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Thread: Psa 300+

  1. #1
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    Psa 300+

    My father has been tested twice for PSA. The first test showed his PSA level to be 25, the second test showed his PSA level to be 372. They had his bones checked, and as far as we know, he doesn't have cancer in his bone mass. They will run a third test to check his PSA level again. What can be done to lower his PSA level? Any advice is greatly appreciated! I am dumbfounded how high his PSA score is. My father is worried. How can I reassure him that his condition is treatable, and there is still hope? Thank you for any help you can provide.

  2. #2
    Moderator Top User HighlanderCFH's Avatar
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    Hi,

    How far apart were the first and second PSA tests? And were they analyzed by the same lab? Other info might also be helpful, such as your father's age and health history.

    Has he had a prostate biopsy? I would perhaps have his PSA checked again, but from a DIFFERENT lab to see if there is any difference. There are other reasons for elevated PSA aside from prostate cancer, although a 372 is certainly a very high reading. Does your father have any difficulty urinating? A "harmless" condition known as BPH (enlarged prostate) can squeeze on the urethra (which runs through the prostate) and make urination difficult. This is not cancer, but it does cause an elevated PSA reading.

    A prostate infection can also cause a high PSA reading.

    If a subsequent PSA test (which should be done very soon) should again show a high PSA, a prostate biopsy should be done. Then you'll have a clearer picture of what is going on. Perhaps a saturating biopsy (where they take lots & lots of samples) might be the thing to do to ensure that the biopsy needle does not happen to miss any tumors.

    Even with a very high PSA, prostate cancer (if he has it) can be highly treatable through surgery, radiation, hormone therapy -- whichever treatment is best in his individual case.

    One more thing is that anyone scheduled for a PSA test should NEVER have any sex, ride a bicycle or do ANYTHING that can stress the prostate. Such activity within 48 hours prior to a PSA test has been known to cause false elevations in the PSA reading.

    Others here will be jumping in with more advice and comments for you.

    In the meantime, please assure your dad that the end is not near. Just remain calm, get the new PSA test done and deal with the situation as it unfolds. I'm sure he has many, many good years ahead of him.

    Take care,
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13, 9/29/14 PSA <0.1
    Semi-firm erections from time to time.

  3. #3
    Has he been diagnosed with prostate cancer? If not, I echo Chuck's question: has a biopsy been done, or is it scheduled? If he was diagnosed, what was his Gleason score?

    Although BPH and prostatitis (both benign) can raise PSA, you would not expect to see it at 300 or more and not be cancer. I've seen on numerous medical sites that when PSA reaches 100, it's almost certainly cancer and it has very likely escaped the prostate. For example:

    "...for PSA levels more than 100 ng/ml, all subjects in our study had proven to have skeletal metastases on radionuclide bone scan. The positive predictive value using a cut off point of a serum PSA more than 100 ng/ml is 100%"
    http://www.omicsonline.org/1948-5956/JCST-03-112.php

    I think it's safe to assume that he has PCa and that it is advanced. It's good that it's not showing up in his bones yet. Is he receiving treatment? Hormone therapy is effective in many men, at least for a matter of months or years (sometimes decades) and then there are other treatments.
    Replicant

    Dx Feb 2006, PSA 9 @age 43
    RRP Apr 2006 - Gleason 3+4, T2c, NXMX, 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 (and thereafter) <0.1
    http://pcabefore50.blogspot.com

  4. #4
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    Step one would be a biopsy if not already done..How old is Dad? In any case "Hormone Treatment" will be prescribed which will control the cancer while they evaluate his overall condition and develop a treatment plan..
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14. On 6/14 PSA 0.4, "T"-5. 10/14 PSA 0.6, T-11

  5. #5
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    Thank you for your replies. Here is the situation as of today. My father is 60 years old. He has been diagnosed with stage 3 prostate cancer. I was told that his tumors are too large and can't be removed surgically (2+ cm3). The two PSA tests were conducted in two different hospitals. They ran a third test today. We'll know the results tomorrow. I spoke with his doctor today, and he told me that if his PSA reading is, indeed, that high, they will have to remove his testicles surgically. Then, after my father heals (in about a month), he will be hospitalized again and they will begin chemotherapy. I will speak with the doctor again tomorrow. What sort of questions should I ask him? Thank you very much!

  6. #6
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    Welcome.
    What country are you from?
    I would ask for the Gleason score. You might want a copy of the pathology report.
    With castration, he will not need hormone therapy. Hopefully, his PSA would go down after castration.
    If his PSA is going up after castration, then he would have castration resistant prostate cancer. Which means the cancer cells would grow independent of male hormones.
    You should ask what kind of chemotherapy they have in mind.
    I hope the castration works for a long time. Good luck.
    DOB Sept. 1947. Prostate cancer Gleason 7 (3+4), PSA 5 in Oct 2010. Cryoablation Jan. 2011. Had some complications.
    Experienced nocturia, irritable bladder summer 2011. "Agent Orange"compensation from VA Oct 2011.
    PSA: .05 01/26/2012, .06 6/26/2012, .04 12/24/2012, .04 6/26/13, .05 1/27/14, .05 10/21/14
    I am eating vegan mostly plus a little fish. Take some supplements.
    (Any advice given is the personal opinion of a layman and is not intended to replace the advice of a health professional.)

  7. #7
    Moderator Top User HighlanderCFH's Avatar
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    Hi,
    Lancepeace had a good question there. Do you know what your father's Gleason score is? That will go a long way in helping us give you more suggestions. A stage 3 PC is very serious, of course, but it might still be possible for it to be cured. Or, at the very least, controlled for many years.

    Take care,
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13, 9/29/14 PSA <0.1
    Semi-firm erections from time to time.

