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AS...psa declining....meaningful?

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Posted 3/6/2018 4:11 PM (GMT 0)
Im 44, diagnosed last sept. gleason 3+3, PSA 3.1. MRI indicated low risk. Im on AS. While I was a reasonably healthy eater and exercised regularly before diagnosed, Ive really stepped up my diet and workouts (who knows if that its helping or not, but I feel great so who cares).

PSA in Sept: 3.1, Dec 3.0, March 2.7 Obviously Im happy with this trend...but is it meaningful? or, do PSA numbers move 13% or more regularly and this is just statistical noise? And, should my PSA stay this low or lower should I consider just getting an MpMri late this year instead of biopsy? I know Im getting ahead of myself a bit

Thanks
Posted 3/6/2018 5:08 PM (GMT 0)
More wiser heads are coming. I would not do anything but keep on keeping on. Keep getting tested.
Posted 3/6/2018 5:41 PM (GMT 0)
have you started taking any supplements, herbal stuff or other meds? PSA due to PC rarely falls without out a reason.

It's also possible there was an error at the lab.

or it just might be good news. I'd just wait for the next test and see what happens.

I think it's too early to consider what to do later this year.
Andrew
Posted 3/6/2018 5:47 PM (GMT 0)

InTheShop said...
have you started taking any supplements, herbal stuff or other meds? PSA due to PC rarely falls without out a reason.

Andrew

Andrew, I guess the bigger question is can diet and exercise lower PSA? And again, how does a reduction in PSA relate to the Pc (if at all)?? yeah
Posted 3/6/2018 5:59 PM (GMT 0)
InTheShop - re my diet changes post diagnosis: I eat a lot of veggies now - all types - but with a focus on broccoli and tomatoes. Ive reduced my red meat intake dramatically...but still have it about 1x a week. Ive all but killed dairy, although I was not having much of it before. I eat a lot of nuts (walnuts, almonds mostly). I add in 1-2 tablespoons of flax seed daily now. I also add in about a teaspoon or two of matcha tea powder to my diet now. I take vit D and a couple fish oil capsules a day. I have been doing a 1 week a month daily dose aspirin routine. Id say 80-85% of my calories are super healthy, and 15-20% are average to very unhealthy. While I was not eating much sugar before, Ive reduced that to rare occasions. Oh, and I cap my booze to 7 drinks a week, never more than 4 in a day, and take at least 4 days off a week completely. No herbs or other meds. In short, Im trying to be healthy but not insanely so.

While I was working out before diagnosis, I am doing more now and very consistently. I also tried to reduce work stress and increase quality time with family. In short, I feel better physically and emotionally by quite a bit than I did before diagnosis. Making the best of it and changing some very long term not very positive habits I used to have.
Posted 3/6/2018 6:15 PM (GMT 0)
Solid diet there, Kev. Good chance that and your other life enhancements account for your declining PSA.

Maybe define "insanely healthy" what would the be? (jk)

Here's to your good (but not insane) health -

Wilderness
Posted 3/6/2018 6:55 PM (GMT 0)
The reason that many AS programs do not use PSA kinetics as a trigger for action is because they fluctuate so much. The PSA test you're using can easily fluctuate ±20% and there are other benign influences (like remitting prostatitis).

I think men on AS should always get at least a confirmatory biopsy within a year. It came up in a thread recently that MSK has a model that predicts if a confirmatory biopsy is really necessary or whether just an mpMRI will suffice. If I were being monitored at MSK, I might consider it because their stats and expertise in reading mpMRIs is so good. Anywhere else, and possibly even there, I would definitely want a confirmatory biopsy.
Posted 3/6/2018 6:55 PM (GMT 0)
Hi KevC,

I'll comment & provide feedback on the 2 topics you've raised:


(1) PSA variation -- two consecutive declines in results. PSA is a notoriously poor marker for prostate cancer in untreated men, primarily because there are multiple possible sources of PSA which all may be contributing simultaneously: i) normal prostate generates a relatively small amount of PSA, and the amount is size dependent; you can calculate yours if you look-up your prostate size from your biopsy report; ii) prostate cancer, you know you have a little bit; it's generally quite steady with a slow increase as a natural part of aging; iii) prostatitis (infection), which most men don't even know that they have, which is the primary cause of the up-and-down of PSA values, and iv) BPH, which is also a natural part of aging, but affects different men differently, but affects many men in at least a small (often undiagnosed) way.

First sentence said that PSA is a "poor marker for prostate cancer in untreated men." PSA is a pretty good marker for prostate cancer in men who have had treatment, especially surgery because after the prostate is removed, the items i), iii) and iv) are eliminated...so any residual PSA in the blood (other than very small possible trace amounts) is typically attributed to prostate cancer alone. But in your case, the important thing to know is that you've probably got some other contributors to PSA, and likely some prostatitis contribution because of the apparent declining trend.

Two finer points to add for this response: (a) There definitely is day-to-day naturally occurring variation in measurement in untreated men. I can't quote this exactly, but somebody did a study by measuring their PSA every day for a period of weeks, and they documented ups-and-downs in the range that you are also experiencing. (b) There are a very, very few interactions which can chemically affect PSA (finasteride, aka Propecia but also used to treat advanced PC, is one known to affect (reduce) PSA), so mostly I wouldn't go on a witch-hunt. But you may be favorably affecting your PSA based on your own diet and lifestyle changes...which leads me to my 2nd comment & feedback.


