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PSA at diagnosis and correlation to disease severity

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Posted 6/4/2018 1:01 PM (GMT 0)
I realize that factors other than cancer can affect PSA values, but still it’s puzzling to me that quite a few men will post with low grade disease following biopsy yet have PSA numbers in the 6-8 range, while other men with PSA values in the 4-6 range might have much worse findings. It’s not unusual to see someone with 4+4, 3+4, several 3+3 with PSA <5, and others with all 3+3 with PSA of 6-8. Is that why the PSA values are often broken down into ranges of <10, 10-20, >20 for prediction tools because the difference between 5 and 8 is not meaningful?

Post Edited (hrpufnstuf) : 6/4/2018 7:04:28 AM (GMT-6)

Posted 6/4/2018 1:55 PM (GMT 0)
Far more important is the Gleason score and not so much the PSA...Any PSA under 10 is not useful for predicting how dangerous the cancer is likely to be....
Posted 6/4/2018 2:36 PM (GMT 0)
What about the PSA doubling time?

I had a significant increase in my PSA over a year ago (5.0 Jan'17 to 7.1 Apr '17)which triggered a referral to a urologist and subsequent treatment for prostate cancer.

However just before starting EBRT I had a PSA test that came in at only 5.2 Dec'18. I had taken an aspirin a couple hours before wondering what effect the NSAID would have on the prostate.

Last summer I freaked out about my rising PSA only to realize that my prostate may have been partially inflamed in April '17.

I've heard that PSADT is important in flagging a serious problem without any suggestion that part of the increase may be non-cancer related.
Posted 6/4/2018 3:19 PM (GMT 0)
If you go back to the posts in 2010 / 2011, one of the big discussions was the German research on the genetic variations of PCa. If I recall, they came up with about 23 variants, which went from deadly with a PSA < 10 to fairly benign with PSAs in the hundreds and more. Walsh covers this concept in his book.

about the only reason anyone pulls this up anymore is to start an argument, but the concept is quite solid.

I was diagnosed on a PSA of 7.4, free PSA of 7.2, and a suspicious DRE. The biopsy was limited cores with G 4+3. If I had only had the 6-core biopsy my insurance limited me to, I would not have been treated. The actual 12-core was a very different story, but still not disastrous.

After surgery? G 4+5 over the entire prostate.

I've had bone mets come and go in spine and ribs with theatment, but never a PSA over 6 in almost 9 years.

So I watch change in the number, not the magnitude of the base number.
Posted 6/4/2018 3:28 PM (GMT 0)
PSA Doubling time is very important...it tends to show the aggressiveness of the cancer producing it..Slow growing Gleason 6 cancers generally have long doubling times..But the rapidly growing prostate cancers, at least at the beginning, usually have short doubling times...As these aggressive cancers (G-8, 9, 10) progress, they tend to mutate into forms that produce very little PSA so that yardstick loses its usefulness as a predictor of disease progression..
Posted 6/4/2018 4:11 PM (GMT 0)
Back 10 years ago there was a lot of discussion on psa, and psa kinetics trying to derive a formula from psa and it's derivative ratios to improve the ability of estimating aggressiveness.
Dr Strum, Scholz, and other pathologists used it to determine tumor volume and aggressiveness.
Subtracting normal expected psa from the prostate (.066 X volume in cc) would give the psa thrown off by the cancer. There was also a formula for each gleason grade, so if you knew the grade and remaining psa you could calculate the tumor size and determine if psa was coming from else where, such as the lymph nodes. Higher grades produce less psa. Then Using PDSDT one could estimate the growth rate of the tumor.

I don't see many doctors using this anymore. I would guess that more accurate scans took the place of this back of the hand formula. I still think it's valid if only as a check to see that it reasonably matches what the scans are showing. For example, a scan may show a 3cm G7 tumor with a psa of 28. After calculating psa through prostate size and gleason grade if the result is a psa of 9, then a good doctor would keep on looking for the remaining 19 points of psa that must be residing in the lymph nodes or the anterior.
Posted 6/4/2018 4:20 PM (GMT 0)

142 said...
If you go back to the posts in 2010 / 2011, one of the big discussions was the German research on the genetic variations of PCa. If I recall, they came up with about 23 variants, which went from deadly with a PSA < 10 to fairly benign with PSAs in the hundreds and more.

University of Michigan, in 2010, published this handy chart How Aggressive Is That (PC) Tumor showing that most variants of PC were not aggressive. They had identified 24 variants.

Elsewhere, lots of work done elsewhere to show how some relatively small number of PC cases are highly aggressive but put out low values of PSA.

So, the point to the original question,in a small number of cases low PSA is known NOT to correlate to low aggressiveness. In a much larger number of cases, there is a positive correlation; and further, very high PSA values rarely are not aggressive. But due to the small cases of low PSA not correlated to low aggressiveness (and other reasons, see below), PSA is not used as an measure of aggressiveness. Gleason score is.


PSA doubling time is NOT a valuable measurement for the vast majority of cases pre-treatment. It is very valuable post-treatment, but pre-treatment nobody should use it as a decision tool when PSA is under 20ng/mL because of the extraordinarily common contributions of PSA by other benign factors.




142 said...
about the only reason anyone pulls this up anymore is to start an argument


w-t-f?

Post Edited (NKinney) : 6/4/2018 2:24:14 PM (GMT-6)

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