usually involve Gleason sums of 8 or more.

>

> In Lynn's husbands case, I agree that the Gleason 4+3 is a focus of concern.

Hence the advice to get a second opinion on the pathology from an expert on

prostate cancer pathology. Also, if the biopsy used the older 6-core sampling,

I would have a repeat biopsy of at least 12 cores.

>

> The PAP test is a good one to suggest whether or not cancer has escaped the

prostate. For early cancers it is a better diagnostic than the much more

expensive bone scan.

>

> The Best to You and Yours!

> Jon in Nevada

>

> , May 30, 2011 5:20 PM

> > To: ProstateCancerSupport ; adopt4u@

> > Subject: RE: Re: Question on doubling time

> >

> > I guess a case could be made for Lynn's husband that with the prostate gland

> > still intact, concern should be evidenced when PSA velocity is greater than

> > 0.75 ng/mL within a year (which certainly is his case). It would also be

> > reasonable to consider a PAP (Prostatic Acid Phosphatase) blood serum test

> > to make sure that PC confined to the prostate is not approaching a critical

> > PAP threshold of 3.0 or higher which confers a poorer prognosis in the face

> > of RP, or any form of RT. What concerns me most with this man is that

> > Gleason Score 4 + 3 cancers are associated with a three-fold increase in

> > lethal prostate cancer compared with 3 + 4 cancers. I hope something

> > motivates him to action.

> >

> >

> >

> > Chuck

> >

> >

>

[Guest guest]

Thank you all for your replies. It is very reassuring that we can ask questions,

and know that there are people out there who care.

To answer a little about my husband, he will turn 65 in a couple of months. He

was staged T1c. He has VA benefits currently, so we are a limited on what tests

we can order. We have already been told that the doctor doesn't want to make

another appointment until my husband has treatment. He can't do that, but the

sentiment was sincere. He really wants my husband to get treatment now and not

later. But it makes it more difficult to get another PSA in a couple of months

because to them it is unncessary. I know ordering one at a different facility

has the issue that we wont know what assay the company is using. So the results

could be useless to us.

So, we are looking at test scores and trying to decide if this PSA reading means

nothing or everything and where to go from here.

I appreciate your insights and best wishes.

Thanks again,

Lynn

>

> It is extremely problematic to base any assessment of PSA kinetics, whether

doubling time or PSA velocity (just the rate of increase in PSA per year) on a

few PSA readings, especially in comparing just a pair of readings. PSAs can

vary by as much as 25% or more just from normal day-to-day changes in a mans

biology and lab variance. If one has episodes of prostate inflamation, there

can be what appear to be dramatic changes between two PSA readings from the

inflamation.

>

> In my own history, between two subsequent PSA readings from 2 to 3 months

apart, I have had apparent PSA velocities over 2 ng/ml per year, both positive

(increasing PSA) and negative (decreasing PSA).

>

> The general advice is that PSA doubling times should be based on at least 3

readings at least 6 months apart. Preferably, at 6 or more readings spaced over

at least 2 years.

>

> The vast majority of prostate cancers in early stages will not present a

dramatic change in either doubling time or velociy in a space of a few months.

Exceptions usually involve Gleason sums of 8 or more.

>

> In Lynn's husbands case, I agree that the Gleason 4+3 is a focus of concern.

Hence the advice to get a second opinion on the pathology from an expert on

prostate cancer pathology. Also, if the biopsy used the older 6-core sampling,

I would have a repeat biopsy of at least 12 cores.

>

> The PAP test is a good one to suggest whether or not cancer has escaped the

prostate. For early cancers it is a better diagnostic than the much more

expensive bone scan.

>

> The Best to You and Yours!

> Jon in Nevada

>

> , May 30, 2011 5:20 PM

> > To: ProstateCancerSupport ; adopt4u@

> > Subject: RE: Re: Question on doubling time

> >

> > I guess a case could be made for Lynn's husband that with the prostate gland

> > still intact, concern should be evidenced when PSA velocity is greater than

> > 0.75 ng/mL within a year (which certainly is his case). It would also be

> > reasonable to consider a PAP (Prostatic Acid Phosphatase) blood serum test

> > to make sure that PC confined to the prostate is not approaching a critical

> > PAP threshold of 3.0 or higher which confers a poorer prognosis in the face

> > of RP, or any form of RT. What concerns me most with this man is that

> > Gleason Score 4 + 3 cancers are associated with a three-fold increase in

> > lethal prostate cancer compared with 3 + 4 cancers. I hope something

> > motivates him to action.

> >

> >

> >

> > Chuck

> >

> >

>