what is considered a safe PSA count ?

Hi, I had a total removal of my prostate in oct 2006...

 I am wondering why all the doctors have a different idea what a safe PSA count is...

After reading so many posts here, i noticed that a few gentlmen had a "low" PSA count ( low 2's) and had cancer. Whereas my doctor later told me ( after i was diagnosed with PC) in 2003 and 2004 my PSA was steady @ 2.7... and and those times she only told me that my PSA was OK.

She failed to include a PSA test in 2005 during my routine blood workup. In 2006 my PSA was 4.5 and I was then directed to see urologist who felt my nodule thru the wonderfully delightful exam they love to do...

When biospsy was performed .. 3/10 areas came back with adenocarcinoma..

here is my point.... what would you consider to be a "safe" PSA score where you would not have to be concerned to want to take a closer look.

 One doctor i know told me he would not be concerned until the PSA was 3.5... another 3.... with so many people here stating they discovered cancer with far lower PSA counts..

why is there no "set" number for PSA?

Since my Prostate situation i tell anyone i talk to that they should take special attention to results of certain test doctors may do on them....  And when they get a PSA test that they ASK the doctor to verbally tell then their PSA number.... not  just tell them the numbers look good.... I also tell them that if They are at least a 2... to see if it is a harmless infection or something more serious.... Altho this is the best kind of cancer a person can ( considering that it is the most curable type to get when caught early ) Going thru even this procedure is still a nightmare in itself... physically and emotionally.

Comments are welcome...

basically ... what should be a "safe PSA count"...

 and yes, i understand age is to be taken into consideration.....

I hope i am making sense with my ramblin.

God bless you all...

Iggy

Tamu,

This is my point... you seem to think 3 is ok... where I think anything around 2 maximum should be looked  into further..... ( infection or something more sinister? )

Yes, it's the TREND in PSA that's relevant, not necessarily any one individual reading. Fast increases and "PSA doubling time" are of concern as they can indicate a more agressive tumor.

To logically interpret PSA, size of prostate needs to be factord in, as a larger prostate naturally produces more PSA. Epstein's treatment criteria refers to "PSA density" which is simply PSA divided by prostate size.

My understanding has always been that the safe PSA had to be under 4.0.  But there is another test and I suggest that you ask your urologist to test your "free PSA".  This test measures the percentage of PSA that is not bound to the proteins in your blood.  The safe score here is at least 25% or higher.  When I was sent for a biopsy, my PSA was 5.7 and my free PSA was 9%.  That was certainly grounds for a biopsy.  And I just completed my high dose radiation treatment last week.  My suggestion is that you ask your doctor for the free PSA test, it's important!

unfortunantly my urologist used the old magical 4 as the concern number, disreguarding the fact that my psa was going up 1 point per year for 3 years, while allowing the cancer to grow to the point that a nodule was felt and was told that it had already escaped prostate.

I tell everyone I can, to keep track of your numbers and don't rely on uro to tell you your numbers are within nornal limits, know what psa velocitiy is and track your numbers from year to year.

on a side note, I had my 15 mos psa report this past Good Friday and it it still <0.04, a number that no one thought going in would be possible post op, must less 15 mos post op, but with path, still have to get one every 3 mos.  God has been blessed me more than I deserve!

NIck's Mom:  Those numbers don't make sense.  I'd get those results given to me again to make sure that's what was reported by the lab.  We deal in numbers of 4.O PSA or less here, according to the old standards, which is changing now, with more info and earlier age men being tested and confirmed with cancer.  Numbers over 100 are so far out of range that I can't imagine anyone saying saying less than 100 was normal.  I hope and pray that these numbers were mis-heard or mis-understood.  Maybe the urologist can straighten it out once he makes the visit.  Until then, Id ask for a restate of those numbers and an explanation of just what they are talking about....

Hey Selmer,

I am very glad my docs found my cancer. Saying we don't want to find it is really sticking your head in the sand. Look at the guys here on this forum in their 40s that have stage 3 or 4 cancer. If they didn't want to find out about it, they would be dead.

Get tested. Got cancer? Get rid of it.

Jim

I have an interesting point of view about PSA acceleration. While I know I have a lot of unusual circumstances the PSA tests below would conflict with using PSA acceleration as a marker.

October 3, 2006: PSA 19.8
October 10, 2006: PSA 18.9
November 3, 2006: PSA 13.9

My urologist was encouraged by the first drop in the retest of my first test. I thought the 13.9 was cool but he ordered the biopsy, thank goodness. He could have decided to wait more, but he said my number should have been lower. For what it's worth, the results after surgery were more in line with the original PSA probabilities. My oncologists have all told me that for all future prognosticating considerations the highest PSA number would be used. But irony for me is, every PSA test I EVER had has been lower than the last until it was finally undetectable. That would never have happened without treatment. I doubt that my decisions were the wrong ones. Yet even more irony, I have an undetectable PSA yet none of my oncologists can say this isn't still serious. If I get a first ever rising PSA test, I will likely be incurable. And probably worse.

