Acoustic4

Acoustic,

Thanks for sharing your story. Unfortunately, you're not the first, nor will you be the last man in here who had what happened to you. The changing recommendations for PSA screening over the years have led directly to this.

Good to hear you've had your treatments, and that your PSA is gone. Now, after the Lupron wears off in a few months, you'll see how you did. Thanks again for joining us.

Thank you to both of you. This is certainly a confounding disease. But no choice remains than to fight it with all you got. Best wishes and prayers for your continued undectable PS A s

Thank you Cyclone. You story illustrates how insidious this type of cancer is. I pray that you continue to progress. We all need to realize this is not only a disease but a new lifestyle to which we need to adapt to....

Hello Acoustic and welcome. It sounds like your treatment was successful and I hope for many more years of zero or near zero in your future. And thanks for passing on the powerful message that men need to be proactive in their health care...getting PSA tests is vitally important.

Jim

G6 gives off about four times as much PSA as G8 as does BPH and prostatitis. That is where the PSA is coming from. I hope you were all G6 as that will be very low risk and your initial treatment should arrest it. You have dropped to nearly undetectable. Rejoice and wait for a few more tests to determine the trend.

Thank you Motown. (Incidentally, my wife's favorite music genre)

JNF said...
G6 gives off about four times as much PSA as G8 as does BPH and prostatitis. That is where the PSA is coming from. I hope you were all G6 as that will be very low risk and your initial treatment should arrest it. You have dropped to nearly undetectable. Rejoice and wait for a few more tests to determine the trend.

JNF, do you have a source for the statement that "G6 gives off about four times as much PSA as G8"? This would contradict all the studies that promote the use of PSA density to predict clinically significant PCa (Gleason score ≥ 7).

The use of prostate specific antigen density to predict clinically significant prostate cancer (2020, Full Text)

"Abstract
The purpose of this study was to assess the predictive value of prostate specific antigen density (PSAD) for detection of clinically significant prostate cancer in men undergoing systematic transrectal ultrasound (TRUS)-guided prostate biopsy. We retrospectively analyzed data of men who underwent TRUS-guided prostate biopsy because of elevated PSA (≤ 20 ng/ml) or abnormal digital rectal examination. Receiver operating characteristic curve analysis to compare PSA and PSAD performance and chi-square automatic interaction detector methodologies were used to identify predictors of clinically significant cancer (Gleason score ≥ 7 or international society of urological pathology grade group ≥ 2). Nine-hundred and ninety-two consecutive men with a median age of 66 years (IQR 61-71) were included in the study. Median PSAD was 0.10 ng/ml2 (IQR 0.10-0.22). Prostate adenocarcinoma was diagnosed in 338 men (34%). Clinically significant prostate adenocarcinoma was diagnosed in 167 patients (50% of all cancers and 17% of the whole cohort). The AUC to predict clinically significant prostate cancer was 0.64 for PSA and 0.78 for PSAD (P < 0.001). The highest Youden's index for PSAD was at 0.20 ng/ml2 with 70% sensitivity and 79% specificity for the diagnosis of clinically significant cancer. Men with PSAD < 0.09 ng/ml2 had only 4% chance of having clinically significant disease. The detection rate of clinically significant prostate cancer in patients with PSAD between 0.09 and 0.19 ng/ml2 was significantly higher when prostate volume was less than 33 ml. In conclusion, PSAD was a better predictor than PSA alone of clinically significant prostate cancer in patients undergoing TRUS-guided biopsy. Patients with PSAD below 0.09 ng/ml2 were unlikely to harbor clinically significant prostate cancer. Combining PSAD in the gray zone (0.09-0.19) with prostate volume below 33 ml adds diagnostic value of clinically significant prostate cancer."

From the Full Text:

"The tendency of PSAD to detect clinically significant prostate cancer has been shown in several clinical scenarios. For instance, the integration of PSAD into active surveillance protocols can be associated with improved enrollment criteria and a reduced rate of upgrading and reclassification down to 17.5%"

See also:

Correlation and diagnostic performance of the prostate-specific antigen level with the diagnosis, aggressiveness, and bone metastasis of prostate cancer in clinical practice (2014, Full Text)

"A higher PSA level may relate to a greater likelihood of positive tissue diagnosis, a higher Gleason score, and a greater likelihood of bone metastasis."

Thanks,

Djin

That study stlll found that PSA correlates with tumor volume, so even if the inverse PSA relation with G grade (per unit tumor volume) reported in this older study has been confirmed (?), high-grade men must produce much larger tumor volumes to make PSAD density correlate with high-grade disease, which is what all the studies now confirm. To say somone with a PSA of 35 (assuming a fairy nornal-size prostate) likely has all G6 seems misguided when the PSAD is so high!

But yes, there is very serious high-grade PCa that produces little PSA. This is the exception rather than the rule, however.

Something isn't right. Higher PSAD correlates with a higher likelihood serious disease (G7 and up).
_____________

I just found a 2018 study that found a significantly higher PSA in men with G7 (4+3) than G7 (3+4). Some difference may be from increased tumor volume from mets with 4+3, but these men had an average PSA of 18 and 11, respectively. What does this say about a PSA of 35 and about PSA production vs. G grade?

(2.8% of the 4+3 men had mets at time of diagnosis vs. 0.9 for the 3+4 cohort. 1402 men were in the study).

Incidence of metastasis and prostate-specific antigen levels at diagnosis in Gleason 3+4 versus 4+3 prostate cancer (2018 Full Text)

Djin

Hello, Acoustic4 ----

Just circling back, checking in with you ---- hoping this finds you doing well.

Fall is here ... hope your doctors have had nothing but GOOD NEWS to share with you lately!

With my best to you ----
CYCLONE - # Iowa State University

Thankful to read this GREAT NEWS, Acoustic4 !

That's a LOW P.S.A. score, to be sure!

Hooray! Hoorah!

With treatments, it's not always an "easy row to hoe" as a Midwestern farmers might say, but you are experiencing noticeable TREATMENT SUCCESS!

Great fellowship here --- glad you are here, Acoustic4 !

Today was a GREAT DAY to hear your GREAT NEWS ----

CYCLONE ~~~ # Iowa State University