exponential rise in psa

I had psa March 20,2011 23.44

 May 17 25.44 (free psa 2.26)

May 23 34.41(!)

Bx may24

May 25 post bx PSA 51.0 free psa 3.94

Bone scan/CRP ESR negative with "perhaps"small nodule on DRE r lobe. Intraoperative Doppler susicous 2cm mass r lobe

I understand that surgery is delayed after biopsy, but in a case such as mine with an exponential rise in the psa (even if the last psa post biospsy is discounted) shouldn't the surgery be performed asap. I presume the Gleeson will be at lesast 3+3 since I understand pathologist don't like to give scores lower than 3

Is Da Vinci an option?

It is my understanding that with this high a psa the tumor has metastasized regardless of the Gleeson scores and so surgery alone can not be curative

TIA

Freepsa,

Welcome to HW - sorry you find psa numbers that send you here.

On the biopsy, if you have less than a Gleason 3, they would likely report is as suspicious, or some other "maybe" term. In general, no one seems to give 2's any more. There is no reason to presume you will get a 3 just because you had a biopsy. It could come back with no cancer found in the samples taken.

Did they run you through a round of anti-biotics? Sometimes infections will cause high psa numbers.

Surgery is usually delayed after the biopsy to allow the rectum and the tissue between the rectum and the prostate to heal. My surgeon wants 6-8 weeks minimum after a 12-core biopsy, longer with more. ASAP has to be considered in context, and may be 8 weeks.

You would be doing yourself a disservice to assume you have metastasis. Walsh will tell you that a high psa may not be cancer, and cancer can be present with very low psa levels.

You will need to find a good surgeon, and a good radiation oncologist, and get opinions from both. Then find another set and get second opinions for both approaches. If you have a positive biopsy, use these 6-8 weeks wisely. Research and consultations will fill that time easily.

 

I really appreciate everyone's concern. However, I have to be realistic untill someone can show me even one case where a psa > 30 with a free psa ratio of 8% was not cancer. Furthermore psa that high suggests that there will be a recurrence after surgery alone. Since the primary tumor would be removed that implies that there are metastases that cause the recurrence

Freepsa,
You are correct, but there may be some rare exceptions. Depending on your Gleason grade you can estimate the tumor size as psa, gleason and volume are correlated. The PCRI web site has a tumor size calculator. Only a transition zone tumor can generate that much psa and still be contained. Tumor volume is directly correlated to extracapsular extension. You are also correct in your assumption that surgery has a low probability of being curable. Once you get your Gleason score you can go to the Partin Tables and better assess your risks. The rapid rise and high psa also are an indication of systemic spread and not just coming from a contained tumor. As soon as you get your biopsy results you should get a 2nd opinion from a medical oncologist that specializes in Prostate Cancer.
JohnT

FreePSA,
Keep reading while you await an active therapy. You need to heal the biopsy stuff because it will improve your chances to avoid infection during the therapy phase. Additionally, I have seen some cases where the PSA were as high as yours but they had excellent disease control with surgery. My PSA was not quite as high as yours but I am four and a half years out with advanced prostate cancer still in remission. It is true that your PSA will likely have positive margins, but PM's are not an indicator of prostate cancer specific mortality. And relapses are not either. If you need more time to decide and the PSA continues to climb at the current rate you may want to see an oncologist and consider a temporary round of hormonal therapy. If your PSA while on that round does not get back to zero or near zero then a local therapy will likely be less successful.

You have a great chance right now to get the varying opinions from your medical options. Take advantage of it. But note that no matter what they say you can likely find someone that will tell you differently ~ and both sides can be right.

Welcome to our board. Good luck in the coming days!

Tony

Ed,
When applying HT the PSA should drop out pretty much completely. If it does not then there is a reason. When applying early HT before a primary treatment therapy it is called neo-adjuvant hormonal therapy. You can get good search results in google when searching it and also with the MSK nomograms:

www.mskcc.org/mskcc/html/10088.cfm

The issue is that there is minimal data available on prostate cancer specific survival in these nomograms. But I just plugged in Freepsa's numbers and checked the neo-adjuvant hormones in and got 10 and 15 year results showing 96% and 90% respectively on the survival stats in the pretreatment calculator. What is not defined is in what combination of treatment therapies. This can be a tough road of various therapies, including surgery with radiation or brachytherapy with radiation as primary treatment options, and various hormonal approaches at some point during these time periods. of course he could also have surgery or radiation mono-therapies and get great results altogether without a combination approach although it's less likely.

That's good news for Freepsa!

Tony

Post Edited (TC-LasVegas) : 5/26/2011 9:35:29 PM (GMT-6)

>>That's good news for Freepsa!<<

i hear that.  thanx for the info.

ed

Thank u all.

Even if the post bx of 51 is ignored, who can explain psa rise of 1.5 in 2 months and then a 9 point rise in 6 days? Hard to believe that a DRE could cause that. anyone with data or references?

I am inclined against RT presurgery since it makes surgery more difficult.

The hormnonal therapy presurgery sounds like a good option

Am considering SKMCC or ColumbiaPresbyterian in NYC for second opinion.

Anyone have any experience with MD Anderson?

the free psa's were indeed run on the same day and I believe they are irrefutable evidence of PCA

Post Edited (Freepsa) : 5/27/2011 3:06:53 AM (GMT-6)

An elevated PSA and a correspondingly low free PSA percentage can be caused by prostatitis, which is a benign rather than a malignant condition. If prostatitis symptoms are noted and/or if expressed prostatic secretions are consistent with prostatitis, four to six weeks of Cipro® or similar antibiotic should be prescribed prior to recommending a biopsy. At the end of the Cipro therapy, a repeat PSA determination should be made. If there is significant lowering of the PSA, an element of prostatitis is likely to be present

This was on Dr Strums website..............I'm not suggesting that you don't have PCa, but I have read in several places that a low fpsa and a high psa is also just as likely Prostatitis.........many here suggest that a low free psa is always a sign of PCa,not true..........................Cooper 

cooper 360:

I don't believe there is ANY instance of a PSA>30 with a free PSA of 8% which was not PCa.

But taking cipro post biopsy won't hurt since I have to take it anyway

I am hoping u can prove me wrong witrh something other than an erroneous post on someone's website. every other website I have seen totally contradicts that misinformation. That's the whole purpose of getting the freePSA

Facts just the facts. Show me them, otherwise these are just words.

These results are consistent with only one thing, no one has yet to show me even one exception to PSA > 30 and a free PSA ratio of 8% being anything other than PCa. I am still waiting for documentation not just someone's unsubstantiated opinion

You mean the free PSA might be 10% instead of 8%? Remember at this level a slight inaccuracy is irrelevant. Also remember these results have been repeated and are consistent.

BTW, I am ofering my extra free PSA tgo anyone who wants it, but this is a one day offer only. So act now!!!

'I am still waiting for documentation not just someone's unsubstantiated opinion"

Freespa, doesn't your remark sound a bit on the rude side? Folks here are answering you the best way they can. This is not a doctor site, this is a patient to patient site.

David in SC