Second PSA in 3 months, at 4.8, while first was 5.8, cmnt?

psajack · New User Joined: 24 Apr 2008 Posts: 3

I posted a couple of earlier posts to this forum, giving infomation about myself, my case, etc., but now, only yesterday, I got PSA results back from my second PSA (first one was 3 months ago). That first one was 5.8 PSA, and second one now is 4.8; they tell me "normal" is less than 4). However, I do have a slightly enlarged prostate, smooth; not rough or lumpy, so with enlarged prostate, wouldn't my PSA be a bit higher than "normal due to that alone?" I am 65. Just how critical is a change of 1 on the PSA scale, is 1 significant? How accurate is a given PSA reading, plus or minus % wise? I plan another PSA test in anotherr 3 months. IF you are a professional, I would especially like to know what your opinion is, with PSA going down 1, from 5.8 to 4.8 in 3 months? What test can I have done to see if prostate has inflamation/infection, as I know that could cause PSA increase. Think I should ask doctor if I should take some drug to get rid of any possible inflamation of prostate, if it indeed is inflamed?

Replicant · Moderator Joined: 01 Nov 2006 Posts: 220

In general a rise of 0.75 or more per year has been considered a significant uptick that needs investigation.

PSA can be elevated from BPH. There is a formula (that I haven't used) that shows how much can be expected from benign enlargement. To use it you need to know your PSA volume in cc's, I think. If no one here can answer this particular question, you could post it on the alt.support.cancer.prostate group (available via Google Groups). There are guys there who know about this.

How accurate the test is depends on the lab. They probably have this data (mine did--I called them). I think a normal variation in the standard PSA is around 0.1 ng/ml. That assumes just regular variation between machines, not a gross lab error. Your lab might be different.

Again, I'm not a pro and I know you want professional advice. As far as I know, we only have one person on this board who is a professional (Dr. Rucker). I do know that it is fairly common for urologists to try a round of strong antibiotics like Cipro to see if that brings PSA down. My uro also tried prescription strength ibuprofen. Neither one helped.

Your doctor can also give you a "free PSA" test which measures the ratio of free to bound PSA. fPSA, as it is called in shorthand, can help determine--but not establish beyond doubt--whether an elevated PSA is caused by something benign or by prostate cancer. fPSA is a common test--google "free PSA" and you'll find lots of information.

Normal used to be 4.0, but the medical community now knows that a standard number like that can't be applied to everyone. What's more important is the trend over time. Yours may be going down. That's great news.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

Beth56 · Regular Joined: 30 Mar 2008 Posts: 30 Location: California

My husband at 62 was diagnosed in 2006 with pc. His PSA was 3.2 and a month later dropped to 2.8. One doctor felt a lump on prostate and another doctor did not. So to be safe, he went ahead with a biopsy under a general as he was scared of doing it awake. He results were 3+4=7 gleason score. He ended up having proton beam therapy for his treatment. So far so good.

Otago · Regular Joined: 20 Jan 2008 Posts: 20

Jack....... read some more about PSA testing and range of scores from day to day and week to week, even at the same lab.

{lynk deleted by admin}

Read about the daily range jumping in a significant manner.

Also there is bacterial prostatitis and non-bacterial, and very important there is asymptomatic inflammation of the prostate which can also raise the PSA score.

Read all the listings on that page I linked you to above.

Otago

chrisz · Regular Joined: 09 Apr 2007 Posts: 37

Otago,

Man...... thanks for the links. I sure learned a lot.
And I have been gathering information for a year or so.

That website really helps explain PSA readings. Mine
has been jumping all over the place. My Udoc did a prostate squeeze
and examined the fluid. He found moochoo white cells..... a Prostate
infection that gave me no symptoms, except high PSA.

That's something I haven't read much about anywhere. More Udocs
should test your seminal fluid in this manner before proceeding to
biopsy. After treatment with 21 days of SulfaTrim my PSA dropped
from almost 9 to below 5. However, not far enough for him. I wound
up getting my second biopsy anyway..... In the hospital, 20 + cores
taken. No PC detected. Now my PSA is 2.5 Sure sounds like the infection
was still there. I wonder why he didn't recheck it first.

Well, I have another PSA test in MAY, we'll see. If it's high again, I gonna
ask for another fluid test. No more biopsies until I'm sure there is no infection or inflammation !!

I learned a lot from that link. I was shocked that high Gleason grade cancer usually results in LOW PSA readings. Even if it has metastasized.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 220

That website contains a lot of abstracts from the literature, mixed with personal experiences and opinion.

I can't find anywhere on the page where it says that "high Gleason grade cancer usually results in LOW PSA readings. Even if it has metastasized."

It is true that *some* men with prostate cancer have low PSA scores--low compared to the old yardstick of 4.0 ng/mL. This is why Walsh says there's no safe cutoff point above 1.0 ng/mL.

But usually tumors with high Gleason scores result in high PSAs. This is because prostate cancer cells leak a lot of PSA into the blood. Not always. But there is a correlation between PSA and Gleason:

"There was a positive correlation of high-grade Gleason score in the surgical specimens to higher preoperative PSA, more extensive tumors, positive margins and more advanced pathologic staging."
Gleason score as predictor of clinicopathologic findings and biochemical (PSA) progression following radical prostatectomy.
by: MS Guimaraes, MM Quintal, LR Meirelles, LA Magna, U Ferreira, A Billis
Int Braz J Urol, Vol. 34, No. 1. (b 2008), pp. 23-29.

