RE: RISING PSA

[Guest guest]

Kevan,

Given the margin of error in reporting PSA

results there is no meaningful difference between your 3.6 PSA and your 4.0

PSA: both are within the same range and therefore do not demonstrate a rise or

any reason in themselves for a biopsy in the first place. You are, in my

opinion, a perfect example of the potential dangers of screening and treatment

by doctors who should know better.

Although I have no medical training, I have

been around this disease for 13 years+ since I was diagnosed and I have learned

a little. I wrote a piece I called PSA 101 to help newcomers understand some of

the issues regarding the (in)accuracy of PSA tests and you might like to read

that – it is at http://www.yananow.net/PSA101.htm

There is a link from that piece to the experiment I ran in 2001 to see just how

much variance there might be in PSA results by having daily tests for 28 days –

the results of that experiment are at http://www.yananow.net/PSAexperiment.htm

and thre is interesting commentary at http://palpable-prostate.blogspot.com/2007/04/psa-variation.html

In answer to you specific questions:

* If the odds are 60% that I don't have

cancer then how do we explain the rising PSA?

As indicated above, you don’t have a

rising PSA, so no explanation is necessary. However, because PSA is not a prostate

cancer specific test, in most cases any elevated PSA is due to some cause other

than PCa, such as BPH (Benign Prostatic Hyperplasia) – the most common cause

– and bladder and prostate infections. A significant number of elevated cases

are labeled as being “idiopathic” which one of my specialists explained

to me is shorthand for “we haven’t a clue”.

* If the test comes back negative do we go thru this whole process again in 12

mths? 24 mths etc.

There seems to be no reason, based on what

you have posted here, to justify a second biopsy. But yes, if the second one was

negative, many medical (and non-medical) people would suggest more biopsy procedures

until finally some atypical cells would be found that might be labeled “cancer”,

leading to the next confusing part of a typical PCa journey – what to do

next? To me this has always seemed to be like the dog that chases the bus and when

it finally ‘catches’ the bus is nonplussed about what to do with his

catch.

* What other tests are there to show that the explanation might be something

else? Though there are other tests, none any more reliable than the basic PSA test,

but the most obvious is what is usually termed the ‘free PSA test’,

a summary of which is included in my piece. There is also what is termed a PCA3

test and some derivatives from that test. Again although considerable success is

claimed for this test, mainly by the people who own the marketing rights, it is

far from clear that their claimed results are replicable. There is a range of further

tests for bladder and prostate infections, but as BPH is a major cause of elevated

PSA, the answer as to why there is an elevated PSA may be as simple as measuring

the volume of the gland.

The Ur wants me

to do what I think is an expanded biopsy under general anathestic from a

different direction??

Not sure what this is but my guess is that

he may be considering a perineal biopsy (through the area between your testicles

and your anus) and may even be considering a ‘mapping’ biopsy when

a large number of needles – 50 or more depending on the estimated size of

your gland are used.

The Ur

then recommended another blood test to pick up the PSA Flow. (Why wasn't this

looked at before?)

Again I am not sure what is meant here,

but assume that reference may be to PSA velocity or PSA doubling time, since

there us a theory that the speed of the doubling time or the absolute increase

in PSA numbers may indicate PCa or an aggressive form of the disease. Like

virtually every other facet, there is no agreement on the reliability of this

theory.

Hope this helps – keep on asking

questions and you’ll have a good chance of avoiding unnecessary treatment.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

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

Sent: Thursday, 26 November 2009

10:20 AM

To: ProstateCancerSupport

Subject:

Rising PSA

Hi,

The story so far...

I'm 49 and have a rising PSA.

1st PSA test Sep 2008 3.6 (result of a general screen)

I had a biopsy Nov 2008 (14 samples) - negative

2nd PSA test Nov 2009 4.0

Ur wants me to

do a second biopsy but I'm now asking a few questions:

* If the odds are 60% that I don't have cancer then how do we explain the

rising PSA?

* If the test comes back negative do we go thru this whole process again in 12

mths? 24 mths etc.

* What other tests are there to show that the explaination might be something

else?

The Ur wants me

to do what I think is an expanded biopsy under general anathestic from a

different direction?? Not sure of the procedure so this is why I baulked.

The Ur then

recommended another blood test to pick up the PSA Flow. (Why wasn't this looked

at before?)

Depending on the outcome of this test I'll decide on the timing on the second

biopsy.

I thought I would post to this group on any suggestions before I talk with the Ur next week.

It seems the only answer is to keep sticking needles into my prostate until

something happens.

Regards

Kevan

[Guest guest]

Kevan wrote:

> ...

> It seems the only answer is to keep sticking needles into my

> prostate until something happens.

Kevan,

I think you are right to be skeptical of the Uro's advice.

First off, let me say I agree with the advice you've gotten from

other posters.

