Early PC

Every three months for a year , to find out any kind of trend upwards, and how fast. terry

My PSA never got over 1.3 .... Gleason 7.

BUT, nodules via a DRE were found before the blood test.

Fauntleroy said...
Your 71 year old brother never had prostate cancer and has a psa of 1.9?
Way below normal for his age. If that’s true, testing yearly seems about right

I agree. Unless nodules were found this sounds fine. What is his PSA history? I assume this is not his first PSA test at age 71?

Jim

I'm trying to get him to remember is last PSA.

But for my curiosity question: All things being equal, does he likely have a small amount of cancer now that is expressing via psa?

You're right about not putting my anxiety on him. He hasn't had a PSA test in at least 5 years and it was done in another city so he's trying to find it.

Vic Hardy said...


But for my curiosity question: All things being equal, does he likely have a small amount of cancer now that is expressing via psa?

That PSA test alone would not suggest any cancer. It is well within normal range for a man of his age. If that is the only data point w/o any other indicators, e.g. a nodule, then he should not be particularly concerned. That doesn't mean 100% that he does not have cancer but to worry him unnecessarily based on this PSA number is not a good idea.

Jim

Agree with every six months. at this point, every 3 months is overkill IMO

Vic, first thing to remember, above all else: PSA is not a cancer test. It is more like the 'check engine light' for men. Elevated PSA means 'something is happening'. That being said, a PSA of 1.9 at age 70 is a long way from being elevated.

Does he likely have detectable PCa? At least a 50-50 chance that he does. Is it something to worry about? Nope. Nope. Nope. Let's say that that 1.9 says that he has minimal G6. And, let's further say that his PSA doubling time is a year. If so, he's several years away from needing to worry about it, and he may well land in the category of men who die with it, not of it.

For peace of mind, your brother should visit a Urologist to discuss (if not doing that) and have a prostate check (DRE) with a trained finger. The Uro should spell out in clear terms a plan going forward (probably test again in 12 mos or do a repeat for a baseline) and explain the minimal risk with such low PSA and a 71 year old man. Almost all men have a PSA over age 60 if not younger. The prostate gets larger and usually does not function exactly right. Absent any urinary problems or complaints, it is just a low number. Yes, odd things can happen with 1/100 men but there would be no reason to expect this unless you are a bad gambler.

Melaine said...
Sr. Sailor said: "One can never absolutely say that a prostate doesn't have a small amount of cancer. One would need to examine a prostate in its entirety (as is done after a prostatectomy)."

This issue came up at our recent meeting with my husband's MO. We were talking about the prostate tissue (after it's removed) and how much of it is actually examined by the pathologist. Given how narrow each slice is, he said it would take thousands of slides to examine every part of the prostate. What they examine is, hopefully, representative of the entire prostate but is not actually the entire prostate.

The issue of post-RP path sampling has interested me, but until searching just now I hadn't come across any info.

Partial versus complete prostatectomy specimen sampling: prospective non-inferiority study for pT3a tumours and surgical margin involvement (2019, Full Text)

Hyperlink doesn't seem to work: https://bmjopen.bmj.com/content/9/4/e024524

"Abstract

Aims The importance of additional information gained by complete versus partial sampling or prostatectomy specimens is uncertain. There is sparse data on the value of complete versus partial sampling and numbers of inclusions in studies are small and retrospective. We present the results of a prospective non-inferiority study to examine if partial sampling is inferior to complete sampling in terms of pathology outcomes and clinical relevance.

Methods 564 robot-assisted prostatectomy (RARP) specimens with prospective registration and analysis were collected over a 2-year period. All patients underwent RARP between January 2014 and February 2016 in our hospital after a diagnosis of clinically localised prostate cancer. For each patient, tumour stage and surgical margin status was recorded after partial and after complete sampling. Upstaging from pT2 to pT3a and upgrading from a negative-to-positive surgical margin was analysed.

Results In 12 of 564 patients (2.1%), complete sampling yielded new information. In eight patients (1.4%), the surgical margin converted to positive after complete sampling. Upstaging from initial pT2 tumour in partial sampling to pT3a tumour after complete sampling was documented in five patients (0.9%). In the follow-up period (mean 35 months), a biochemical recurrence occurred in one patient.

Conclusions Complete sampling provides new information in only 2.1% of cases, compared with partial sampling. We conclude that the additional information gained by complete sampling in terms of stage and surgical margin detection is statistically insignificant compared with partial sampling. Furthermore, partial sampling compared with complete sampling does not change postoperative clinical management."

(See the Full Text for details about the sampling procedures.)

Djin

Sr.,

My post-surgical pathology report includes an estimate of the total tumor volume in the gland, the final G score, and whether or not there were extensions. What was interesting was that it found multiple lesions across all 4 quadrants, and a higher G score than my biopsy, which only showed positive cores on one side of the gland.

Whether the pathologist looked at every slice, IMO is less important than the overall big picture: A definite upgrade from biopsy and DRE.