Confused about PSA

I will start this by saying best wishes and thanks to everybody on this forum. The folks here (Guys and Gals), are truly helpful and informative. Even though nobody wants to be here, I think that the vast majority of folks here, if not all, truly want to make this corner of the world a better place.

I am a bit confused and wondering if anybody has had a decreasing PSA w/o treatment, even though being positive through their biopsy?

6.36 in Dec. 2012
5.3 in Jan. 2013
4.5 in May 2013

Last 2 tests in same lab. Still not started treatment.

Just curious and thanks and best wishes.

What does your Uro say? What are you thinking? I would get another one each month till it reaches its lowest point for 2 consecutive monthly tests. same lab. Do not have sex, ride a bike, motor or otherwise the previous 48 hours prior to blood draw. From there I would make my plan for treatment, including AS. In the meantime educate yourself about this disease, from whatever reputable source you can find..

You actually should get those slides reread from a topnotch PCA pathologist. Epstein is one , there are others, I don't know. Or at least from a pathologist from a hi volume Pca medical center John Hopkins is one

Also be aware of, that while biopsies do/can confirm cancer, they do not give a 100% picture of the cancer. It is just a small sampling of the cancer. It could be all G6, and sometimes, the Gleason score is upgraded depending on the type of treatment.

iSpark brought up a VERY important point about the biopsy diagnosis. I hate telling people this, but it's important that they understand that a biopsy report (if positive) is only an educated GUESS on the nature of the cancer.

Almost 3 out of every 10 prostatectomy cases has a post-op pathology report that shows the Gleason score was actually HIGHER than suggested by the biopsy. For this reason, I'm always a bit reluctant to advise anyone to do Active Surveillance.

Another way to look at it, however, is that 7 out of those 10 patients end up having accurate biopsy reports.

But how do you tell if you are one of the lucky 7 or one of the unlucky 3? Until we have a test that can definitely identify the intrinsic nature of PC, Active Surveillance can be a very dangerous roll of the dice.

Those currently doing AS, or considering it, should have a good discussion with their doctor on the chances of it being more aggressive than it might seem from the biopsy report.

Most of us on this site, and on another PC forum I belong to, have read lots of posts where someone went into surgery as a Gleason 6 and ended up a Gleason 7 ..... or were diagnosed with a Gleason 7 and had a post-op pathology report of Gleason 9, etc.

As we so often say in our club, "You only get one shot at this. Make it your BEST one."

Take care,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.