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Just When You Thought You Had It Figured Out .... Dropping PSA Level

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

After having a biopsy in February because my PSA had risn from 3.8 to 4.3 in 18 months the pathologist discovered 1 of 12 cores with adenocarcinoma with 15% involvement. DRE was normal and there were no physical symptoms. Gleason score was evaluated as 3+3=6. Staging was evaluated as T1c. A Bone scan, full blood panel, and chest x-ray indicated no evidence of PCa spread beyond the prostate. Prostate size was 47 cc which is relatively normal for a man my age (59).

I went through several weeks of consultations and research and ended up deciding to seek treatment using the Cyberknife method over surgery, proton treatment, or other forms of radiation. Although I was tempted to go the active surveillance route, I felt for someone my age with a 15+ year life expectancy that the more prudent course was to get treatment.

In preparing for the Cyberknife procedure I was required to get another PSA reading as the one that started the whole process was more than three months old. DRE in conjunction with pre-treatment was completely normal. Still have no other physical symptoms such as an enlarged prostaste, difficulty with urination, blood in urine, or erectile issues.

The most recent PSA was taken last week and came back at 2.8! I had expected a slight rise or something close to the earlier 4.3 reading but not such a significant decrease.

Since my diagnosis in March, I have eliminated dairy and red meat from my diet. One of my doctors treating me for elevated chloresterol also put me on a low dose of Crestor, a statin, in late January before I was diagnosed with PCa. Many of the studies I have read indicate that the elimination of dairy, the addition of soy, and statins have all been associated with reducing PSA levels but I was not prepared for such a dramatic drop.

While I will be consulting with the doctors this week on what this PSA decrease could mean, I was wondering if anyone else had experienced a significant PSA drop in early stage prostate cancer before treatment that could possibly be attributed to diet changes and the use of statins. There isn't much in the available literature that describes this type of PSA reduction except for some antecdotal case histories associated with the elimination of dairy products.

I realize, of course, that I still have PCa.

Any feedback would be appreciated.

nymets1
Posts: 26
Joined: Sep 2009

Kongo,

Of course, even with the drop in pas, you still have PCa, albeit a very small, minimally aggressive form. Deciding on what to do is very stressful, in itself. However you ARE a great candidate for active MONITORED surveillance. By monitored, you will need a psa test at least every six months and biopsies at time intervals determined by your doctor. The benefit is you will maintain a high quality of life for a period that could last one year, ten years or somewhere in between. Of course, you could always proceed now with a primary treatment, if you want to kill the beast and not worry about it (however, we PCa patients go through active surveillance even after primary treatment since many men are not totally cured and PCa re-surfaces sometime in the future. I will say your chances for cure are excellent.

As to the drop in the psa, as you know, statins and/or low cholersteral have been noted as possibly slowing the growth of PCa. While there is nothing definitive with that, in my own experience, my psa had stayed relatively flat until I loaded up with pomegranite but stopped taking my statins (pomegranite and statins don't mix). Six months later, both my cholestral and psa doubled. I'm back on statins and (fingers crossed) hopefully my psa will fall when I get my next test.

luckyman2's picture
luckyman2
Posts: 54
Joined: Sep 2009

I was diagnosed with prostate cancer in March 2007. The biopsy showed 1 out of 8 samples having 20% cancer cells with a Gleason score of 6 (3+3).

I started this journey when my PSA hit 4.96 in January 2007, prompting me to see a urologist. There was a significant drop in my PSA after the biospy from 4.96 to 3.71 in May 2007 and a further drop to 3.40 in July 2007. I had not changed my diet at all and I was not on a statin at the time. I opted for laparoscopy surgery to remove the prostate in November 2007. The pathology report showed that the Gleason score increased to 7 (4+3).

Important note about statins: One side effect just happens to be ED. I had full erectile function just 3 months after my prostate was removed. Then I was put on Crestor(10mg) to deal with a borderline cholesterol problem... and noticed that things started to "go south" within a couple of months of being on this statin. I went online to research statin's side effects to find out that they do indeed mention ED (but not on the information slip that comes with the medication).

I immediately got off the statin. However, I stepped up my workouts at the gym and I monitor my cholesterol regularly... with good results all around. I told my doctor that I might die from a stroke when I'm 90, but I will die a very happy man!

bdhilton
Posts: 752
Joined: Jan 2010

K…You never know what this beast PCa will serve you in the end. Most clinical results change when you have surgery to higher level (I read 90% of all clinical results increase with a pathology after surgery).

My clinical results were: PSA 2.82, Gleason 3+4, TB2 (and I had all test you could have, I am a study for multiple studies at Northwestern plus I had one of the best surgeons (William Catalona) and authority on prostate cancer do my surgery) and my post surgery pathology report (which is posted in it entirety in my profile) gave me a Gleason 4+3. T3B w/ right seminal vesicle invasion and a positive right mid margin….this is a whole lot more aggressive than my clinical results.

