RE: Pleasant Reversal but questions

[Guest guest]

billikm wrote:

> After my 3.43 PSA, we decided I would get one more PSA a month

> later because the 3.43 PSA was done a few days after major

> surgery (I had a gangrenous/necrotic/severely inflamed gall

> bladder - it was BAD). Anyway, I was wondering if that last PSA

> boost might have been due to that inflammation. I think my

> doctor was skeptical (remember, I don't have a prostate).

Hello Mel,

I don't have any expertise on this but it seems to me that your

doctor's skepticism is well founded.  

Inflammation raises the PSA in an intact prostate because the

tissue that produces PSA is inflamed and, apparently, inflamed

tissue that expresses PSA expresses more of it than when not

inflamed.  So I would think that in order for inflammation to

raise the PSA, tissue that produces PSA would have to be

inflamed.

I've never heard of the gall bladder producing PSA.  Maybe if you

had metastases in the gall bladder that could happen, but I've

not heard of that either.  It's my understanding that the most

common sites for mets are in the tissue around the prostate, then

in the bones.

> However, could the avodart be masking a greatly increasing PSA?

> I know with a prostate, one often doubles the number to get the

> true reading. But I don't think that is true after surgery.

> Does anyone know?

I should think the Avodart could reduce the PSA.  Avodart

inhibits an enzyme that converts testosterone to the more active

dihydrotestosterone.  I believe it inhibits it by binding to the

site on the surface of the enzyme that would normally bind

testosterone and catalyze the reaction.

Prostate tissue has this enzyme.  It doesn't matter whether the

tissue is in the prostate gland, or if it's escaped from the

gland and metastasized elsewhere in the body.  You don't have a

prostate gland but you've got a lot of prostate cells in your

body - they're the tumor cells.  These cells still have the

enzyme and it still converts testosterone to the dihydro form.

And it is my understanding that the dihydrotestosterone

stimulates the tumor cells to continue to divide and multiply.

I'm not sure about calling it a " false " reading and saying the

" true " reading is double the " false " reading.  As I understand it

(which doesn't mean much because I'm not expert), by reducing the

availability of dihydrotestosterone the Avodart causes the

cancerous prostate cells to become more quiescent, to reproduce

less often and to express less PSA.  If that's right, the Avodart

really is working to suppress your disease.  But it's probably

not working nearly as well as Lupron would.

I would think the business of " true " and " false " PSA readings is

really just a way of saying that if a man has PSA in the " normal "

range of 0-4, and he's on Avodart, then his " normal " reading is

less of an indicator that he has no cancer than it would be if

he weren't on Avodart.  In other words a man on Avodart with PSA

= 4 is more likely to have cancer than a man NOT on Avodart with

PSA = 4.  In theory, he'd be more comparable to a man with PSA =

8 with respect to the question of whether he has cancer.

Saying that his " true " reading is 8 is metaphorical way of saying

that he has the same amount of prostate tissue as a man who is

not an Avodart and has PSA = 8.  In reality of course, his " true "

reading is what it is, not double what it is.

Hope that helps.

    Alan

[Guest guest]

Hi MelI seem to be coming from a similar place to you although my gall bladder is behaving so far. I also failed to achieve zero PSA with either surgery or adjuvant radiotherapy. The one thing so far which has knocked it on the head is Triptorelin (equivalent to Lupron although easier to administer). I am currently in an off-phase of intermittent therapy and my PSA is rising again quite quickly. They don’t go in for Avodart much over here but I was told by my consultant that if you are on Avodart the true PSA reading is double the test reading. I expect to be back on Triptorelin before long. No telling how long it will be effective. There seem to be quite a few new therapies coming along for Castrate Resistant PCa so all is not quite doom and gloom.Good luck with what you decide to do.Bob From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of billikmSent: 28 March 2012 04:13To: ProstateCancerSupport Subject: Pleasant Reversal but questions OK – just some brief background information.I was dx. with PC 12/2/2009.I failed surgery and then failed SRT.After SRT, my PSA's have been:2/23/2012 3.43 PSADT--3.19 mos. for last 12 months figures1/6/2012 Started Avodart12/22/2011 1.97 Continuing 3.08 months calculated PSADT11/1/2011 1.38 Looking for sure like HT8/11/2011 0.75 Confirm failure -- looks like HT if it goes above 1.07/11/2011 0.6 Looks like SRT FailedI was hesitant to start HT and Dr. Lam suggested I try just Avodart. Basically, he said to consider it the " off cycle " of HT and we would see how I did. As you can see, it appeared not to work.After my 3.43 PSA, we decided I would get one more PSA a month later because the 3.43 PSA was done a few days after major surgery (I had a gangrenous/necrotic/severely inflamed gall bladder – it was BAD). Anyway, I was wondering if that last PSA boost might have been due to that inflammation. I think my doctor was skeptical (remember, I don't have a prostate).Dr. Lam said if my PSA increased further (he gave me some leeway to 4.0) we would start the triple blockade.Fast forward to today. I just did another PSA. and I was shocked at the result: 2.28.ly, after all these PSA increases, I fully expected to start HT. So, now I get a month reprieve until the next PSA.However, could the avodart be masking a greatly increasing PSA? I know with a prostate, one often doubles the number to get the true reading. But I don't think that is true after surgery. Does anyone know? Also, I'm wondering if the surgery/inflammation did increase the PSA on 2/23/12. I have to assume that the avodart is working.Bottom line is that eventually the PSA will rise again and I will have to commence HT, but I am pleased at this decrease. Perhaps this augurs well for when I do get on HT?Any comments/insight would be appreciated.Mel