The biopsy is the only test I know about that is absolutely

positive for cancer. If the pathologist sees cancerous cells

under his microscope, he's looking at the cancer directly. But

there are other useful tests.

Ira suggested endorectal MRI and color-Doppler ultrasound. It is

my understanding that those tests don't specifically show cancer,

but they do show tissue that is denser than it ought to be and

might be cancer. If they come back negative, then that doesn't

mean you don't have cancer, but it does mean that you don't have

solid tumors big enough to show up.

Two blood tests that can also be used are a " free PSA " test and a

PCA3 test. PSA is a protein that can either appear by itself in

the bloodstream ( " free PSA " ) or it can appear bonded to other

proteins ( " complexed PSA " ). The ratio of the two is an indicator

of cancer, the more free the better.

I don't recall how the PCA3 test works but, like PSA and free

PSA, it's another blood test and doesn't involve much

invasiveness. You can look it up on the web.

Terry said there was no significant difference between 3.6 and

4.0. I have been told by a cancer research doctor that PSA can

vary for unknown reasons by up to 30%, meaning that no cancer,

and no prostatitis are involved, it's just normal variation from

time to time. The change from 3.6 to 4.0 is certainly less than

30%. And that's even assuming that the tests are performed

identically by the same lab with the same technique.

Your PSA is higher than normal. Possible causes for your

elevated PSA are cancer, bacterial infection, viral infection,

inflammation due for example to calcium or other mineral

deposits, enlarged prostate, and perhaps " PIN " (prostatic

intrapethelial neoplasia), which is an alteration of cells that

is like cancer but is not necessarily malignant and may or may

not ever become malignant.

Elevated PSA can also result from stress on the prostate. If you

had sex recently (some say 48 hours) before the blood draw, or if

you had a digital rectal exam before the blood draw, it is

possible that could have elevated the PSA.

I'm not a doctor and I hesitate to say your urologist is wrong.

He knows more than I do. But if I were in your shoes I would

want to get some of these other tests, particularly the blood

tests (the others are, literally, a pain in the ass) on a regular

basis and see what happens. Be sure not to have sex or get DRE a

few days prior to the draws. A test every 3 or 6 months might be

reasonable.

I'd also ask for a complete copy of the biopsy report and read

it. There may be comments from the pathologist that explain the

high PSA reading. For example, he might report that he saw

inflammation or PIN.

The doctor might propose to put you on a course of antibiotics to

see if your high PSA is caused by bacterial infection. The great

majority of urologists will do that. In my inexpert opinion,

that's an invasive waste of time. We know that most prostatitis

is not caused by bacterial infection, and that not all bacterial

infections are treatable with antibiotics because not much of the

chemical actually reaches the prostate. Furthermore, a recent

study showed that the percentage of men whose PSA went down after

a course of antibiotics is EXACTLY the same as the percentage of

men whose PSA went down without taking antibiotics. I wouldn't

take antibiotics unless there were signs of infection other than

PSA, which is hardly specific for it.

If you do have cancer, I presume you don't have much. None

appeared in 14 samples. It generally takes years for cancer to

develop to the point where it threatens to metastasize and become

dangerous.

What would he do if he took 20 samples and found a speck of

cancer in one of them? Would he recommend immediate major

surgery that might leave you impotent and/or incontinent? Ask

him that question. If he is responsible and conservative I think

he'd have to say, let's watch it and see if it develops.

I should think that advice would be sound even if he found small

amounts of cancer. " Active surveillance " , i.e., doing regular

PSA tests, will find problems well before they become serious.

The outcome of having a second biopsy, even if it finds a tiny

amount of cancer (and why would it find lots of cancer if there

was none in the original biopsy samples?) would therefore be no

different than if no second biopsy were performed. What would be

the point of another biopsy? It sounds to me like the wrong

thing to do.

However, having said all that, I want to emphasize that I'm not a

doctor. If you're not sure what to do, you might want to get a

second opinion from a real doctor before making a final decision.

Pick one whom you know advises active surveillance to at least

some of his patients. There's no point going to another " always

operate right away " doctor who will always give the same advice

no matter what the results of a biopsy are.

Best of luck.

Alan

[Guest guest]

If I understand right, your PSA readings:

Sep 2008: 3.6

Nov 2009: 4.0

1. The difference could be just " measurement error " . Or you might have a

chronic, low-grade prostate infection. Or you might have BPH (benign prostatic

hyperplasia, if I remember right), which can raise PSA levels, but is not

cancerous.

Or you might have given the second blood sample after having sex, or after

having a digital rectal exam, either of which raises the PSA level.

2. If the numbers are right, your " PSA doubling time " is quite long -- about 7

years.

If you check one of the Partin-table calculators online, I think you'll find

that the chances of the tumor being " out of the capsule " is pretty low. And a

" negative " (no cancer) biopsy suggests that the tumor is quite small.

At 49, you _don't_ want to deal with the consequences of surgery or radiation

treatment, for a cancer which is " indolent " . Those consequences are serious,

and they'll happen to _you_, not your urologist.

