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Is there any correlation between level of PSA and the amount of Cancer?

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Posted 12/1/2012 7:24 PM (GMT 0)
In general, although this is controversial, there is a rough correlation between the level of PSA in the blood and the amount of cancer that is present. This is used in several statistical models that attempt to predict the risk of spread of the cancer and thus help your doctor decide which treatment options might be best for you.For example, many doctors feel that prostate seed brachytherapy is only appropriate and is most curable for patients with a PSA of 10 or below.



Prostate-specific antigen (PSA) levels. PSA is a substance produced by the prostate gland. It is normal to secrete small amounts of PSA into the bloodstream. Larger amounts of PSA in the bloodstream usually signal that the prostate gland is enlarged, infected, or malignant. PSA levels are determined by a simple blood test. The higher the number the more likely the patient is to have prostate cancer. PSA levels of less than 10 fall into the low risk category, 10-19 the intermediate risk category, and 20 or higher the high risk category.
Posted 12/1/2012 7:36 PM (GMT 0)
Fox,
It's worth noting that after radical prostatectomy, PSA becomes a surrogate for prostate specific disease progression. Meaning any PSA is coming from prostate cancer. There are cases where the doctor did not remove the entire prostate that measurable PSA was residual, but if any PSA is rising ~ it is tumor and it is likely scaled in size to the amount of PSA measured.

Tony
Posted 12/1/2012 10:15 PM (GMT 0)
TC:

My PSA is rising, but it has had a few drops along the way.

Why? I mean, if it truly measures the PC, wouldn;t it keep rising?

Mel

Posted 12/1/2012 10:24 PM (GMT 0)
FoxRun,
The amount of psa in the blood versus risk may apply to the majority of men diagnosed but does not appear to apply to you or me! At diagnosis, my psa was 4.89 which was outside of the "age adjusted normals"; in theory my gleason scores should have been low--they were not..Out of 10 cores I had 5 gleason 8's with some focal areas of 5 and 4 g7's (4+3)..Maximum involvement was approximately 80% of a single core and approximately 60% of the total prostate volume..
Oh well, I've lived my 3 score and 10
Bill--
Age 70 now
Dx'x Sept 2010--psa 4.89--79.2g's IMRT completed Feb 2011 w/3 years lupron--1 year to go..psa after rad .06 and now <.03
Posted 12/1/2012 11:13 PM (GMT 0)

gunfighter said...
FoxRun,
The amount of psa in the blood versus risk may apply to the majority of men diagnosed but does not appear to apply to you or me! At diagnosis, my psa was 4.89 which was outside of the "age adjusted normals"; in theory my gleason scores should have been low--they were not..Out of 10 cores I had 5 gleason 8's with some focal areas of 5 and 4 g7's (4+3)..Maximum involvement was approximately 80% of a single core and approximately 60% of the total prostate volume..
Oh well, I've lived my 3 score and 10
Bill--
Age 70 now
Dx'x Sept 2010--psa 4.89--79.2g's IMRT completed Feb 2011 w/3 years lupron--1 year to go..psa after rad .06 and now <.03

I hear ya Bill.....it quite a journey isn't it!
Posted 12/1/2012 11:59 PM (GMT 0)
Fox,
There is an absolute correlation to tumor volume and psa. The PCRI web site used to have a tumor volume calculator that could accurrately calculate your tumor volume given a gleason grade and a psa. Different gleason grades give off a different ratio of psa, the higher grades giving off less psa. Strum and others advocate using this formula to predict tumor volume as part of the staging process.
There are some exceptions as TZ tumors give off large amounts of psa in relation to their size and some varients give off little or no psa, but it works well for the run of the mill PZ tumors, and definately helps in identifying varients and other abnormal conditions.
Scholz used this calculator after reviewing my biopsy report that showed a 5% G6. He said the biopsy was wrong and said I had a much larger tumor, even though 12 previous biopsies never turned up anything. He was absolutely right. I often wonder why only a few doctor use this valuable tool which is simple an Excell program available to anyone.
Mel,
PSA is accurrate if looked at over time. In any given reading there could be variations due to lab variations, body activity, time of day and time of season. Strum told the story of one of his AS patients that would panic everytime when his psa went up in the winter only to see it go back down in the summer. This happened year after year so it was just a normal variation without any trend. You have to look at the trend and base your decisions on that, not one particular psa reading.
Psa is a valuble tool before and after treatment to help understand the biology of the cancer and how it is acting. Unfortunately only a few doctors know how to use this tool and all it's variations like PSADT, PSA Density, PSAV and tumor volume calculators to truely understand what is happening in a patient.
Posted 12/2/2012 12:21 AM (GMT 0)

