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A good question I sure couldn't answer for someone

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Posted 2/22/2009 4:56 PM (GMT 0)
My ex-boss asked me an interesting PC related question the other day, I couldn't answer it, nor could I easliy find an answer, so I throw it out here.  He said, if it's normal for men without PC to have PSA scores all their lives, ranging from .5 to 4.0, which was the threshold for getting a biopsy, and they never get PCa, then how come after someone like me that had surgery, or someone that had radiation or whatever treatment comes back with low amounts of PSA, and its a bad thing.  His point was, if its normal for a man to register PSA without having PC, then how can the small or trace amounts ever be dangerous?

The answer may be simple, and I never seem to get the obvious, but his question stumped me, so come help me out here brothers/sisters!  I told him I would ask you guys for a straight answer.

David in SC

Posted 2/22/2009 5:09 PM (GMT 0)
I had read that normal prostate tissue produces the antigen at 1/10th the amount that the same weight of cancerous tissue.
I am not sure if the tissue that is associated with BPH would produce the same as the normal tissue surrounding it I would guess yes.

So that is one reason why the urologist likes to know the total prostate size - so they can calculate how much of your PSA total is from the benign prostate tissue and any of the rest could be due to cancerous or precancerous causes.

And of course if you no longer have a prostate (or a radiated one that is 'dying') then most all of the reading would be from cancerous or pre-cancerous growths -- which would be a bad thing.

That is my take on this - no doubt lots of exceptions -- like people with WAY high PSA but not any sign of cancer -- strange..

Jim
Posted 2/22/2009 6:19 PM (GMT 0)
How about this: If a person has had prostate surgery, radiation to destroy the gland or other less used treatments, then the source of the psa is supposedly destroyed. Hence zero's, undetectables, and such results. If the psa comes back elevated from that zero, undetectable range then the cancer is/has reoccurred and it is showing by the test. The absence of any psa is evidence of no cancer, then present in any elevated form is evidence of cancer. Maybe the fact that most of the psa is from the gland itself, and if psa shows after removal, then the psa is coming from a cancer other places. ???? tongue
Posted 2/22/2009 7:16 PM (GMT 0)
Personally, I believe the medical community is still not sure what PSA represents. It may be named Prostate Specific Antigen, but it is not prostate specific, as women even have measurable PSA. http://www.ncbi.nlm.nih.gov/pubmed/10234897.

Furthermore, in men there is no specific level that positively indicates prostate cancer. http://www.medscape.com/viewarticle/517248_3.

PSA level only indicates increased risk. This is why Free PSA level, PSA Velocity, DRE and family history must also be considered when evaluating for PCa. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1122361.

After treatment the PSA level should drop to a minimal level, which is the body's baseline.
"Low concentrations of PSA have been identified in urethral glands, endometrium, normal breast tissue, breast milk, salivary gland tissue, and in the urine of males and females. PSA also is found in the serum of women with breast, lung, or uterine cancer and in some patients with renal cancer."
http://emedicine.medscape.com/article/457394-overview

Unless there is something, i.e., micro-metastases, that causes an increase in PSA level it should remain at baseline. Once micro-metastases have grown large enough they contribute to the overall PSA level and the PSA doubling time after biochemical failure appears to determine the aggressiveness of the metastatic cancer... http://clincancerres.aacrjournals.org/cgi/content/full/10/11/3927.

Bottom line, in my research I have found nothing other than PCa reoccurrence that can raise PSA levels in a meaningful way after PCa treatment. And I have done a lot of research as I am at extremely high risk for reoccurrence.
Posted 2/22/2009 9:37 PM (GMT 0)
The simple answer of course is the prostate gland leaks PSA into the bloodstream at slightly different levels in different men. If a man leaks PSA at a particular rate (PSA density= PSA per unit volume of prostate tissue) then as his gland increases in size (as in BPH) the amount of PSA leaked will correspondingly increase (but the PSA density should remain roughly the same) . In general, once the gland has been removed there is no longer a source of PSA (unless some prostate tissue or cancer has been left in) so the PSA level in the blood becomes undetectable (because it is not there). That is why the surgery goal is zero PSA while the radiation goal is falling PSA as the gland dissolves. If any prostate tissue is left post treatment, the PSA level should remain unchanged. If there is cancer (still basically prostate cells) present microscopically, it will not be large enough to produce enough PSA to be detected, but as the cells multiply over time more PSA is produced and it will become detectable. As the overall volume of tumour cells increase (could be at multiple sites as the cancer metastasizes) the PSA level will rise ever higher. The rate at which the PSA is increasing (PSA velocity) is an indicator of how fast the total volume of tumour is growing (i.e. how aggressive). Complicating this is that in general, higher Gleason grade cells produce less PSA per unit volume of tumour by virtue of the fact that they behave less like the normal prostate cells from which they arose. An interesting read can be found here:
www.prostate-cancer.org/education/riskases/Strum_StrategyOfSuccess2.html
Bill
Posted 2/22/2009 10:01 PM (GMT 0)

Sleepytime:

You said:

Bottom line, in my research I have found nothing other than PCa reoccurrence that can raise PSA levels in a meaningful way after PCa treatment. And I have done a lot of research as I am at extremely high risk for reoccurrence.

