PSA how accorate a progbosis

Kongo said:

PSA and BPH
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.

Kongo said:

Survival
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,