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Low PSA = no growth in cancer

ralph.townsend1's picture
ralph.townsend1
Posts: 359
Joined: Feb 2012

In the case of my metastasis Prostate cancer and with a PSA of only 0.2 now and taking ZYTIGA. One would think that there is no growth in the tumor's which is in the Lymph Nodes.

If that is the case, then why would MD Anderson would want me to do a full CT / bone scan in July. Is it money or is it to check the size of the tumor's or is it that there can be more growth of this cancer and that just because it is 0.2 psa it can still grow?

The last CT/Bone scan was in Oct. 2011.

VascodaGama's picture
VascodaGama
Posts: 2577
Joined: Nov 2010

Ralph

You can get an answer from the guys at MD Anderson. The trials’ protocols include tests which in your case may be a CT scan done at certain periods. What is surprising is your comment regarding “money”. I thought that you were having it for free.

I also tend to believe that a stable PSA level equals to negative growth of cancer, but it seems that the theory is not totally correct. Some guys report on metastases while having stable PSA marks.
RoxysDad is an example (http://csn.cancer.org/node/239231)

Dr. Glenn Tisman presented at the PCRI Conference, evidences that tumour growth is specific to each patient. Cases can be considered similar but not equal. When discussing about the benefits of intermittent modality for hormonal treatments, he says that guys should monitor developments not only through the PSA. His reasoning is that “tumor growth rate may increase despite slowly rising or stable PSA”.

I do not know if you can get a copy/DVD of his presentation but in PCRI site there is a summary with references to 5-ARI drugs where they write about his discussion topics;
http://www.prostate-cancer.org/pcricms/node/356

I would appreciate if you could inquire about that at MD Anderson. Can any comrade forward information on this matter?

Best
VGama

ralph.townsend1's picture
ralph.townsend1
Posts: 359
Joined: Feb 2012

I pay 20% co-pay the Zytiga and lupron is thought VA, which is free! It's late tonight talk to you tomorrow!

muckdown
Posts: 27
Joined: Jul 2011

No there not doing it for free.However was the test necessary or "hey lets run this test,just to see whats going on " to many doctors order test and procedures wihtout knowing whats really going on . I went in the doctors office at Urology of austin and the doc order IMRT treatments. There was no way knowing if the treatment would be effective becase the ptostate was already taken out.So 39 treatment days later the PSA was were it was before.There was a good bit of money spent on nothing.

ralph.townsend1's picture
ralph.townsend1
Posts: 359
Joined: Feb 2012

Muck, the way it works for me is that MD Anderson cancer center write the prescription to VA Hospital to fill. Since I'm 100% disabilty with VA all medicine is free.

I agree about the 39 wasted treatment that did not kill the cancer. Waste of money and time!! The side effect were terrible!

Good luck with yours!

Samsungtech1
Posts: 351
Joined: Jan 2011

Ralph,
There are plenty of people on this site who are tested every three to six months. No one knows exactly what is going on so they have tests to see if everything is in sync. Good for you. Better than doctors who know everything so do not test.
Saw a press release for your drug, did not mention liver problems. On another note I had a customer come into shop today who knows about my condition and told me about a friend of his who had metastis to bones and was going into kidney failure. They gave him MD3100. He claims that his friend was cancer free in seven days and kidneys were fine. Gave me name of doctor who did the recommendation for trial. Gave me name and number of his friend to call and see what happened. Sounds too good. Not sure but will follow up.

Good luck,

Mike

Samsungtech1
Posts: 351
Joined: Jan 2011

Ralph,
There are plenty of people on this site who are tested every three to six months. No one knows exactly what is going on so they have tests to see if everything is in sync. Good for you. Better than doctors who know everything so do not test.
Saw a press release for your drug, did not mention liver problems. On another note I had a customer come into shop today who knows about my condition and told me about a friend of his who had metastis to bones and was going into kidney failure. They gave him MD3100. He claims that his friend was cancer free in seven days and kidneys were fine. Gave me name of doctor who did the recommendation for trial. Gave me name and number of his friend to call and see what happened. Sounds too good. Not sure but will follow up.
By the way I use to get tested every three months ct including barium, and bone scan. I told them to do it every six months. That was when it doubled. I get all of them wednesday, and thursday. My right vein is getting worn out. Just had VA do blood, oncologist did blood and had these clowns trying to find my left vein and put the needle in and then poked it around trying to find the vein. Should have seen the bruising, classic.
Good luck,

Mike

ralph.townsend1's picture
ralph.townsend1
Posts: 359
Joined: Feb 2012

Mike,
I in my heart that they are doing the right thing. It's about every six months that they do a full body scan ct,bone scan. They are good at the test, but it still not something I in joy. Your friend was at a state of condition that warranted the medicine. I do not think I qualify for the test with MD3100. My psa is to low. But if you have a doctor that will write a prescription to you. Then maybe VA will give the drug to you :-)! They always have hard time finding the vein!! :-(

Good luck, and thank you for your service!!!

GOD bless!!!!

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

Ralph,

As prostate cancer advances the cells become more primitive and highly disorganized. At a certain point these prostate cancer cells no longer need testosterone to grow and they cease making PSA. This is how you can have low PSA scores but rapidly growing cancer. This is the stage where drugs like Zytiga become effective. Taking the scans will enable your medical team to determine the extent of cancer growth in other parts of your body since the PSA is ceasing to be a reasonable indicator.

Best of luck with the scans.

K

ralph.townsend1's picture
ralph.townsend1
Posts: 359
Joined: Feb 2012

Kongo, what are you saying that the cancer to could be growing??? I'm not sure that it is growing, because all the test ct scan in the past as the psa went up the cancer the lymph node's tumor's size went up and when the psa went down the lymph nodes tumor's went down.

If your saying it could move to another area as a different cancer cell that is not psa cell.
I'm still going to do all the testing they want. I trust MD Anderson, and will continue on there direction.

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

Ralph,

Yes, of course the cancer can be growing. That's why your doctors want to do these additional imaging tests even though your overall PSA score is low. When cancer cells advance and become significantly non differentiated the are more primitive than the early cancer cells that act much like a regular prostate gland cell. These irregular cancer cells produce very little PSA and when they become castrate resistant they no longer need testosterone to grow.

There are several types of prostate cancer (at least 25 variations as I recall) and they have different evolutionary paths and symptoms but it is entirely possible to have a growing prostate cancer with low PSA as the disease advances.

Ask your doctor about it.

Best,

K

ralph.townsend1's picture
ralph.townsend1
Posts: 359
Joined: Feb 2012

I go to treatment first to VA on the 6 of July for blood test to get free Zytiga. As long as my blood test comes back normal, they will supply Zytiga free. Then I go to MD Anderson on the 9th of July for full body CT and Bone scan, blood test. Its all done in a half of a day. Wham bam thank you mam.

I keep you inform, and good luck and God bless.

Trp911
Posts: 8
Joined: Jun 2017

I'm new here and not sure if you all are still on this thread. This is information I have been seeking for years. Can the cancer progress in spite of only a small rise in PSA.  I will read the info you provided and see what, if any, updates there may be. 

VascodaGama's picture
VascodaGama
Posts: 2577
Joined: Nov 2010

Trp911,

You are correct. The aggressivity of one's case is never verified by the PSA. At present one can get a genes test that provides a more accurate understanding of one's type of cancerous cells. It is known that there are at least 25 varieties of PCa. The Gleason provides just a clue on the pattern of the cells comparing them with the pattern of a normal cell. Those poorly differentiated (more disfigured) tend to be more aggressive and with tendency for multiplying and spreading. Some are not hormonal dependent (do not respond to ADT) and some do not produce PSA at all.

Researchers are also involved in discovering newer therapies that practically involve curing the genes (conversely saying it). Here are links that may be of your interest;

https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq

https://www.multivu.com/players/English/8098751-genomic-health-oncotype-dx-genomic-prostate-score/

http://www.news-medical.net/news/20170619/Scientists-develop-new-three-in-one-blood-test-that-could-transform-prostate-cancer-treatment.aspx

Best,

VG

Miao
Posts: 6
Joined: Jun 2017

VascodaGama,

If some one has very low psa under 1 without any symptom, why they go to see doctor. I am newer here, many things make me confusing

Thanks

 

VascodaGama's picture
VascodaGama
Posts: 2577
Joined: Nov 2010

Miao,

I do not know which cases you have in mind but the PSA pre-treatment and after treatment should be considered differently. Patients that did surgery should have remission levels in PSA terms at lower levels less than 0.05 ng/ml. Post radition therapy one should also reach a similar low level lesser than 1.0 but it would take several months to get to such nadir. Any increase after a nadir PSA could be guessed as recurrence, typically named as biochemical failure.

Recurrence thresholds to identify treatment failure differ from doctor to doctor and it can go from 0.03 to 0.06 in RP guys or up to 1.5 in RT guys. There are also those doctors that even prefer using ultra sensitive assays with three decimal places (PSA=o.XXX ng/ml) to judge an earlier recurrence, leading patients to start salvage therapies with PSA levels lower than 1.0 and most probably without symptoms.

In fact each case is never equal to the other so that the PSA should not be the only marker to tell the story. Many patients with advanced cases of metastases are assymptomatic.

Best,

VG

Miao
Posts: 6
Joined: Jun 2017

VG,

Thank you very much for your explaining. i did learn more and more from here. I did biopsy today, and doctor gave me a PCA3 test as well. who here knows about PCA3?

Thanks again

M

xtim999
Posts: 1
Joined: Oct 2017

Diagnosed in May with Gleason score 9, 11/12 biopsy cores at 90%, PSA 26. No apparent matastisis and needle biopsy of "suspiscious lymph node" was negative. MRI showed possible seminal vessicle invasion. Bone scan negative. MD Anderson Doctors started me on Degerelix for 30 days along with Zytiga & prednisone. At 30 day checkup testosterone <20 and PSA was .9 Doctor seemed very pleased & replaced Digerelix with 90-day Lupron and sent me home with lab work orders for PSA test every 30 days. The plan is to reduce the tumor size and to return in January for bone scan & MRI and hopefully surgery in February. They say that they have not closed the door on a "cure" but it seems to me like the door is just barely open. I'd appreciate anyone's comments if you have had similar treatments. Thanks

Clevelandguy
Posts: 228
Joined: Jun 2015

Hi Miao,

A PCA3 test is a urine test where most PSA tests are blood tests.  The doctor massages the prostate then takes a pee sample,  the massage stimulates the prostate to release PCA3(prostate cancer gene) into the urine.

Dave 3+4

hopeful and opt...
Posts: 2053
Joined: Apr 2009

Surgery is effective for localized cancer, that is if the cancer is within the prostate.

With extensive, aggressive cancer as you have been diagnosed with, without a doubt, the cancer has escaped your prostate, and surgery will not be effective. You will still need other treatment(s) that would be a combination of radiation and hormone treatment, or hormone treatment only. The side effects of each treatment modality is cummulative.

Please note that the perimeter of  radiation treatment can be extended beyond the prostate, so that it can treat cancer that is outside the prostate...this may or may not be all of the cancer.

Please make sure that the MRI that you will receive will be a 3T multiparametric MRI...uses a 3.0 magnet, the best definition in clinical use. 

Also inquire about a PET scan.

Wishing you the best

 

VascodaGama's picture
VascodaGama
Posts: 2577
Joined: Nov 2010

XTIM999,

I agree with the opinion of Hopeful above. Your doctor's suggestion for surgery should have the purposes of cure. That is proper when the case is diagnosed as contained, otherwise surgery will just serve to debulk the "big tumor" therefore, with low assurances of cure.

I also cannot understand the need in reducing the tumor size to perform surgery. This is typically done in radiation interventions to avoid the risks for collateral damage of closed tissues/organs. Probably you have miss-listen his suggestion. Can you tell what did they read from the MRI image, what was the size of the prostate?
I would think that your doctor wants to accommodate your organ to facilitate a robotic surgery because open RP style doesn't require such reduction.

Your comment on the possibility of seminal vesicle invasion turns your case worse and still leaning further toward a bad prognosis for a surgery approach. In your shoes I would get a second opinion from a radiologist. In any case, you can continue with this initial ADT protocol because it wouldn't alter any future treatment decision. Apart from showing already success in the control of cancer advancement, ADT (Zytiga + