Back again

Glad ur Back David. We need you. Todd

PSA velocity is, IMO, more important than many parameters especially with AS.

The problem/difficulty with AS is working out when to switch from AS to having treatment, as my reading of the role of AS is that it is a way of delaying treatment till the optimum moment, rather than a way of not ever having treatment. (So that you can continue to not have side effects or QOL issues for as long as possible) It is probably only with the older gentlemen among us that AS will involve never having any treatment.
The problem with AS for others is thus picking the optimum moment to act. If in between two PSA tests your cancer decides it's going to change up a gear and get nasty, then, by the time you see a corresponding change in your PSA, you may have left it too late. (My comment to my uro when it came to making the decision to act was that I'd rather feel that I'd acted a year too early than a day too late.)

I don't know what my PSA velocity was before surgery as my first PSA came back as 8.6, which couple with my biopsy results mean I was already having surgery before I could ever get retested. But who knows if it was 8 or 4 twelve months before. I encountered PSA velocity all right later mind you.

My first post-op PSA coming in at 0.1 on top of "nasty" pathology indicated that there was clearly still something in me making PSA. (Despite having acted as early as I could I may not have been in time) The SVI in the pathology showed the PCa was already on the move, and while it was a 3+4 Gleason 7 rather than a 4+3 it was still up from the 6 at biopsy.

As for the second post op PSA coming in at 0.4 well that gives a PSA doubling time of about 2 months, which really felt nasty. (If you put those kind of numbers into a nomogram the results aren't pretty)

The fact that my SRT nonetheless got the PSA down to <0.1 suggests that even though there was nasty stuff still in me after surgery it was still in the prostate bed and thus targetable, so I may still have caught it in time. But I feel that that sudden post-op jump has still raised the old PSA anxiety into another league for a while until I have had several "less thans" under my belt. (And so I fully understand your move David in not having a November PSA test, it being the lesser of two evils when the bigger picture is about getting as much of a break as possible for a while after so many difficult months.)

Anyway on your side of the Atlantic you are approaching Thanksgiving, which we don't have over here, so I hope you and your families all enjoy the holiday. (Even without the holiday I still know I have plenty to be thankful for in my life).

I saw a joke that said you guys are lucky they killed a turkey otherwise who knows what you might be eating: skunk, lizard, wildcat, eagle etc!

Alf

This is a very interesting discussion about PSA velocity as it is a topic I am not very clear about at all. If a guy has both prostatitis and PC how does velocity get calculated? A hypothetical example:

45 year old male is in good health with no symptoms. However:
May 07: 1.3
Nov 07: 4.0 (doctor suspects prostatitis, but suggests a retest before taking antibiotics
Feb 08: 2.1
Jun 08: 2.3
Dec 08: 3.8 (given a course of antibiotics)
Mar 09: 3.1
Biopsy in Jun 09 shows 3+4 PC in 3 cores/12
Sep 09: 4.6
Dec 09: 3.5
RRP in Dec 09, focal positive margin, 3+4, no other negative post op pathology

What is this guys PSA velocity?

Regards,
An

a psa velocity calculator - nomogram

mskcc.org/applications/nomograms/Prostate/PsaDoublingTime.aspx

here are the nomogram results from your figures - leave that to others to decifer -or better yet - have him talk about this with his doctor....

Months
Slope Log (PSA) 0.03
Doubling Time 25.91 months
Velocity 0.07 ng/ml/mo

Years
Slope Log (PSA) 0.32
Doubling Time 2.16 years
Velocity 0.80 ng/ml/yr

..........................

Very useful, thank you!

Note: it was a made up hypothetical example, just to help my understanding. Don't know anyone with these stats.

An

An, tsk tsk, I took those set of numbers as being literal, didnt know they were made up, that's one reason they didnt make sense.

David,

My husbands numbers jumped around like a ping pong before his surgery from 2.5 to 1.7 to 3.6 then 4.2 then 2.7. No antibiotics. I never understood the concept of PSA velocity because for us it did not make sense to us and a theoretical example was definately the way to go as this isn't far from what I have seen with another member some time ago.

I'm sure Bronson helped many of us.

Regards,
An

David,

I just dropped by HW today for the first time since July. I'm glad I did because the best news I could get was to see you in rehab and feeling well enough to be there. It will take awhile to see some results, but being a big believer in PT, I'm sure it's going to make a huge difference in your sense of well being and overall health. Once the tide of improvement begins it will soon become a flood. Good for you, best of luck!

Steve

David, it is good to read that you no longer are in pain!  My husband has finally ended his rehab.  He learned many exercises which build the pelvic floor.  He also worked with these rubber band things.  Would this be similar to yours.  He's going through maybe one pad a day, but leakage is still there. (I realize your situation is different).

Wishing you the very best as you go on with your journey!

Hugs,

Aimzee