  8. #8
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    A biopsy will be needed to determine the Gleason score...I would insist on a biopsy.....Castration IS hormone therapy..Drugs can be used to achieve the same end, but they are expensive and don't work as well as castration..

    Before your Dad submits to castration, it must be verified by a biopsy that he actually has prostate cancer..

  9. #9
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    His Gleason score is 4+4.

  10. #10
    Moderator Top User HighlanderCFH's Avatar
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    Hi,

    Sounds like he's had his biopsy. A Gleason score of 8 is definitely an aggressive prostate cancer. Anything from 7-10 is considered aggressive, with 10 being the worst. So, at least he is a couple notches down from there.

    Have they ruled out surgery and/or radiation due to the stage 3 diagnosis? In any case, there are treatments available that will hopefully be able to help him keep going for many years.

    Please let us know how things are going as time goes on.

    Take care,
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13, 9/29/14 PSA <0.1
    Semi-firm erections from time to time.

  11. #11
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    Chuck, they told me they couldn't operate on him because his PSA is so high and cancerous lymph nodes are bigger than 1 cm3. His are over 2 cm3. They told me they don't remove nodes that are bigger than 1 cm3 surgically. Basically, they said that the first step is surgical castration, and the second step is radiation therapy to kill off cancerous cells in his prostate. Does this sound like a normal procedure?

  12. #12
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    They most often use chemical castration in USA, rather than surgical castration. Thats why I assumed you were not from USA. The surgery is cheaper and works well.
    The plan sounds reasonable to me.
    DOB Sept. 1947. Prostate cancer Gleason 7 (3+4), PSA 5 in Oct 2010. Cryoablation Jan. 2011. Had some complications.
    Experienced nocturia, irritable bladder summer 2011. "Agent Orange"compensation from VA Oct 2011.
    PSA: .05 01/26/2012, .06 6/26/2012, .04 12/24/2012, .04 6/26/13, .05 1/27/14, .05 10/21/14
    I am eating vegan mostly plus a little fish. Take some supplements.
    (Any advice given is the personal opinion of a layman and is not intended to replace the advice of a health professional.)

  13. #13
    Moderator Top User HighlanderCFH's Avatar
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    Hi sappho,

    Does your situation allow him to seek a second opinion from another, completely different medical facility? For something this important, a second opinion would seem to be very important. It's possible that a second opinion would concur with the original -- but I'd seek one on the chance that another medical center might know more than the first one.

    In any case, sending wishes for the best of luck your way,
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13, 9/29/14 PSA <0.1
    Semi-firm erections from time to time.

  14. #14
    Quote Originally Posted by sappho View Post
    Basically, they said that the first step is surgical castration, and the second step is radiation therapy to kill off cancerous cells in his prostate. Does this sound like a normal procedure?
    Yes, that management sounds completely reasonable. They will also almost certainly administer radiation to the suspicious lymph nodes to hopefully kill any cancer inside of them. After he's done with the radiation treatments, he'll probably be clinically monitored to make sure the cancer is not coming back. The monitoring would involve--among other things--periodic blood tests and visits to the doctor.

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    Do you live outside the U.S. or perhaps lack medical insurance? The hormone treatment, regardless of how it's done, will shrink the cancer and make it more susceptible to the radiation. The radiation will be more effective when augmented by the HT...

  16. #16
    Quote Originally Posted by Fairwind View Post
    Do you live outside the U.S. or perhaps lack medical insurance? The hormone treatment, regardless of how it's done, will shrink the cancer and make it more susceptible to the radiation. The radiation will be more effective when augmented by the HT...
    Orchiectomy/surgical castration is considered to be equally efficacious as medical castration with agents such as leuprolide (Lupron), so his dad will be getting an effective therapy.

  17. #17
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    Orchiectomy, effective, cheap ($850) one time expense. Has severe psychological impact..So in the States at least, $2000 a pop drugs are favored, a profit center for urologists and oncologists..An orchiectomy is permanent hormone therapy. The drugs can be stopped in patients where it is thought the treatment will be temporary, as when it's combined with radiation as a primary treatment..But once HT is used as a palliative measure, castration makes more sense..

  18. #18
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    Hi. Thank you all for your replies. My father lives in Russia, so I don't think that chemical castration was even an option. I actually found a helpful article on this topic, if anyone else needs more information:

    http://www.prostate-cancer.com/hormo...chiectomy.html

    The first clinic he went to was regional. Right now he is in the main clinic in the country. They ran two PSA tests along with many other tests, and this is the conclusion, at which they have arrived. They thought that his lymph nodes would be operable but after running all these tests they changed their treatment plan to surgical castration and then radiation therapy.

  19. #19
    Moderator Top User HighlanderCFH's Avatar
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    Hi there,

    Any chance at all of him visiting a clinic in the USA, such as Mayo Clinic or Johns Hopkins? Those would be marvelous places to get a second opinion.

    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13, 9/29/14 PSA <0.1
    Semi-firm erections from time to time.

  20. #20
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    Chuck, if I had a chance to bring him to the States to get the treatment done, I would do it without thinking twice. Right now, we have to rely on the judgement of the Russian doctors and hope that they will do everything to help my father. I am trying to gather more information on the Internet to make sure that whatever they are doing agrees with what is usually done in such cases in the West. So, any valuable advice on this site is more than appreciated.

    Below are more questions that I have, and if anyone can help, I will be very grateful:

    1) What kind of drugs are usually prescribed after the surgical castration?
    2) What can my father do to help him overcome this operation psychologically?
    3) Are there any exercises or diets that would help him heal better?
    4) What are the next steps after the surgery in treatment of the prostate cancer?
    5) What physical changes should he expect after the surgical removal of his testis?

    ANY other information is greatly appreciated.

 
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