PSA Rising

I am on active surveillance and you can see my history below. My PSA was 2.77 in Jan/10. I just got the results of my July 21/10 test and my PSA reading is now 3.96. I know PSA fluctuates but this is a 42% increase in 6 months. I dont know if I should be getting another biopsy to see if there is disease progression or assume this is in the realm of normal fluctuation. I see my Urologist  next week so I will get his opinion then - in the meantime any commments would be appreciated.

Thanks

You could probably wait one more month and see what it does..But I would be setting up a date with a surgeon. You are too young to rely on AS. Cancer doesn't just go away. Three of my cores were Gleason 6 too, but one was G-9..You don't want things to get out-of-hand..

Since you KNOW you have PC, I would not do any more biopsies. That just complicates the surgery. You can do the BIG biopsy when they get it out...

I was not on active surveillance, but my PSA did make a dramatic increase after bouncing around a lot, and my biopsy showed Gleason 7. Talk to your urologist, but if I were you I would be inclined to do another biopsy to see if the cancer is getting aggressive. You still have fairly low numbers, though, so it's not an urgent thing, and your urologist might recommend another PSA test before doing another biopsy.

Frankly, with that increase, you should be looking at a first line treatment.

Mel

Optimist,
That is quite a jump in 6 months. Your Urologist should be able to advise you on what to do next.

Kongo, help me out here, how did you come up with your numbers, the psa increase is 1.19 in six months?

 

normek said...
Kongo, help me out here, how did you come up with your numbers, the psa increase is 1.19 in six months?

 

Normek...the numbers came out of a Sloan Kettering Cancer Center nomogram that calculates PSA doubling time and velocity given a PSA history.  I just used the numbers Optimist listed in his initial thread post and plugged them into the nomogram on line.   The link to the nomogram I used on this thread is:  http://www.mskcc.org/mskcc/html/10088.cfm

There are other similar nomograms from various other institutions...some give a graphical readout.  With a good history of PSA readings as Optimist has, the most important thing, in my opinion, is the trend, not a single point.  This is statistics 101.  The more data you have, the less important any individual reading becomes.  In my own case, I eliminated dairy and my PSA dropped from 4.3 to 2.8 in six weeks.  I also saw my PSA jump from 4.1 to 5.3 in 4 weeks when I unwittingly had morning sex a few hours before the blood draw.  Several factors can affect PSA such as the normal standard deviation of the laboratory procedure, an inflamed prostate, prostate manipulation (like when they do the DRE), sex before the blood draw, taking statins, drinking pomegranate juice, and so on.

Obviously, PSAs can increase rapidly and should be a cause of concern but a single data point given the overall trend exhibited by Optimist is not something I would worry about unless follow on PSAs at 3 and 6 months showed the same trend.

I certainly wouldn't do another biopsy or make a date with a surgeon based on that single reading.  My personal opinion (and you can find several studies that suggest it as well if you do a goodle search) is that the very act of repeatedly inserting the biopsy needle might enable PCa cells to escape from the prostate capsule and there plenty of post RP pathology reports showing cancer growing along the needle tracks.  Surgery itself might also be an inadvertent cause of spreading prostate cancer and I've often wondered if the relatively common recurrence of PSA following RP (particularly when it occurs three or four years after surgery) might in part be a result of the surgery itself, allowing cancer cells that were previously contained in the prostate to escape into the blood stream, eventually metastasizing somewhere else.

In evaluating my own condition, I found that PSA velocity, PSA doubling time, and PSA density (the ratio of PSA to prostate volume) to be valuable indicators to assessing my cancer and what treatments would be appropriate.  Of course these should be balanced with the traditional PSA at Dx, Gleason, stage, biopsy involvement, and so forth and used to lay out an entire picture with your medical team.

Hope this answers your question.

normek said...
Kongo. I'm not an expert in the nanograms but it says to enter the psa results of the last 12 MONTHS or all psa results after surgery. I don't think this nonogram is intended to be used with long term data pre dx. Its for sure if you have 4 of 5 years of normal test is going to lower your velocity and doubling time.

normek...thanks for catching that.  The Sloan Kettering nomograms are indeed modeled for post-RP not for pre-treatment.  I went back and ran Optimist's numbers again using a pre-treatment nomogram and come up with different numbers, which are:

PSADT:  6.78 Years.

Slope =  0.1

Velocity = 0.51 ng/ml/year

I had overlooked the fact that the nomograms I originally referenced were constructed to take into account that PSA=0 reading expected immediately following an RP.

 

These numbers, while different that the earlier ones I listed, are (from my perspective) still in the "no big worry" range.  Dr. Walsh has indicated that pre-treatment PSA velocity is one of the most important considerations in treatment and that a velocity of > 2.0 ng/ml/year is a strong indicator of high risk cancer.   The velocity is more important that the actual doubling time.

 

Obviously another, higher PSA reading in six months would increase both the velosity and thePSADT and might be casue for concern unless there was some other factor like BPH or prostatitis or sex before the blood draw which might explain the rise.

 

I think anyone on an AS protocol is always going to be looking at the ups and downs of PSAs as they go forward.  Probably one reason why so many switch to a treatment without a significant change in their symptoms.

 

Thanks again for catching my mistake.  The nomogram I used for these numbers can be found at http://www.nomogram.org/ in the prostate cancer section.