According to what I've read, you're a good candidate for " Active Surveillance " .

You could take PSA readings every 3 months or every 6 months. When they start

to rise (and _if_ they start to rise), you can decide to re-biopsy and treat the

cancer.

I don't have any medical degrees, and your uro does. So weigh our suggestions

appropriately. But don't rush into another biopsy, and don't rush into

treatment.

>

> Hi,

>

> The story so far...

>

> I'm 49 and have a rising PSA.

>

> 1st PSA test Sep 2008 3.6 (result of a general screen)

>

> I had a biopsy Nov 2008 (14 samples) - negative

>

> 2nd PSA test Nov 2009 4.0

>

> Ur wants me to do a second biopsy but I'm now asking a few questions:

>

> * If the odds are 60% that I don't have cancer then how do we explain the

rising PSA?

> * If the test comes back negative do we go thru this whole process again in 12

mths? 24 mths etc.

> * What other tests are there to show that the explaination might be something

else?

>

> The Ur wants me to do what I think is an expanded biopsy under general

anathestic from a different direction?? Not sure of the procedure so this is why

I baulked.

>

> The Ur then recommended another blood test to pick up the PSA Flow. (Why

wasn't this looked at before?)

>

> Depending on the outcome of this test I'll decide on the timing on the second

biopsy.

>

> I thought I would post to this group on any suggestions before I talk with the

Ur next week.

>

> It seems the only answer is to keep sticking needles into my prostate until

something happens.

>

> Regards

> Kevan

>

[Guest guest]

,

You say <snip> If you check one of

the Partin-table calculators online, I think you'll find that the chances of the

tumor being " out of the capsule " is pretty low. And a

" negative " (no cancer) biopsy suggests that the tumor is quite small.<snip>

I am just intrigued why you think there is

a tumour at all, when there is absolutely no evidence of one. Why do you think

that?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

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

Sent: Friday, 27 November 2009

2:43 AM

To: ProstateCancerSupport

Subject:

Re: Rising PSA

If I understand right, your PSA readings:

Sep 2008: 3.6

Nov 2009: 4.0

1. The difference could be just " measurement error " . Or you might

have a chronic, low-grade prostate infection. Or you might have BPH (benign

prostatic hyperplasia, if I remember right), which can raise PSA levels, but is

not cancerous.

Or you might have given the second blood sample after having sex, or after

having a digital rectal exam, either of which raises the PSA level.

2. If the numbers are right, your " PSA doubling time " is quite long

-- about 7 years.

If you check one of the Partin-table calculators online, I think you'll find

that the chances of the tumor being " out of the capsule " is pretty

low. And a " negative " (no cancer) biopsy suggests that the tumor is

quite small.

At 49, you _don't_ want to deal with the consequences of surgery or radiation

treatment, for a cancer which is " indolent " . Those consequences are

serious, and they'll happen to _you_, not your urologist.

According to what I've read, you're a good candidate for " Active

Surveillance " .

You could take PSA readings every 3 months or every 6 months. When they start

to rise (and _if_ they start to rise), you can decide to re-biopsy and treat

the cancer.

I don't have any medical degrees, and your uro does. So weigh our suggestions

appropriately. But don't rush into another biopsy, and don't rush into

treatment.

>

> Hi,

>

> The story so far...

>

> I'm 49 and have a rising PSA.

>

> 1st PSA test Sep 2008 3.6 (result of a general screen)

>

> I had a biopsy Nov 2008 (14 samples) - negative

>

> 2nd PSA test Nov 2009 4.0

>

> Ur wants

me to do a second biopsy but I'm now asking a few questions:

>

> * If the odds are 60% that I don't have cancer then how do we explain the

rising PSA?

> * If the test comes back negative do we go thru this whole process again

in 12 mths? 24 mths etc.

> * What other tests are there to show that the explaination might be

something else?

>

> The Ur

wants me to do what I think is an expanded biopsy under general anathestic from

a different direction?? Not sure of the procedure so this is why I baulked.

>

> The Ur

then recommended another blood test to pick up the PSA Flow. (Why wasn't this

looked at before?)

>

> Depending on the outcome of this test I'll decide on the timing on the

second biopsy.

>

> I thought I would post to this group on any suggestions before I talk with

the Ur next

week.

>

> It seems the only answer is to keep sticking needles into my prostate

until something happens.

>

> Regards

> Kevan

>

[Guest guest]

Have you had the level 2 PSA test yet? This is a somewhat different look at the

PSA with a " free " reading that might more reliably indicate cancer or a benign

condition. Do a search for Free PSA for more info.

