Prostate Velocity = great confusion!!

PSA 5 months ago was 3.32 and a year before that was 2.68. Got thinking about this climb without any knowledge of PSA velocity and talked to GP who ordered another PSA and a date with the Urologist. New PSA was 4.3 and Urologist says I have a 20% chance of "curable" cancer. I am feeling stressed but hopeful. Biopsy coming on May 9 followed by May 16 consultation.

Than I start reading more about PSA velocity including every thread I can find on this forum regarding PSAV. "10 times greater chance of dying" struck home plus the fact that every thread I read about PSA velocity led to cancer abeit some had to eventually get a "Doppler" biopsy to reveal their suspicions.

I am 65 and in good health with no urinary problems which probably rules out an infection or BPH. What's left???? I am pretty much convinced that I have cancer and hoping it is low Gleason, TI, etc.

Also curious as to why some of you chose various radiation treatments when you lose the option of surgery if the radiation fails?

Please excuse my "new" mostly uninformed remarks. I am still learning.

Hello browntrout,

I looked quite closely at this issue of PSA velocity since it is relevant to my own situation. There is one researcher, Dr. Catalona, who is a strong advocate for the importance of PSA velocity and he published the article you referenced showing a 10 X or more risk of death for people with high velocity. A number of other researchers at well-regarded institutions have looked at this as well and come to different conclusions. So this is far from a settled area.

One explanation that makes sense to me is that the information is different implications depending on the context. 2 things can cause high PSA velocity, one is a fast-growing cancer, and the other is an infection. So the 1st thing to do is to rule out infection. Once cancer has been confirmed, other information is available from the biopsy. Then, if the patient chooses surgery, additional information is available from the pathology report when the prostate that is removed is sent to the lab for further examination.

It has been argued that a high PSA velocity implies a greater chance of an adverse pathology for example extra capsular extension, positive surgical margins, lymph node involvement, etc. but that once the pathology has been determined, that the high PSA velocity does not provide any additional prediction as to the severity of the disease or the likely course.

At this point, there is no value for you in becoming anxious about the PSA velocity. If I were in your position I would be getting a biopsy at this point because your PSA shows a steady uptrend and a fairly brisk rate of increase. If your earlier PSA's from 2 and 3 years ago also show a steady uptrend then that would be even more of a reason to get a biopsy at this point. The information from the biopsy will be extremely important in the consideration of radiation versus surgery. For example, if you have only a few cores that are positive and not much of each core is positive, then it is likely that the cancer is still contained in your prostate and surgery is a reasonable option to consider. But if you have extensive cancer revealed in the biopsy, that would increase the likelihood that the cancer has begun to move out of the prostate, and that would tend to make radiation somewhat more advisable and surgery somewhat less than an option. The Doppler ultrasound can also help to determine whether the cancer is still contained in the prostate, but not every doctor uses that technique as yet.

So, bottom line, try to keep your fears in check at this point and get the biopsy information you will need to understand what you are really dealing with, and then you can make a more informed decision.

Sounds like you have done one of the 2 things you need to do:

1. Schedule the biopsy for May 9 with follow up a week later.

2. Get a new urologist.

Anybody who causes undue emotional stress before they even have the results of the initial biopsy, is not the urologist I would want.

I am a big believer in PSA Doubling time as that is how I found out I had advanced PCa Gleason 9 (4+5) with Oligometastasis at initial diagnosis a little over a year ago when I was 64. PSA on consecutive semi-annual readings went from 1.6 t0 2.62 to 3.68. We ordered the biopsy despite being below the mythical level of PSA = 4 danger signal.

Good luck and let us know when you get the biopsy results.

LupronJim

Brown Trout,
Good luck and get that biopsy and a new uro unless you need hearing aids and misunderstood. My psa went from 2.72 with my good Dr and 4.89 with my new Dr in 13 months; he didn't bother to tell me and I was diagnosed by "symptoms" a year and a half later..I'm still standing and decided to "do it right the first time" with hormones and radiation..
Please don't get too uptight since the biopsy is a piece of cake and I was drinking a cold beer an hour later. You might not even be invited to our club! All the best to you.
Bill

Regarding PSA velocity, you may be interested in:

http://www.cancer.gov/clinicaltrials/results/summary/2011/psa-velocity2011

http://www.medscape.com/viewarticle/777868

As others have said, the predictive significance of psa velocity is very unclear. And if that is true on a population basis, it is even more true for any one particular individual.

Once you get your bx results, you will know a lot more.

Best wishes, Medved

Both my long time urologist, and my oncologist of 3 1/2 years, are big believers in the PSA Velocity issue. It has to do with one's PSA velocity, in particular, in the year before one is diagnosed.

Mine went from 4.x to 12.x in the final year, and in the last 4 months prior to surgery, went to 16.x.

Though I am "only" a Gleason 7 case, my PC has been very aggressive despite the numbers. I quickly failed surgery (9 months), then quickly failed salvage radiation (<9 months). I am now dealing with advanced metastatic cancer. Last PSA check late last year put me at 80.x and climbing.

My doctor says I am the poster boy for the PSA Velocity theory. While no prognosis is based on certainty or exactness, both doctors put me at 7-10 years max, from the time I was first diagnosed in 2008.

So I am coming up on the 6 year mark.

Not writing this to scare you, but to show you a first hand case of how that Velocity issue can be with a particular patient, me in this case.

They say that even a rise of .35 in a year is reason to be concerned. When mine jumped over 8 whole points in a year, then a total of 12 points in a 1 1/3rd, a lot of red flags flew up.

Good luck in your situation,

David

Trout,
I would suggest you consider a 3t multiparametric MRI with and without contrast. My situation was similar to yours although my psa was higher. I opted for the color doppler ultrasound scan which identified a suspicious lesion. I followed that up with the MRI. The MRI identified a different lesion missed by the color doppler. The doctor who read the MRI predicted a gleason 7 or higher on the one he located. He dismissed the lesion detected by the color doppler.

Two weeks after the MRI, the same Dr. that read the MRI conducted a MR guided biopsy and took three cores from the suspicious lesion he had identified. The result was 4+4. Several doctors have since seen my MRI disc and agreed the trus biopsy would not have hit the gleason 8 tumor due to the location.

I am not sure where I would be if I would have followed my first uro who wanted me to have a 12 core random needle biopsy in his office. I believe an under diagnosis was probable. Just more things to consider, but, obviously I am an advocate of the prostate MRI and the MR guided biopsy.

On a positive note... I had my second three month Lupron injection on March 18th. I finished 25 IMRT/IGRT treatments on March 31st and had Brachytherapy last Tuesday. Sitting here this morning, I feel pretty good.

Prostate Velocity still = great confusion?

Read a thread with a similar PSA velocity (3.1, 3.4, 3.8, 4.1, etc.) Biopsy revealed 3 + 3, G6 with recommended wait and see treatment because PC was slow growing and may not be problematic for 30 years.

When I do the math, his PSA could be !!! in 30 years????

There are a couple is ways of interpreting the statement "you have a 20% chance of a curable cancer". The interpretation that best fits the data is: you have a 20% chance of cancer, and if you do have cancer, it is highly likely to be curable.