John T said...
Fox,
There is an absolute correlation to tumor volume and psa. The PCRI web site used to have a tumor volume calculator that could accurrately calculate your tumor volume given a gleason grade and a psa. Different gleason grades give off a different ratio of psa, the higher grades giving off less psa. Strum and others advocate using this formula to predict tumor volume as part of the staging process.
There are some exceptions as TZ tumors give off large amounts of psa in relation to their size and some varients give off little or no psa, but it works well for the run of the mill PZ tumors, and definately helps in identifying varients and other abnormal conditions.
Scholz used this calculator after reviewing my biopsy report that showed a 5% G6. He said the biopsy was wrong and said I had a much larger tumor, even though 12 previous biopsies never turned up anything. He was absolutely right. I often wonder why only a few doctor use this valuable tool which is simple an Excell program available to anyone.
Mel,
PSA is accurrate if looked at over time. In any given reading there could be variations due to lab variations, body activity, time of day and time of season. Strum told the story of one of his AS patients that would panic everytime when his psa went up in the winter only to see it go back down in the summer. This happened year after year so it was just a normal variation without any trend. You have to look at the trend and base your decisions on that, not one particular psa reading.
Psa is a valuble tool before and after treatment to help understand the biology of the cancer and how it is acting. Unfortunately only a few doctors know how to use this tool and all it's variations like PSADT, PSA Density, PSAV and tumor volume calculators to truely understand what is happening in a patient.

Interesting.....wouldn't the tumor volume be the same as a Gleason score?
Posted 12/2/2012 11:50 AM (GMT 0)
Go along with Tony and John T and others explanations and adding these factors in the real world mix:
If PCa is more aggressive or weird variant type(s) (sometimes never categorized correctly by Joe pathologist), or as PCa can morph to more aggressive strains via DNA-ploidy (changes in DNA chain= 3 categories of DNA prognosis types), so some versions of PCa do not give off much PSA's to measure, but a wise onco-doc monitors many other blood and urine parameters and/or methods to determine what might be happening. (this is also more rare among the whole population of PCa patients, but is one of the major exceptions in just PSA analysis). This is all related to the exceptions in PCa.  Now as others mentioned psa can be a good measurement of disease tumor burden and esculations happening and effect the odds for detectable 'seeable' mets via scans, however micro mets can go unfound for years and years and scans miss those and so the docs assessment can be a huge guess and with unknowns.

PCa is complicated and the rule book is still be detected, thus some say first rule in PCa: 'there are no rules', there are generalizations and averages like in Partin tables and nomograms. They are still practicing medicine in effect, we went from the stone age, dark ages and maybe now are in the enlightenment stage, still miles from the perfection age. Scans are imperfect and so is total definitiveness in many areas of pathology, scans, psa and other analysis's.

**just an average Joe in my opinion in this stuff, so far have not seen anything to change that thinking, of course I did stay at a Holiday Inn Express last night (lol).**  Opinions are like toliet paper, you can use them, you can roll with it, you can hold it and you can wipe away some bad stuff or flush it down, butt it is useful stuff and replaced neandrathal leaves used by prior Romans and countrymen: friends-Romans-countrymen lend me your ears!!!  yeah

Post Edited (zufus) : 12/2/2012 5:01:35 AM (GMT-7)

Posted Yesterday 2:21 PM (GMT 0)
Dr. Stephen Strum has an excellent chart showing the tumor volume correlation between PSA and G score on the PCRI website, www.prostate-cancer.org.