[Guest guest]

Tom my blood test PSA was 8. 2 mark but I was told by my doctor, that free PSA is normily around the 15 mark, for some one with out prostrate cancer I know the last time I had my free done, it was about the 8 mark so it come up, but in 2008 it was just 4 so it got better by 4 points has any one else free PSA come up Randall

To: ProstateCancerSupport Sent: Fri, 27 November, 2009 8:38:46 AMSubject: RE: Re: Rising PSA

Have you had the level 2 PSA test yet? This is a somewhat different look at the PSA with a "free" reading that might more reliably indicate cancer or a benign condition. Do a search for Free PSA for more info.

Win 1 of 4 Sony home entertainment packs thanks to Yahoo!7. Enter now.

[Guest guest]

Terry --

You're right. I should have said:

" _If_ there's a tumor, the negative biopsy result tells you that it's very

small. If you check one of the Partin-table calculators online, I think you'll

find that the chances of such a small tumor being " out of the capsule " is very

low. "

I don't know what the " age vs normal PSA " graph looks like. If " normal " PSA is

much lower than 3.6 at age 49, I can understand the doctor's concern. But the

PSA test is _non-specific_; it tells you that _something_ is wrong, not _what_

is wrong.

My memory (which is flakey) is that some AS programs have used " PSA = 10 " as a

trigger for treatment. In which case (assuming the test results are absolutely

accurate, _and_ assuming there really is a cancerous tumor) the original poster

would defer treatment for about 8 years.

This is a situation where the standard advice:

.. . . Don't rush into treatment

has a lot of weight.

>

> ,

>

>

>

> You say <snip> If you check one of the Partin-table calculators online, I

> think you'll find that the chances of the tumor being " out of the capsule "

> is pretty low. And a " negative " (no cancer) biopsy suggests that the tumor

> is quite small.<snip>

>

>

>

> I am just intrigued why you think there is a tumour at all, when there is

> absolutely no evidence of one. Why do you think that?

>

>

>

> All the best

>

>

>

> Terry Herbert

>

> I have no medical qualifications but I was diagnosed in '96: and have

> learned a bit since then.

>

> My sites are at www.yananow.net <http://www.yananow.net/> and

> <http://www.prostatecancerwatchfulwaiting.co.za/>

> www.prostatecancerwatchfulwaiting.co.za

>

[Guest guest]

Randall Crossley wrote:

> Tom my blood test PSA was 8. 2 mark but I was told by my

> doctor, that free PSA is normily around the 15 mark, for some

> one with out prostrate cancer I know the last time I had my

> free done, it was about the 8 mark so it come up, but in 2008

> it was just 4 so it got better by 4 points has any one else

> free PSA come up Randall

I think you've got it backwards Randall. Your free PSA got WORSE

by 4 points, not better.

What you want is a high free PSA. Here's a table showing percent

free PSA in the left column and probability of cancer in the

right column, for men with total PSA of 4-10.

Free PSA % Probability of Cancer, %

0 - 10 56

10 - 15 28

15 - 20 20

20 - 25 16

>25 8

Only 8% of men with free PSA > 25% had cancer whereas 56% of men

with free PSA < 10 had cancer.

The source is:

http://www.health.uab.edu/12798/nationally-ranked-urology/13608/

Alan

[Guest guest]

Alan looks like I might have got it the wrong the way I explaned it.

My free PSA was a ratio of 4 in 2007 it now a free PSA ratio of 8. So it come up 4 points I was told normal free psa is a ratio of 15. So the closer the free PSA is to the ratio number of =15 is healthy. But < 15 means we have a sick prostrate is this right or not Randall

To: ProstateCancerSupport Sent: Sat, 28 November, 2009 11:42:35 AMSubject: Re: Re: Rising PSA

Randall Crossley <randall.crossley@ yahoo.com> wrote:> Tom my blood test PSA was 8. 2 mark but I was told by my> doctor, that free PSA is normily around the 15 mark, for some> one with out prostrate cancer I know the last time I had my> free done, it was about the 8 mark so it come up, but in 2008> it was just 4 so it got better by 4 points has any one else> free PSA come up Randall I think you've got it backwards Randall. Your free PSA got WORSEby 4 points, not better.What you want is a high free PSA. Here's a table showing percentfree PSA in the left column and probability of cancer in theright column, for men with total PSA of 4-10.Free PSA % Probability of Cancer, % 0 - 10 5610 - 15 2815 - 20 2020 - 25 16>25

8Only 8% of men with free PSA > 25% had cancer whereas 56% of menwith free PSA < 10 had cancer.The source is:http://www.health. uab.edu/12798/ nationally- ranked-urology/ 13608/Alan

Last chance to win a Sony entertainment pack thanks to Yahoo!7. Hurry, ends Nov 30. Enter now.

[Guest guest]

>

> Alan looks like I might have got it the wrong the way I explaned it.

Here's a pretty simple explanation of the Free PSA readings:

High free PSA -- above 25% -- usually indicates BPH (benign prostate

hyperplasia).

Low free PSA likely signals prostate cancer. Most men with prostate cancer have

a free PSA below 15%.