"The higher values of PSA were proportional to the Gleason scores of the primary prostatic biopsy."
M. Lekili Contact Information, M. Zengin, H. Postaci and A. R. Ayder--Relationship between histologic grading and serum prostate specific antigen in prostatic carcinoma--- International Urology and Nephrology-- Volume 26, Number 6 / November, 1994

"Prostate-specific antigen has been increasingly employed as a valuable tumour marker, with a fairly good correlation between PSA level and extent of disease." p. 292, Cancer and Its Management
By Robert L. Souhami, Jeffrey Tobias (2002: Blackwell Publishing)
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

jimschlemmer · Regular Joined: 28 Apr 2008 Posts: 22 Location: troy, ny

[i]I can't find anywhere on the page where it says that "high Gleason grade cancer usually results in LOW PSA readings. Even if it has metastasized."
[/i]
My urologist mentioned that sometimes high Gleason cancers don't produce any or as much PSA. I think the idea is that the cancer cell can be so mangled in its mutation that it no longer can carry on the function of PSA production.

He said that in some very rare cases the PSA remains low while an aggressive cancer is present. In that case it's difficult to catch using present testing methods.

-Jim

Replicant · Moderator Joined: 01 Nov 2006 Posts: 220

I've heard the idea that sometimes it's the low PSA cancer that's most aggressive. But I've heard it on discussion boards and not from any published studies.

Walsh, on p. 156, citing data from the New England Journal of Medicine, shows that if your PSA is:

Less than 0.5, your chance of high grade disease is 0.8 percent.

0.6 - 1.0, chance of high grade disease is 1 percent.

1.1 -2.0, 2.6% chance of high grade disease.

and so forth.

"Although some men with PSA this low [less than 1.0] may harbor prostate cancer, it is unlikely to be the life-threatening, high-grade kind. What matters more is what happens to this PSA level--whether it rises over time, and how fast." (again, from Patrick Walsh's book, p. 156)

Nothing is certain when it comes to PSA and prostate cancer.

I am only trying to point out here the inaccuracy in an earlier post that stated "high Gleason grade cancer usually results in LOW PSA". If anyone asserts that, please post evidence in the form of peer-reviewed research. I have posted abstracts from more than one source that show just the opposite.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

Otago · Regular Joined: 20 Jan 2008 Posts: 20

I have not posted here for a few months.

I think that is why my link in the prior post was deleted after only a few of you got to see it.
As I remember I think I was given some explanation months ago that seemed reasonable as to why newer members cannot link in the beginning.

Anyway, that page is good so I won't give a link but instead give you some information that will enable you to do a Google search to reach the same page. I don't think that is inappropriate. Its a well known person and responsible organization.

search the following six terms all at once in Google

Kyoto Prefectural Cipro Hyperplasia Prostatitis undectable

That will give you the page. A very good page on PSA and its variability.
Too many people think the PSA test is a accurate test and that going from 3.5 to 4.0 means something when all it may mean is that you had once blood draw done on Monday and the second one on Friday.

chrisz · Regular Joined: 09 Apr 2007 Posts: 37

Replicant,

This is the text I lifted from that website :

---------------------------------------------
Gleason Grade

We know that the Gleason Grade also is involved in this charade. The higher the Gleason grade the lower the PSA. Lets repeat this - the higher the Gleason Grade the lower the PSA. The Gleason Grade are those two figures that combine to make the Gleason score 3+4 (Gleason Grades) = 7 (Gleason Score). I have heard of a case where a man had a Gleason of 4+5=9 and a PSA of 0.8.
----------------------------------------------

Whether it is true or not, I don't know.

Sorry if there was any misunderstanding.

Chris

Replicant · Moderator Joined: 01 Nov 2006 Posts: 220

Chris, I see it now.

The author makes that assertion (and repeats it) but does not cite his sources for that assertion.

In the literature references at the bottom of the page he created, there is evidence that contradicts his "low PSA = high Gleason" assertion:

"High levels of total PSA, PSA density, and PSA-TZ density correlated significantly with capsular penetration, high Gleason scores, and large cancer volumes in the prostatectomy specimens." (Horninger W, Rogatsch H, Reissigl A, Volgger H, Klocker H, Hobisch A, Bartsch G)

See what I mean? High levels of total PSA correlate with high Gleason.
That's the opposite of what he claims in his discussion higher up on the page.

Also, check out the author's credentials--he is a well-meaning layperson, but that is all.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

Otago · Regular Joined: 20 Jan 2008 Posts: 20

[quote="Replicant"]
Also, check out the author's credentials--he is a well-meaning layperson, but that is all.[/quote]

True, he is only a layperson, but I dare say, one would get better information from him than from the average primary care doctor.....and in some ways better than from many urologists, in that one is given so few minutes with the urologist to ask questions and get answers.
So he does his best and has done so for over 10 years. He is well known by many local groups.

Speaking of local groups, one of the best is the Prostate Cancer Networking Group of Greater Cincinnati. (PCNG)

If you go to look at their site, you will find a excellent newsletter with years of archives, in which many professionals come to speak and write for the local group. If you Google--- PCNG and newsletter--- you will easily find it.

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