Basically, the healthy benign prostate gives off .066 ng/ml PSA per cc of volume. So a 40 cc prostate should give off about PSA 2.64.

The cancerous cells give of much more PSA but in descending order,
roughly:

G6 4 PSA per cc of volume,
G7 3 PSA per cc of volume
G8 2 PSA per cc of volume
G9 1.5 PSA per cc of volume, and
G10 1 PSA per cc of volume.

Thus given the same PSA a G10 is four times the tumor volume of a G6. And remember that the PCa can mutate to the point that it expresses little or no PSA.

My doctors walked me through the exercise based on my PSA and specific G scores from each biopsy core to estimate that I had about 16.14 cc of tumor volume which would represent about 42% of the prostate size if completely contained. Since several cores showed a lower percentage of involvement and the uro could feel a one centimeter nodule, they all assumed it would not be contained and ruled out surgery. They then all agreed that IMRT, Brachytherapy and adjuvant HT would be the best approach.
Posted Yesterday 5:45 PM (GMT 0)
JNF is the perfect example of how a tumor volume calculator can assist in staging and provide information as to the best treatment options. I'm amazed that it is not widely used.
Posted Yesterday 5:58 PM (GMT 0)
John T & Zufus,
I tend to agree with you both but without a biopsy the answers are moot--I stay at the "Hilton"--LOL
Bill
Posted Yesterday 7:07 PM (GMT 0)
John T said...
"There is an absolute correlation to tumor volume and psa."

Generally true but not always. Some PCa's do not cooperate with this. We have had cases of no PSA rise but tumor progression existed here at HW. And John T's PSA of 40 was a transition zone tumor that did not correlate to the tumor size reported at initial biopsy nor the later CDU biopsy. John your case does not seemingly agree with the comment. Correct me if I'm wrong.

Living 1963's PSA at arrival here was 3000+ with mets to the lungs. Gordy's PSA was 0.5 with mets to the lung when he was at the end game.

Hawkfan arrived here with g6 1.9 PSA but after surgery he had a pT3b case with a large tumor volume.

There is no absolute with this...

Tony
Posted Yesterday 7:28 PM (GMT 0)
JNF posted an excellent summary from Dr Strum about the most typical PC cases, and their direct correlation between PSA and the volume of tumor.

 

But in his book with Donna Pogliano, Dr Strum also discusses the high Gleason score cancers which sometimes revert to an embryonic state in which PSA secretion into the blood is markedly reduced.  This less frequently found variant is associated with very low PSAs and high Gleason scores (4+3, 4+4, 4+5, 5+4 and 5+5).

 

So, the correlation between PSA & volume is typical, but there are observable exceptions.

 

Posted Yesterday 9:30 PM (GMT 0)
Casey well put. But it's always worth noting that PSA is NOT produced by the prostate nor by prostate cancer necessarily. In general the trending of PSA does act as a surrogate for disease progression as opposed to the actual number.

Mel asks above why sometimes his PSA falls. But that is again his bodies immune system not necessarily the disease that flutters. But also PCa growth is not a constant either. It will expand and contract as well over time. But over time is the right way to use PSA. Mel's PSA shows a very slow growing tumor(s). Looking month to month you get fluctuation but looking at several months or year to year you get a consistent indication of a slow progression.

This is also true of guys on AS that have a 6.whatever when detected, and two years later have a 3.whatever. many factors can weigh in including BPH, UTI or simply fluctuating tumor size.

After RP, all bets are off on those reasons. Rising PSA is in that case a tumor marker...

Tony

Post Edited (TC-LasVegas) : 12/3/2012 2:50:42 PM (GMT-7)

Posted Today 2:01 AM (GMT 0)
Tony,
If you reread my post you will see that I mentioned both exceptions in my 2nd paragraph.
Posted Today 2:20 AM (GMT 0)
Can someone tell me where I can find this tumor volume calculator? I went to the mentioned web site but did not see it.