Tony

Just joined and thought I would give my opinion.  I have found out a couple of things "after the fact".  The fact is I just had a prostatectomy on 3 February 2009.  Background:  I retrieved copies of all my blood test and lab test *after* being diagnosed with prostate cancer.  My father and his father had prostate cancer.  My father lived to be 81 and my grandfather 71.  I'm 69.  There is no such thing as a SAFE PSA count.  It is the velocity or rate of change that is significant.  And, there is another test that could be significant, "Free PSA Percent".  I found in my records that I only had one "Free PSA Percent" blood test, in April 2007.  It was 15% which indicated a probability of 20-28% that I had prostate cancer.  My PSA at the time was 2.85.  My doctor never discussed the "Free PSA Percent" and had I known about it in April, 2007 I might have saved myself the agony of having a prostatectomy!  One year later my PSA was 3.14.  Ten months later during an examination for an Insurance policy, the PSA was 4.2.  I went to my family doctor for another PSA and it was 4.42.  He said "That's not bad".  I said, "Yea but it's my life and I want to see a Urologist".  (I've since learned that a general practioner or family doctor is not the best source for determining a cancer diagnosis).  The Urologist did the finger business, told me my prostate was about 50cc (normal 20cc) and scheduled me for a biopsy.  All during this time I was not thinking cancer I was thinking this is just a routine percautionary examination.  Biopsy results:  5 of 6 sections on one side were cancerous with a Gleason score of 7, 7, 6, 6, 6.  That came as a real shock!  The Urologist also stated that the pathology report is almost always on the safe side or down side and the cancer could be more wide spread.  He was not trying to scare me into doing anything he just wanted to give me the facts.  He has been in the business for 24 years and studied at the Mayo Clinic.  Just prior to surgery, my PSA was 4.96.  I opted for the prostatectomy and removal of the lymph nodes and sure enough the cancer was in both sides and came within a millimeter of breaching the margin.  It may have in fact breached but I will not know until 20 April when I get my first post surgery PSA test.  I'm sorry for the lengthy description but I just want to let everyone know that it is the rate of change and not the PSA count that is important.  And, ask about a "Free PSA Percent" whenever you have your blood checked for PSA.

Les, that's the fun, isn't it? From the time I first started faithfully getting my yearly PSA, the standard was 4.0. What's sad, is my very first one at age 50, in 2002, my PSA was like 2.8, which is higher than the new 2.5 standard, and higher than what was accepted ok for my age at the time. But again, my GP continued to use the 4.0 threshold. I wonder what would have happened if I had been biopsied in 2002, instead of my first one in 2007, 5 years later. Can't unscramble those eggs now, I realize. I think the threshold should be 2.5, and the first PSA should be done at age 40, regardless of race or family history. Just my take.

David in SC

Hi Les and David. Thanks for the updates and great information. I've updated my two brother's (ages in 2009 66 and 64) and one half-brother (same father) age 46. I was appalled that the 64 year old and the 46 year old have never had a PSA count. They are both going to do so this month, I hope. I have another question concerning diet. My doctor has put me on a high fiber diet but the list includes just oil fish (salmon, trout), some fruits, vegetables, but not meats. (Oh, he did say red meat just once a week). I've just bought the book "Eat to Beat Prostate Cancer Cookbook". I'm not sure it has anything to do high fiber however.

I agree with stxdave who notes that there is no right answer. I also find that Gordy's rebuttal of Selmers' opinion as "hogwash" is poor protocol. I think Selmer has many good points to be considered (and I agree with most of them) and am quite glad that he is willing to present his views. If there is disagreement, I would respectfully propose that one presents, specifically, the point(s) that are of issue. From my perspective it is a personal decision relating to the degree of cancer risk with which one is willing to deal and must be considered with education of prostate cancer, it's detection, and it's consequences. One problem is that the cancer risk cannot be zero no matter what test is done. The way I see it, snik67 says it well- there is no safe level of PSA, rather the best consideration is PSA velocity. One needs to establish a PSA baseline. In my case I had a PSA bump which later went back to my baseline -so I am less worried- but NOT totally unworried. So I will continue to watch my PSA carefully. BTW, What do people think about the PCA3 test???

Rich

I think the answer is that there is no one right answer.
This is Cancer with a capitol "C". It doesn't play nice or by any rule book.

PSA, Hypersensitive PSA and even tesing for Biomarkers to be used as survival predictors offer no verifiable scientifically proven "safety" zone. They can be very useful tools in determining treatment options but that presumes the values are being interpreted by experts, not lay people who feel compelled to become quasi experts on their own based on their own experience with the disease because that is how they choose to live with their PC.

Remain very compliant with what your specialist(s) recommend and stay vigilant.
While there is nothing wrong with being your own advocate, know what your knowledge limits are- are you qualified to interpret the latest research out there, all the studies and trials being done and apply it to your particular situation? Do some research on your own, talk to experts as you can but don't it rule the quality of your life in the here and now.

Unless the plenitude of posts you see in this Forum for PC are from folks who ID themselves as qualified experts in the field don't ever forget once PC is diagnosed it compels people to try to become quasi experts so that they can gain a better understanding of the disease and the treatments they are being advised to consider.
The stories posted in this Forum are just that, personal stories by individuals. Some of the posts are highly technical. If that is how that person chooses to address his own PC, that's fine. Just don't think you too have to function at or should have an interest at attaining such a level for yourself. Knowledge available to all via the Internet always has to be put into context of an individual's personal situation and it can be a double edge sword. I venture to say true experts in this field are not participating in this type of Forum.

One of the reasons Cancer is so hard to treat is that it doesn't respond to all people affected in the same way. It just doesn't and that's one of the most frustrating aspects of having to live with it in one's life. What happens or works for 1 person may not for someone else with a similar history.