If free PSA is below 7%, prostrate cancer is most likely. According to American

Cancer Society and National Cancer Institute, men with free PSA at 7% or lower

should undergo biopsy. If biopsy is negative but free PSA remains low, repeat

biopsy is in order.

[Guest guest]

> Alan looks like I might have got it the wrong the way I

> explaned it.

>

> My free PSA was a ratio of 4 in 2007 it now a free PSA ratio of

> 8. So it come up 4 points I was told normal free psa is a ratio

> of 15. So the closer the free PSA is to the ratio number of

> =15 is healthy. But < 15 means we have a sick prostrate is

> this right or not Randall

Randall,

I'm not an expert of course, but my understanding of free PSA is,

the higher the percentage of free PSA, the better.

I'm not sure what your doctor meant by " ratio of 4 " and " ratio of

8 " .

If that means 4% or 8% of your total PSA was " free " (not combined

with other proteins), that's a strong indication of cancer. If

it means that your ratio of total PSA to free PSA was 4 to 1,

that means that your percent free was 20%, which is a fairly good

number, and better than 8 to 1, which is only about 11%.

In the U.S. the numbers would be given as percentages. 8% would

be low and indicate cancer. 4% would be even lower, even more

strongly indicating cancer.

In your particular case you already know that you have cancer, so

I'm not sure that the free PSA means much at all for you. I

haven't seen anything that indicates that it has anything to do

with the extent or aggressiveness of the cancer. If not, then

your change from 8 to 4 may mean nothing at all. You should ask

your doctor for more info if you can, or maybe someone else here

knows if the free PSA number is of any other diagnostic

significance than just saying whether your elevated PSA is due to

cancer or not.

Alan

[Guest guest]

Hi Alan,

I think the free PSA ratio is pretty straight forward before treatment and a useful tool prior to diagnosis, particularly in deciding whether to have a biopsy or not with an elevated PSA. As you indicate I think it's of dubious relevance after treatment yet my Onco still asks for it as part of my blood tests. I've just opened my 1 year post IGRT results today (pretty brave I think as I'm also celebrating my 50th today!) and my free PSA is 0.09ng/ml. My total PSA is 1.73, down from 2.39 three months ago which I'm hoping is pretty good. This gives a ratio of 0.05, while the stated normal is 0.2-1.0 As I say I think this is pretty meaningless 12 months after treatment. More worrying, I think (but irrelevant to this group), is that my cholesterol has gone from 235 to 325 mg/dl - even tho I've finally given up butter for 'marg lite' - yuck !!

I see the Onco on 2nd Dec so any comments anyone has re questions I should ask with these results would be appreciated. Anyone else wishing to share their 12 months PSA results post IGRT would be greatly appreciated. I think 1.73 is OK but not great. Thankfully my Dihidrotestosterone results are down from 0.9 three months ago to 0.59 ng/ml (normal 0.3 -1.0 ng/ml) so I'm hoping ADT isn't suggested or necessary.

Randall, I'm impressed (congratulations) with your 16 year survival on diet alone. You mentioned your Gleason after biposy in 2007(?), did you also have a first biopsy (and Gleason score) 16 years ago when you were first diagnosed with prostate cancer? I've just finished the last of my home grown harvest of pomegranates this week so will have to go onto carton juice from now on.

Good health to all,

Malaga, Spain

Re: Re: Rising PSA

> Alan looks like I might have got it the wrong the way I> explaned it.> > My free PSA was a ratio of 4 in 2007 it now a free PSA ratio of> 8. So it come up 4 points I was told normal free psa is a ratio> of 15. So the closer the free PSA is to the ratio number of> =15 is healthy. But < 15 means we have a sick prostrate is> this right or not RandallRandall,I'm not an expert of course, but my understanding of free PSA is,the higher the percentage of free PSA, the better.I'm not sure what your doctor meant by "ratio of 4" and "ratio of8".If that means 4% or 8% of your total PSA was "free" (not combinedwith other proteins), that's a strong indication of cancer. Ifit means that your ratio of total PSA to free PSA was 4 to 1,that means that your percent free was 20%, which is a fairly goodnumber, and better than 8 to 1, which is only about 11%.In the U.S. the numbers would be given as percentages. 8% wouldbe low and indicate cancer. 4% would be even lower, even morestrongly indicating cancer.In your particular case you already know that you have cancer, soI'm not sure that the free PSA means much at all for you. Ihaven't seen anything that indicates that it has anything to dowith the extent or aggressiveness of the cancer. If not, thenyour change from 8 to 4 may mean nothing at all. You should askyour doctor for more info if you can, or maybe someone else hereknows if the free PSA number is of any other diagnosticsignificance than just saying whether your elevated PSA is due tocancer or not.Alan

[Guest guest]

Randall,

I am looking into diet and foods that effect cancer negatively. So can you email your diet info. I will put it on this site if it is allowed.