My point is do not read too much into your PSA number as good or bad (it could mean you have a low grade cancer or an extremely aggressive form of cancer) and in reality your choice of treatment you will never know what your real grade of cancer is. Once you hear those words you have prostate cancer your life (from my perspective) becomes a new journey and your life changes forever so enjoy each day and make the best decisions for you #1 and your family and friends and the journey might be short or you might make it to a 100 but “enjoy the ride…”…This cancer is hard to call for the experts….they cannot even agree on “the best treatment”…what a beast…

Best to you

hopeful and opt...
Posts: 1278
Joined: Apr 2009

Did the same laboratory do the PSA? Each lab. has slightly different calibrations.

Sex, exercise, especially bike ridding causes an increase in PSA.......Did this occur before the first PSA.

I don't know anything about the effect or non effect of statins on PSA.....

Once again, a reminder to have an MRI to find out what the nodule involvement is.

By the way, when your passing thru my area on the way to the airport or to visit family , etc. let me know and we can meet.

Ira

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Thanks for the feedback. Yes, the same lab did the before and after PSA tests and don't believe exercise, diet, or sex impacted either of the two readings as I was pretty aware of the timing. Should be having an MRI/CT scan in the next week or so.

I've talked to the nurse about it and she is dumbfounded and I'll be talking to the doctor tomorrow.

Will be sure to give you a heads up the next time I'm through LA. Have been trying to stay close to home and restrict travel a bit while crashing on a big project and trying to schedule medical appointments. We did get away to San Francisco over the weekend for a "just because" getaway.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Thanks all for your cogent comments. I had not realized that pomegranate juice interferred with how statins are metabolized in the liver. I had heard about grapefruit juice but not pomegranate juice. Although many of studies available on the internet hint at a relationship...even strongly suggest...it's still squishy but I had been drinking at least 8 ounces a day and will rethink that.

Regarding the ED issue with statins. Hadn't heard that one either and haven't noticed any issues I could relate to statins but will keep aware.

While I've learned not to put too much stock into a specific PSA reading or even PSA in general, when you have the cancer, the PSA trend is an important indicator that parallels the progression of PCa in our body. If PSA increases significantly and rapidly, it's most likely caused by PCa growth or metasasis. Conversely, a drop in PSA, particularly after treatment, is an indicator of the efficacy of the treatment.

My intuition is that my PSA drop is more associated with the elimination of dairy than anything else but maybe that's just because I want it to be. I know that removing dairy from the diet has had a dramatic effect on some breast cancer and prostate cancer cases, and I don't think I've been taking the statins long enough to have had that much impact.

RiverRider
Posts: 15
Joined: May 2009

A few points.
PSA indeed jumps around.
3.8 to 4.3 is not much of a jump over 18 months, but you did indeed pass the 4.0 line.

Last year I had a jump from 1.8 to 4.3 than back down to 2.5 only a few weeks after the 4.3. Then on to two readings a few months later both in the 3.4 to 3.5 range.
Then a biopsy that showed nothing.

Now, yes indeed diet seems to be able to change psa, but it is also very easy to have your kind of jump due entirely to a lower case of prostatitis. Even asymptomatic prostatitis that you may not have been aware of, nor which is cured by the use of antibiotics.

In short, lower psa is better, but you could jump back up to a 3.5 in a few weeks.
Some people just jump around.
Or your true normal may be around the 2.8 range which if such at the time you were taking earlier would have never put you into a position to even get a biopsy.
Then, today, you wouldn't have prostate cancer any more than a good percentage of undiagnosed men your age.
I may be in that exact situation as I write this. But in my case they missed the one positive sample. Who knows.

Now, I don't know your diet prior to the change and prior to your cholesterol test.
Why were you put on a statin? how high was it. 200, 220, 250, higher?
You would be surprised how far a truly healthy diet can reduce "some" people's results without even using statins.
A drop from 210 to 175 is not all that unusual.
If you really change your diet for the PCa, you very well may not even need a statin.
Many folks can go down to the 150 to 170 range with no pills. Plus, its better for you to lower it naturally as regards your goals with PCa.

When you consult with the doctors, don't expect them to think much about the 2.8 psa drop, as they see it often and will still concentrate on the PCa they found.

I don't know your whole history of PSA rise over the years.
You might just wait and see how it does in six months.
Like I told you in my prior post, as you read and read and spend more time with this prostate cancer education, you are going to come to adjusting opinions about it all.
A few weeks ago you were only 5 weeks into drinking from the fire hose.
Now, you've been at it a couple months.

