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PSA how accorate a progbosis

tonybuxton
Posts: 78
Joined: May 2012

I am confused about PSA statistics. Many people seem to think that a high PSA of say 8 or 9 means cancer.
12 years ago my PSA was 4 .Then I had three biopsies. 10,5 and 3 years ago. My PSA was 10, 20 and 27 respectively. The biopsies were all negative. I had severe BPH and took a lot of medication for it including finesteride. 6 months ago my PSA was 42 and I had TURP which revealed High grade localised cancer gleason 3+4. Unfortunately I did not have my PSA taken after TURP but immediately had IMRT after which my PSA dropped to <0.1 I also had 3 months HT.
My grading was based on a high PSA so my life expectancy will also be evaluated on my high PSA. But I wonder how much of my high PSA was due to BHP rather than cancer?

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

Tony,

Cancer is not based on PSA since so many different things, such as the BPH you described, can cause high levels of PSA. Cancer is staged and graded on the Gleason score, whether or not the cancer is palpable (the doctor can feel it during the DRE), and the location. PSA is only one of many indicators that may or may not have anything to do with cancer.

A PSA of 8 nor 9 with BPH is not unusual and is not high for someone with BPH. PSA also increases with age. Most PSA scores between 4 and 10 are in fact caused by BPH and not cancer. When your prostate is enlarged with the non cancerous fibrous growth near the center of the prostate (BPH), it pushes the prostate gland against the surround pelvic skeleton structure and squeezes more PSA into the bloodstream. Severe cases of BPH such as you had can be accompanied by high PSA levels and a TURP is the only way to remove a considerable amount of prostate volume. Drugs such as Finestride can cause the prostate to shrink some but for really enlarged prostates they have to go in and scoop it out.

Your cancer was diagnosed from the biopsy of the cells taken during the TURP -- not the PSA score. The 3+4 localized diagnosis is not high grade unless it is a virulent strain of prostate cancer such as small cell cancer or squamous. If your biopsy report described adenocarcinoma (adeno means "associated with a gland and carcinoma means cancer) then a 3+4 is in the low end of the intermediate risk range.

The treatment of IMRT and HT is a common and effective treatment for such a diagnosis. The effectiveness of your treatment can be gauged after you have stopped HT and your testosterone levels return to normal. At that point, monitoring your PSA will give you an indication of whether or not you have curbed the cancer. If indeed it was contained, there is a high probability that you won't have any more problems with it.

To answer your question, I suspect that most of your high PSA was caused by the BPH and not the cancer but I would have a frank conversation with your urologist and have him explain this in more detail.

Best to you.

ralph.townsend1's picture
ralph.townsend1
Posts: 352
Joined: Feb 2012

Kongo, your comments are right on. In my case my PSA has since 2008 has never been over 9 at the time of prostate surgery and most of the time been no more than 1. My gleason score 4+5 in 7 out of 12 points. Which is why it makes my cancer dangerous. Even with my PSA low, the Doctors at MD Anderson cancer center that it has metastasis to other area's. PSA is at 0.3 right now, but very dangerous because of the Gleason score.

tonybuxton
Posts: 78
Joined: May 2012

Hi Kongo
Thanks for your reply, it was the most informative and reassuring one I have had since I was first diagnosed with Pca last year. I would like to confirm my exact diagnosis as follows.
DRE before TURP negative. TURP removed 30 gm of my prostate and the pathologist found andenocarcenoma in both lobes 70-75% volume. Gleason 3+4( I do not know how large my prostate was)
When the oncologist graded the cancer he told me that it was T2c. But because my PSA was 42. He upgraded it to T3a, which he said would need more aggressive treatment. i.e. two years of Hormone treatment. I only had three months and had to stop due to side effects.
I am rather obsessed with my survival chances, but if I base them on on Grade T3a and PSA of 42 they are not so good.
It is 5 1/2 months since my first 3(month) hormone injection and I will have another PSA test in 2 weeks time. This will be 3 months after the expiration of the injection.
Unfortunately my Urologist (who did the TURP at a small local hospital) speaks very little English and my Oncologist (who did the IMRT at a very large hospital)is a very busy man and does not seem to be very communicative. So I do have rely on these sort of FORUMS to get advice.
Thanks again and any more comments would be appreciated.
Tony

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

Tony,

I appreciate your concern about the statistics but many, many factors come into play. And lets face it, none of us are getting out of here alive. If prostate cancer doesn't get us something else surely will and going just on statistics alone, the leading cause of death among men with prostate cancer is heart disease.

If your doctor removed 30 grams of fibrous material in your prostate then you had an ENORMOUS gland given that the average size is somewher between 25 and 35 cc. Hopefully this reduction alleviated some of the symptoms of BPH. I have read that PCa associated with BPH which tends to be toward the center of the prostate instead of toward the edges is less of a threat and is more ameniable to treatment because it is apparently all contained. Your IMRT should have addressed any remaining cancer in the prostate gland and remember that a lot of it was removed during the TURP.

Until your testosterone returns to normal levels your PSA test is not a very good indicator. Be sure to have them run a T-test when they draw your blood and then compare your testosterone levels with the normal range. The lab report should indicate what the normal range is.

I agree that these forums are good sources of advice but they don't substiture from one-on-one conversations with your doctor. If these guys are too busy or have language challenges, by all means find another oncologist who can explain it to you.

Best,

tonybuxton
Posts: 78
Joined: May 2012

Thanks again Kongo. The TURP operation removed all the effects of BHP which I had had for ten years and the relief was enormous. Only a few days after the operation I was able to pee normally and no more getting up at night. But of course it was a shock to have been told I have prostate cancer.
I will have a free testosterone test when I do my next PSA and since I feel so much better having stopped the HT. I am taking a very positive view of everything. I have a pomegranate tree in my garden and I am going to eat a bit of the whole fruit every day since I have seen so many references about this fruit. And I am following a healthy diet and exercising as much as possible.
best regards
Tony

laserlight's picture
laserlight
Posts: 165
Joined: May 2012

The psa score can be misleading. MY score at the time of Prostate cancer diagnosis was only a 2.25. I was already at stage T2C. All of my biop samples came back with cancer between 40 to 60 percent I also had the bad 7 gleason score. The only true indicator of cancer is the Biopsy. My doctor tells me that the lower the better, but I donot think that this worked in my case. From what I understand the psa levels move about and are an indicator that something is going on, but does not indicate cancer. I had one doctor tell me that he was not to concerned with a psa level of .80. I changed doctors and the new doctor got concerned, I am glad he did.

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