Thanks in advance.
Posted Today 3:07 AM (GMT 0)
My pathology report show that my prostate weighed 57 gram but didn't specify a volume. Is there anyway to extrapolate the volume from the weight?
Posted Today 3:45 AM (GMT 0)
 

Ed C. (Old67) said...
My pathology report show that my prostate weighed 57 gram but didn't specify a volume. Is there anyway to extrapolate the volume from the weight?

 

Ed C, the density of the prostate is approximately 1 gram per 1 milliliter (1 cubic centimeter) of volume.  So a 57g prostate was probably about 57 cc.

Posted Today 5:12 AM (GMT 0)
Casey,
Do you have anything that explains the 1g per ml? I have never heard of any constant here.

John T,
I thought I worded it differently than you explained in the second paragraph. Just a note, I have seen TZ tumor cases with low PSA and large tumors that had mets to the bone. Not so sure of any constant there either...My point is that until after a front line therapy has been given is there any constant pattern available. You can take any PSA and G sum and not get an accurate read on tumor volume from one case to the next.

I think the Kattan tables and the MSK nomograms are still the best tools for the newly diagnosed. For example my numbers at Dx were T1C, G7, PSA of 19.8 and half of my cores were positive. 48% of these patients had contained disease. 18% had mets. The rest were in between.

That's a pretty strong variation in tumor size...

Tony
Posted Today 12:44 PM (GMT 0)
"explain" density? It is the mass per unit volume. Fresh water is a reference point, at exactly 1.000g/cc. (Salt water is slightly more which is why we are more buoyant swimming in the ocean, and ice is slightly less which is why it floats in a glass of water.). The body is mostly water, and many glands like the prostate have a density similar to water. The rule of thumb for prostates is used by Dr Catalona here: http://www.drcatalona.com/qa/arch_prostate-gland.asp
Posted Today 1:59 PM (GMT 0)
Thanks Casey.
Posted Today 3:52 PM (GMT 0)
More information on determining the weight of the prostate… The basis for clinically determining the weight in grams of the prostate is the trans-rectal ultrasound (TRUS) often performed at the time of the biopsy, to first determine a volume estimate.   Software is built into the TRUS unit which allows the doctor to use the screen images to measure “diameters,” or length, width and height distances from one side to the other in various directions (in 2-D).   The prostate is roughly spherical, but actually more like an elongated spheriod, which is obtained by rotating an ellipse in 3-D around one of it’s principal axes (like a football), or an ellipsoid which is a somewhat flattened spheroid. The volume of a sphere is calculated as   V=4/3*(pi)*r^3, which is equivalent to V=1/6*(pi)*D^3; for a sphere, r or D are consistent.   Instead of having a Diameter (D), t he spheroid or ellipsoid has a width (W) and a height (H), or W, H and length (L), respectively. It’s a bit difficult (uncomfortable for the patient) for the doctor to rotate the TRUS transducer (hand-held device) outside of the transversal plane to get the 3-D measurements, so the spheroid volume formula (a modification of the spherical formula, given above) is often used, V=1/6*(pi)*W*W*H, where W is the anterioposterior measurement and H is the transverse measurement. In reality, any individual’s prostate is not exactly smoothly shaped, and therefore the conversion of the linear arc measurements from the TRUS into a volume measurement is not precise…but it’s pretty good.   The software spits out a number based on the calculations.   The Catalona rule-of-thumb conversion of volume to weight is also not exact, but close enough. Lastly, for those who eventually undergo surgery, the post-op pathologist will weigh the prostate before examining it. Maybe more information than you wanted to know…
Posted Today 5:23 PM (GMT 0)
I also understood the 1 gram=1 cc equivalent (rough) and had calculated it, but a little simpler than what Casey has explained. Don't remember where I saw it.

Regading the Strum paper for MsWorryWart. Go to www.prostate-cancer.org and look in "Insights", July 2002, Vol.5, No.1, "A Study of Success in the Treatment of Prostate Cancer" page 2, by Dr. Stephen Strum. You will find the table that shows the more exact factors and the rough numbers I put in my earlier post. This measurement is attributed to a study headed by a doctor named Aihara, but I have not looked at it, nor can I tell you where to look for it. I believe Strum also has the table in his excellent book "A Primer for Prostate Cancer".
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