I'd not be rushing anything. What if you dropped to a 1.8 next time? (you probably won't)
I dropped from 2.6 to 1.6 once and from 4.3 to 2.5 as I stated earlier.

How about if they do another biopsy and find nothing? I'd think that would be more disconcerting than a psa drop from 4.3 to 2.8.
All very interesting.
Keep at it, tell us what the doctors say.

More opinions than grains of sand on the beach...

PS...just saw your last post...
You said "If PSA increases significantly and rapidly, it's most likely caused by PCa growth or metasasis."

Actually if the PSA rise is rapid over a short time, it is less likely to be caused by PCa growth, but rather by inflammation, prostatitis.
In other words a rise of 2.0 or greater in a year or less is, according to some, more likely not caused by PCa
according to some studies..
As usual, the information and opinion and conclusions jump all over the map and any individual patient may vary. Jumps ranging from .3 to 6.0 could all be from prostatitis.
Here is but one article discussing the velocity factor

http://www.medpagetoday.com/HematologyOncology/ProstateCancer/2754

Makes one's head spin.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Thanks for the feedback. A couple of clarifications: The statin was prescribed with a cholesterol level of 221. I also have Type II diabetes but A1c shows it is under good control at 6.9%. PSA records show a slow rise in PSA since I first began having PSA recorded in 2002. (2.2 in 02, 3.4 in 06, 3.1 in 07, 4.3 in 2010 then followed by the 2.8). PSA velocity is pretty low with a PSA doubling time of more than 13 years. Diet before diagnosis was pretty standard junk...lots of eating out (I travel a lot), mostly red meat with a lot of fast food, high dairy usage, fairly high alcohol consumption.

Since diagnosis no red meat, no dairy, and alcohol reduced to 3-4 glasses of wine per week.

My urologist told me that based on the small amount of cancer found in the biopsy that odds were greater than 50% that if they did another one it would be negative. Don't believe prostatitis was the cause. No inflammation, no enlargement, no symptoms.

RiverRider
Posts: 15
Joined: May 2009

"PSA recorded in 2002. (2.2 in 02, 3.4 in 06, 3.1 in 07, 4.3 in 2010 then followed by the 2.8)."

Yes, that is a fairly slow rise, especially if the 4.3 is a blip above the real trend line for whatever reason.

"Don't believe prostatitis was the cause. No inflammation, no enlargement, no symptoms."

Much of the prostatitis that causes PSA rises as small as "may" be the case in your 4.3 could easily be causative with no symptomatic inflammation or enlargement.
Asymptomatic prostatitis is very very common and it can be bacterial or of other causes.

I spent a lot of time a few years ago looking into all aspects of asymptomatic prostatitis.

Google-- "asymptomatic prostatitis" psa ---

Of course prostatitis may have nothing to do with your rise. No way to know without microscopic examination. Although sometimes it can be noted in the biopsy report of the other 11 samples.

I see there is are some articles on PSA and Metformin if you happen to be taking that common drug. I haven't looked into that connection.
All in all, it sure doesn't look like your PCa is taking off quickly. Of course, there are always exceptions.

Given your cholesterol (very controllable) and Type2 diabetes, it would seem that any probable PCa is a lesser concern compared to keeping a close eye on cardiovascular issues.
The good thing is that some of the best diets happen to address both.
It may be that this brush with PCa and hence your changed diet, will have gotten you to address the dietary issue which otherwise could have led to more dangerous issues unrelated to PCa. All for the good.

Eating differently can be a real adventure. I've become about 90% vegetarian over the years, but still enjoy an occasional BBQ burger.
Now I can't even eat a full sized steak without feeling "heavy". Tastes change and much smaller portions of meat or fish can be completely satisfactory.
BTW, I switched to Vanilla flavored Soy milk and hardly noticed the difference.
Of all my changes, that was the easiest.

steckley
Posts: 100
Joined: Aug 2009

Kongo,

Kongo,

I had a friend whose PSA went up. His wife was into herbs ... big time. They developed a herb cocktail (I believe it contained saw palmento and other things) that sent his PSA way down. I figured that the herbs masked the PSA. I believe diet can impact your PSA.

As you pointed out, the PSA can go down, but the cancer remains.

I also was diabetic and had high LDL cholestrol and Triglycerides(and had borderline high blood pressure). I lost 20 pounds, changed my diet (mainly veg and whole grains), do fish oil, vitamin D, etc., and walk a lot. Cholestrol has lowered, no diabetes or high blood pressure ... I feel the weight loss had a lot to due with the results.

I still drink a glass of Bugundy each night, sometimes more. Found that after my prostate was removed, I would get night sweats if I drank hard liquor ... so I stopped.

Congratulatons on your diet changes and good luck with CK!

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