Would be gratefully appreciated,

Tom

To: ProstateCancerSupport Sent: Sat, November 28, 2009 4:41:40 PMSubject: Re: Re: Rising PSA

Hi Alan,

I think the free PSA ratio is pretty straight forward before treatment and a useful tool prior to diagnosis, particularly in deciding whether to have a biopsy or not with an elevated PSA. As you indicate I think it's of dubious relevance after treatment yet my Onco still asks for it as part of my blood tests. I've just opened my 1 year post IGRT results today (pretty brave I think as I'm also celebrating my 50th today!) and my free PSA is 0.09ng/ml. My total PSA is 1.73, down from 2.39 three months ago which I'm hoping is pretty good. This gives a ratio of 0.05, while the stated normal is 0.2-1.0 As I say I think this is pretty meaningless 12 months after treatment. More worrying, I think (but irrelevant to this group), is that my cholesterol has gone from 235 to 325 mg/dl - even tho I've finally given up butter for 'marg lite' - yuck !!

I see the Onco on 2nd Dec so any comments anyone has re questions I should ask with these results would be appreciated. Anyone else wishing to share their 12 months PSA results post IGRT would be greatly appreciated. I think 1.73 is OK but not great. Thankfully my Dihidrotestosterone results are down from 0.9 three months ago to 0.59 ng/ml (normal 0.3 -1.0 ng/ml) so I'm hoping ADT isn't suggested or necessary.

Randall, I'm impressed (congratulations) with your 16 year survival on diet alone. You mentioned your Gleason after biposy in 2007(?), did you also have a first biopsy (and Gleason score) 16 years ago when you were first diagnosed with prostate cancer? I've just finished the last of my home grown harvest of pomegranates this week so will have to go onto carton juice from now on.

Good health to all,

Malaga, Spain

Re: [ProstateCancerSupp ort] Re: Rising PSA

> Alan looks like I might have got it the wrong the way I> explaned it.> > My free PSA was a ratio of 4 in 2007 it now a free PSA ratio of> 8. So it come up 4 points I was told normal free psa is a ratio> of 15. So the closer the free PSA is to the ratio number of> =15 is healthy. But < 15 means we have a sick prostrate is> this right or not RandallRandall,I'm not an expert of course, but my understanding of free PSA is,the higher the percentage of free PSA, the better.I'm not sure what your doctor meant by "ratio of 4" and "ratio of8".If that means 4% or 8% of your total PSA was "free" (not combinedwith other proteins), that's a strong indication of cancer. Ifit means that your ratio of total PSA to free PSA was 4 to 1,that means that your percent free was 20%, which is a fairly goodnumber, and better than 8 to 1, which is only about

11%.In the U.S. the numbers would be given as percentages. 8% wouldbe low and indicate cancer. 4% would be even lower, even morestrongly indicating cancer.In your particular case you already know that you have cancer, soI'm not sure that the free PSA means much at all for you. Ihaven't seen anything that indicates that it has anything to dowith the extent or aggressiveness of the cancer. If not, thenyour change from 8 to 4 may mean nothing at all. You should askyour doctor for more info if you can, or maybe someone else hereknows if the free PSA number is of any other diagnosticsignificance than just saying whether your elevated PSA is due tocancer or not.Alan

[Guest guest]

correction for 1.e should read 1.3

With a Gleason 6 about a year ago I opted to have Seed implantationknown as Brachy Therapy.After 3 months PSA was 1.1, three months later 1.e, just had a PSA reading yesterday 1.7 and my Uroligist said lets take another PSA in three months...This has me worried..What comes next?Ed

[Guest guest]

correction for 1.e should read 1.3

With a Gleason 6 about a year ago I opted to have Seed implantationknown as Brachy Therapy.After 3 months PSA was 1.1, three months later 1.e, just had a PSA reading yesterday 1.7 and my Uroligist said lets take another PSA in three months...This has me worried..What comes next?Ed

[Guest guest]

Alan,

Thank you so much for your comments, almost identical to what my Doctor told me. You sure know your stuff.