(2) Lifestyle changes — don't think for a minute that you are going to "cure cancer" by your diet and lifestyle changes. But there is evidence that you can help yourself by reducing intake/actions which "fuel" cancer growth conditions, and increasing intake/actions which "fight" cancer growth conditions.

One of the best known urologists to study this was Dr Peter Carroll (a number of men from this site have been treated by him; he's a surgeon as well as a researcher). An interesting study he did about 10-years ago was to randomize about 100 men diagnosed with low-risk PC (like you) into two groups. Their "before" PSAs were measured, and the average of each group of about 50 men was nearly identical. They all agreed not to pursue any aggressive treatment for at least a year. The "test group" undertook significant lifestyle changes which included 3 parts: exercise, Mediterranean diet, and stress reduction. The "control group" made no lifestyle changes. After a year, PSAs were re-measured. The average PSA of the "test group" actually went down, and the average PSA of the "control group" went up. Important point--this showed a correlation, but did not demonstrate cause-and-effect, but noteworthy nonetheless, and from this landmark study many AS programs now include elements of the three components: exercise, diet improvements, and stress reduction. Good for you to adopt lifestyle improvements, too.

So while nothing was definitively proven by Carroll's study, it's understood that a prostate-healthy lifestyle is also heart-healthy, and as a prostate cancer patient you should be aware that you are 10-times (!) more likely to die from heart disease than from prostate cancer.


There's an "old saying" that I've written about previously which I think also seems to be aligning with your approach...I offer it to you to keep in mind in the long-run: "Anyone with prostate cancer who would forego all traditional medicine treatment paths in lieu of only an alternative medicine approach is foolish, but at the same time anyone who would undertake only traditional medicine treatments without also including complimentary medicine tactics is also foolish."
Posted 3/6/2018 9:37 PM (GMT 0)
Kev, one other thought beyond the current conversation -- did you get your biopsy slides read by an expert, i.e. Dr. Epstein at JHU? If not, I would suggest that. It would not be the first time Dr. E. raised a G6 to a G7 indicating possible treatment OR, even better, it would not be the first time Dr. E. found "no cancer", i.e. below G6. Anyway, food for thought as you move forward.

Jim
Posted 3/6/2018 10:30 PM (GMT 0)
I’ve asked that myself.
Posted 3/7/2018 1:56 AM (GMT 0)

NKinney said...

One of the best known urologists to study this was Dr Peter Carroll (a number of men from this site have been treated by him; he's a surgeon as well as a researcher). An interesting study he did about 10-years ago was to randomize about 100 men diagnosed with low-risk PC (like you) into two groups. Their "before" PSAs were measured, and the average of each group of about 50 men was nearly identical. They all agreed not to pursue any aggressive treatment for at least a year. The "test group" undertook significant lifestyle changes which included 3 parts: exercise, Mediterranean diet, and stress reduction. The "control group" made no lifestyle changes. After a year, PSAs were re-measured. The average PSA of the "test group" actually went down, and the average PSA of the "control group" went up. Important point--this showed a correlation, but did not demonstrate cause-and-effect, but noteworthy nonetheless, and from this landmark study many AS programs now include elements of the three components: exercise, diet improvements, and stress reduction. Good for you to adopt lifestyle improvements, too.

So while nothing was definitively proven by Carroll's study, it's understood that a prostate-healthy lifestyle is also heart-healthy, and as a prostate cancer patient you should be aware that you are 10-times (!) more likely to die from heart disease than from prostate cancer.


There's an "old saying" that I've written about previously which I think also seems to be aligning with your approach...I offer it to you to keep in mind in the long-run: "Anyone with prostate cancer who would forego all traditional medicine treatment paths in lieu of only an alternative medicine approach is foolish, but at the same time anyone who would undertake only traditional medicine treatments without also including complimentary medicine tactics is also foolish."

 

All I know is shortly after my DX I went on the Mediterranean Diet and started exercising regularly.  I lost a bunch of weight, feel great mentally and physically, and my PSA has been decreasing every test for the past number of months.  Again, your body is getting healthier to battle the cancer.  It's a "win/win"!!! yeah

Posted 3/7/2018 5:06 PM (GMT 0)
dbell and KevC, yes it's a clear win/win!


I was getting caught-up on some PC InfoLink site articles and one made me think of this thread. The article was about a study which concluded that exercise alone showed no indisputable scientific evidence on lowering one's prostate cancer risk.

The sitemaster seemed keen to make sure that readers remained smart about how to digest this information. He wrote an excellent conclusion which lines-up with my comments above. I thought I would share it here:

The 'New' PC InfoLink sitemaster said...
The “New” Prostate Cancer InfoLink would note that risk for diagnosis with prostate cancer has been associated with a broad spectrum of factors that is known to include genetics, heredity, race, diet, environment, annual levels of sunlight, obesity, smoking, and others. Consequently, the idea that exercise alone would be likely to have significant impact on risk for prostate cancer is questionable, whereas combinations of exercise levels with other factors might actually be significant. For example, it might be more relevant to ask whether African American men who are not obese or overweight and who do exercise regularly have a significantly lower risk for prostate cancer diagnosis than African American men are overweight and don’t exercise regularly. However, such studies are hard to carry out prospectively over time unless there is a serious long-term commitment by the research team (and the necessary funding to support a study that might take 20 to 30 years to complete).


link

There's no silver bullet, but you can create a set of conditions where odds are in your favor for success by choosing wisely. Choose wisely.

Post Edited (NKinney) : 3/7/2018 10:23:46 AM (GMT-7)

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