I would like to offer one small correction to that statement and that it refers to SURGERY patients.  With radiation patients, particularly brachytherapy patients, there is frequently a "PSA bounce" that occurs some time after treatment.  Such a bounce does not indicate reoccurance of the cancer and the PSA level typically falls back to the nadir.  This bounce also does not indicate that the patient who experiences the bounce will have any higher reoccurrance of the cancer than those who do not experience the bounce.

...just wanted to clarify for those who may have had or are considering radiation as the primary treatment.

Tudpock

Posted 2/22/2009 10:08 PM (GMT 0)
Tudpock18

Thanks for the extremely valid clarification.

Shawn
Posted 2/22/2009 10:18 PM (GMT 0)
Thanks so far, got some good well thought out answers. I should have stuck to my gut feeling on the original question, but got confused at the time, lol.

David
Posted 2/22/2009 11:50 PM (GMT 0)
Hello Sleepytime.
This is VERY interesting. I checked the site that you mentioned...about the fact that Women also have PSA counts... News to me...(Im a woman), PSA can be found in a normal womam's breast., but more when pregant, is in amniotic fluid, breast milk . ? WOW! It is also very interesting to me that Vitamin D3 seems ( by some accounts that Peter and I have read ) haa some kind of a relationship with both breast cancer and prostate cancer. I so believe that there may be some connection between Vitamin D and cancer. I may be off the wall on this, but if you look at the statistics of prostate cancer across the country...It seems the farther north you go the more cancer... . Could it be Vitamin D....The sunshine Vitamin? Diane

David....Im not nutty am I??? :) maybe!
Posted 2/23/2009 12:24 AM (GMT 0)
Diane, don't think you are nutty, I love a good conspiracy theory! Go!
Posted 2/23/2009 12:29 AM (GMT 0)
Diane-
I'm with you on the Vitamin D theory. The same holds true with MS. Definitely makes you want to go out and soak up a little sunshine. Seattle is clearly not the place. :)
Posted 2/23/2009 12:33 AM (GMT 0)

divo said...
Hello Sleepytime.
This is VERY interesting. I checked the site that you mentioned...about the fact that Women also have PSA counts... News to me...(Im a woman), PSA can be found in a normal womam's breast., but more when pregant, is in amniotic fluid, breast milk . ? WOW! It is also very interesting to me that Vitamin D3 seems ( by some accounts that Peter and I have read ) haa some kind of a relationship with both breast cancer and prostate cancer. I so believe that there may be some connection between Vitamin D and cancer. I may be off the wall on this, but if you look at the statistics of prostate cancer across the country...It seems the farther north you go the more cancer... . Could it be Vitamin D....The sunshine Vitamin? Diane

David....Im not nutty am I??? :) maybe!

I live in the sun belt where we average 300 days of sunshine a year. On top of that I play a lot of golf out in it. It didn't help me unless altitude negates the benefits, after all we are the #1 skin cancer state.
Posted 2/23/2009 12:34 AM (GMT 0)
Makes me wonder now, Doting, I never drink milk, hated it as a kid, and I avoided the direct sun most of my life, as I am very sensitive to heat and very prone to sunburn. Now it makes me wonder if that was the wrong move on my part! Now, a few days of all dark clouds and/or rain, and I start to come unglued, it will depress me.

David
Posted 2/25/2009 2:27 AM (GMT 0)
Purgatory -

As a high school & collegiate cross country & track runner, and now a soccer coach, I think I have spent at LEAST an average amount of time in the sun - if not more. I still got PCa, and I also have to wear sunscreen and worry about melanoma (along with everybody else). Sometimes I think you can't win for losing.

kcragman
Posted 2/25/2009 3:14 AM (GMT 0)
Always loved milk, drank plenty of it, and have spent my life in the sun but still it got me. 7 aunts and uncles on my mother's side and 7 on my father's side............ about 40 first cousins and they have maybe 100 offspring. In all of those close relations the only cancer sufferers are myself and one aunt (mother's sister) who had a stomach cancer back in the late 50's. (she was cured by a radioactive cobalt treatment). Aren't I the lucky one.
Bill
Posted 2/25/2009 1:15 PM (GMT 0)
Well Billy and Krag, guess we are chasing a circle here. More Vit D = still getting PC, Less Vit D= still getting PC. I mostly believe it doesnt matter what we do or don't do, should have done or not done, there are still genetic and hereditary issues going on, and we would all admit that PC is an aggervating enemy at best - doesn't like to be contained or defined by "normals".

Now the plus side of being a sun/heat avoider like me - for a 56 year old guy, I don't have wrinkles on my hand, neck, or face. I don't have any sun related skin cancers. And my skin is still soft and pliable.
Posted 3/25/2009 8:44 PM (GMT 0)
smhair   Wow.  My dad will be 84 this May and I believe he's had biopsy twice.  For several years his PSA has been over 4, but the biopsys never find anything. I always tell him to count his lucky stars.
Posted 3/25/2009 8:47 PM (GMT 0)
Consider your father very fortunate there, justus.
Posted 3/25/2009 9:09 PM (GMT 0)
Interesting...wouldn't a PSA of 4.0 for an 84 year old be in the normal range...and yet he has had two biopsies? Or did I misread what you meant Justus, in that he had prior biopies at a younger age. I can't imagine why at that age they would be looking for prostate cancer based on a PSA of 4.0 and no other symptoms. It seems to me that I read that a vast majority of men over the age of 80 would have some slight amount of prostate cancer anyway.
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