PSA - What in a Number?

PSA prognosis outcome probability distributions are usually listed as PSA   < 4, PSA <10, PSA >10, sometimes PSA >20   - Yes, of course the g-score is extremely important (I have not yet had a biopsy).   Being that PSA is reported with such sensitivity (.01 increments) every PSA whole digit would appear statistically significant for prognosis outcome i.e., PSA 9.5 vs. PSA 10.5. - But then again PSA appears to be fickled at times - low PSA - High Gleason (7s , 8 or 9) - or - High PSA - Low Gleason (3 + 3)  but these casses appear to be outliers.   I centaintly like the 4 < PSA <10 stats MUCH better and I'm only 2.76 PSA  away from 10 (my PSA is 12.76). But perhaps close only counts with horseshoes and handgrenades?   The NCCN uses a three component matrix: Stage, Gleason and PSA for risk - see below.  But PSA does appears to be indicative of statistical outcomes of Stage and Gleason. The higher the PSA the worse Gleason stastically - and being statistics they always allow for exceptions as mention above. But they're just that - exceptions.   I haven't seen ANY posts of PSA >10 and Gleason 3 + 3   In post treated patients .01 PSA   changes appear to be important to many esp. if trending   The NCCN Breaks Risk Down Like This: Very Low: - Stage T1C; AND - Gleason score <6; AND - PSA <10; AND - Fewer than three biopsy cores positive, <50 percent cancer in each core; AND - PSA density <0.15. Low: - Stage T1 to T2a; AND - Gleason score <6; AND - PSA <10. Intermediate: - Stage T2b to T2c; OR - Gleason score 7; OR - PSA 10-20. High: - T3a; OR - Gleason score 8-10; OR - PSA >20.     Any thoughts?   K2 PSA 12.76 / DRE Abnormal Appt Sch w/ local Urologist Looking into City of Hope Cancer Center      

Although there are many similarities between individuals that have PCa, everyone is different.  Determining an individual's risk of how severe PCa is based upon PSA values or other indicators is really just a statistical indicator created from past studies and historical experience.  Any one individual can fall outside the highest odds situation.

Based upon my personal experience, one needs to cross their own bridges when they get to them.  In other words, since you have the initial indicators that you MAY have PCa, your next bridge is to get the biopsy.  The results of the biopsy will give you another bridge to cross.

Each step of the way provides you the information you need to get to the next step.

The initial indicator that triggered my biopsy was an abnormal DRE.  The biopsy revealed PCa and thus my next step was to choose a treatment. 

 

Since having da Vinci RP, my pathology report revealed pT3b stage.  But since I am only 3 weeks out from surgery I am unsure of what my next bridge may be (if any).  I will cross it when I get to it.  Meanwhile I will get the information I need to see if there are any more bridges in my future. 

 

It is true that the statistical information that assesses the odds of a certain level of risk is interesting, but it is only a part of the information you need to proceed down your individual path.

 

 

Pre treatment psa is not very specific to less than one whole number. PSA after treatment is specific to .1 as there is no prostate to create psa leaving only prostate cancer cells to generate psa.
PSA is additive' the benigh psa from an entact prostate registures .660 of psa for over cc of prostate tissue and can be affected by infection. There are standard formulas for psa generated by prostate cancer using the size of the tumor and the gleason grade. Higher grades of gleason create less psa. You can find these formulas on the PCRI web site or in Dr Strum''s book "Primer on Prostate Cancer."
JT

and my pre-biopsy psa was 2.9 and biopsy gleason 4+5