Thanks again,

Ed

eddiek712 wrote:> With a Gleason 6 about a year ago I opted to have Seed> implantation known as Brachy Therapy. After 3 months PSA was> 1.1, three months later 1.3, just had a PSA reading yesterday> 1.7 and my Uroligist said lets take another PSA in three> months...This has me worried..What comes next?Ed,It is possible that you still have cancer. However it is alsopossible that you don't. It is my understanding that, of all ofthe different forms of radiation, brachytherapy is the one mostlikely to cause PSA "bounce", i.e. the PSA going up but thenlater coming down again.I had HDR brachytherapy and my PSA bounced around a lot. My highpoint was 1.8. Of course that was the measured high point. Noone knows what it was on the days when no measurement was made.I assume the actual highest point was higher than 1.8 since itseems very unlikely that the blood draw would just happen tooccur on the highest day. My PSA went up and down for threeyears before beginning a slow and gradual decline. Now, eightyears later, my most recent PSA reading was 0.11 and I think itlikely that I'm cancer free.So, my suggestion is the same as that of your urologist. Toughit out for a while. See what happens in three months. Even ifit goes up a little at that time, probably tough it out foranother three months. I don't think you want to start hormonetherapy if it turns out that you don't need it.If the PSA goes up again, and then again, and if the urologistthinks this really does look like a recurrence, then I think itis time to see a medical oncologist. Look for one with seriousexperience in prostate cancer.If you do still have cancer it's not necessarily a deathsentence. It might be entirely controllable with drugs. Sowhile I know you can't be happy about what's happening and youcan't help feeling a lot of anxiety and some depression, try notto give into it. You still have a lot of options left, a lot oflife left, and can still stay in control.Do check in with us again. Like all of us in this group, you'vegot friends here who know exactly what you're going through.Best of luck.Alan

[Guest guest]

> correction for 1.e should read 1.3

> In a message dated 6/21/2011 03:43:23 P.M. Pacific Daylight Time,

> Eddie21bj@... writes:

>

> With a Gleason 6 about a year ago I opted to have Seed

> implantation

> known as Brachy Therapy.

> After 3 months PSA was 1.1, three months later 1.e, just had

> a PSA reading yesterday 1.7 and my Uroligist said lets take

> another PSA in three months...This has me worried..What comes

> next?

Bearing in mind that a urologist is a surgeon, not necessarily a

cancer specialist:

(1) What was your PSA when diagnosed?

(2) It appears that the brachytherapy was ineffective. If it was

done correctly, then the PCa cells must be elsewhere, which means

that the PCa is systemic -- if the PSA continues to rise.

(3) If it does, then your best course would, IMO, be consultation

with a real cancer specialist, a medical oncologist, preferably

one who is well-trained in treatment of prostate cancer.

Regards,

Steve J

[Guest guest]

eddiek712 wrote:

> With a Gleason 6 about a year ago I opted to have Seed

> implantation known as Brachy Therapy. After 3 months PSA was

> 1.1, three months later 1.3, just had a PSA reading yesterday

> 1.7 and my Uroligist said lets take another PSA in three

> months...This has me worried..What comes next?

Ed,

It is possible that you still have cancer. However it is also

possible that you don't. It is my understanding that, of all of

the different forms of radiation, brachytherapy is the one most

likely to cause PSA " bounce " , i.e. the PSA going up but then

later coming down again.

I had HDR brachytherapy and my PSA bounced around a lot. My high

point was 1.8. Of course that was the measured high point. No

one knows what it was on the days when no measurement was made.

I assume the actual highest point was higher than 1.8 since it

seems very unlikely that the blood draw would just happen to

occur on the highest day. My PSA went up and down for three

years before beginning a slow and gradual decline. Now, eight

years later, my most recent PSA reading was 0.11 and I think it

likely that I'm cancer free.

So, my suggestion is the same as that of your urologist. Tough

it out for a while. See what happens in three months. Even if

it goes up a little at that time, probably tough it out for

another three months. I don't think you want to start hormone

therapy if it turns out that you don't need it.

If the PSA goes up again, and then again, and if the urologist

thinks this really does look like a recurrence, then I think it

is time to see a medical oncologist. Look for one with serious

experience in prostate cancer.

If you do still have cancer it's not necessarily a death

sentence. It might be entirely controllable with drugs. So

while I know you can't be happy about what's happening and you

can't help feeling a lot of anxiety and some depression, try not

to give into it. You still have a lot of options left, a lot of

life left, and can still stay in control.

Do check in with us again. Like all of us in this group, you've

got friends here who know exactly what you're going through.

Best of luck.

Alan

[Guest guest]

Steve:

you said "(2) It appears that the brachytherapy was ineffective. If it was done correctly," A few years ago there was a story about a VA doctor that was terrible at aiming and missed a lot of prostates completely. So it is a possibility (see below) How often things like this happen in private practice is an unknown... Henry

http://www.emaxhealth.com/1024/33/31861/veterans-receive-wrong-prostate-cancer-treatment-va-hospital.html

-------------------------

Now the Philadelphia VA Medical Center is the focus of a failure of oversight and problems in prostate cancer care. As many as 92 veterans received incorrect doses of radiation for their prostate cancer treatment.

The veterans were to receive implanted radioactive seeds (brachytherapy) as treatment for their prostate cancer. The use of these radioactive seeds when implanted correctly focus the radiation in the prostate and limit the damage to nearby tissues.

Several of the veterans received incorrect doses (often too small for adequate treatment) of radiation while others had improper placement of the seeds. Some were improperly placed into the bladder and/or rectum rather than the prostate. In at least one case, the improperly placed seeds may have contributed to rectal bleeding.

It is reported that all of the affected veterans have since gotten follow-up care. Eight patients received additional seed implants for their prostate cancer treatment at the VA Medical Center in Seattle.

Brachytherapy is usually done as an outpatient procedure under spinal anesthesia. An ultrasound probe is inserted into the rectum and used to guide the placement of the radioactive seeds. The seeds are then implanted into the prostate through very thin needles. Depending on different variables, between 50 and 100 seeds are used. The needles are inserted into the skin between the scrotum and rectum. The US probe is used to guide the needles into the right place to most effectively treat the cancer.

The seeds used in prostate brachytherapy may include Iodine-125, Palladium-103, and echnogenic Iodine-125 seeds. They emit a low level of radiation which doesn’t usually travel beyond the prostate. Because there is such a small amount of radiation involved, it is not considered a risk to others. Ask your doctor questions about what the precautions should be, or any other questions that you have about the safety of the radiation used in brachytherapy therapy.

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> To: ProstateCancerSupport > Date: Tue, 21 Jun 2011 16:07:40 -0700> Subject: Re: RISING PSA> > > > > correction for 1.e should read 1.3> > > >> > With a Gleason 6 about a year ago I opted to have Seed> > implantation> > known as Brachy Therapy.> > After 3 months PSA was 1.1, three months later 1.e, just had> > a PSA reading yesterday 1.7 and my Uroligist said lets take> > another PSA in three months...This has me worried..What comes> > next?> > Bearing in mind that a urologist is a surgeon, not necessarily a > cancer specialist:> > (1) What was your PSA when diagnosed?> > (2) It appears that the brachytherapy was ineffective. If it was > done correctly, then the PCa cells must be elsewhere, which means > that the PCa is systemic -- if the PSA continues to rise.> > (3) If it does, then your best course would, IMO, be consultation > with a real cancer specialist, a medical oncologist, preferably > one who is well-trained in treatment of prostate cancer.> > Regards,> > Steve J> > > > ------------------------------------> > There are just two rules for this group > 1 No Spam > 2 Be kind to others> > Please recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options. > > Try to delete old material that is no longer applying when clicking reply> Try to change the title if the content requires it

[Guest guest]

Chuck Maack wrote:

> Way too early to get overly excited. It can take over a year

> and a half to reach nadir, and for some men much longer. I

> know of one man who didn’t reach nadir until 4 years

> post-radiation ...

.... Or even more than 4 years.

I just checked my medical records and found the following PSA

values after my treatment in December 2003-January 2004:

4/29/2005 0.51

6/23/2006 0.25

6/22/2007 0.21

6/20/2008 0.13

5/1/2009 0.12

11/25/2009 0.09

6/25/2010 0.10

6/15/2011 0.11

These records are from my HMO (they have these online). There

are some missing data points that were significantly higher from

other times in between that appeared on tests made by the doctors

in the clinical trial I was in outside the HMO, of which the

highest was 1.8, some time in 2005 if I remember correctly, and

1.2 some time in 2006. If I hadn't been in the trial and getting

frequent PSA tests, I wouldn't even have known that I had several

PSA bounces. In fact, I had one a few months ago at the clinical

trial follow up when my PSA hit 0.26 and I wondered if I was

having a recurrence. But when the HMO tested last week I saw

that the PSA was back to 0.11.

In my case, the low point ( " nadir " ) was reached almost six years

after treatment!

I still suffer occasional bouts of prostatitis. Each one seems

to cause my PSA to go up.

Alan

[Guest guest]

Okay…..now I know a man who didn’t reach nadir for nearly six years! (grin) From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Alan MeyerSent: Tuesday, June 21, 2011 8:26 PMTo: ProstateCancerSupport Subject: Re: RISING PSA Chuck Maack wrote:> Way too early to get overly excited. It can take over a year> and a half to reach nadir, and for some men much longer. I> know of one man who didn’t reach nadir until 4 years> post-radiation ...... Or even more than 4 years.I just checked my medical records and found the following PSAvalues after my treatment in December 2003-January 2004:4/29/2005 0.516/23/2006 0.256/22/2007 0.216/20/2008 0.135/1/2009 0.1211/25/2009 0.096/25/2010 0.106/15/2011 0.11These records are from my HMO (they have these online). Thereare some missing data points that were significantly higher fromother times in between that appeared on tests made by the doctorsin the clinical trial I was in outside the HMO, of which thehighest was 1.8, some time in 2005 if I remember correctly, and1.2 some time in 2006. If I hadn't been in the trial and gettingfrequent PSA tests, I wouldn't even have known that I had severalPSA bounces. In fact, I had one a few months ago at the clinicaltrial follow up when my PSA hit 0.26 and I wondered if I washaving a recurrence. But when the HMO tested last week I sawthat the PSA was back to 0.11.In my case, the low point ( " nadir " ) was reached almost six yearsafter treatment!I still suffer occasional bouts of prostatitis. Each one seemsto cause my PSA to go up.Alan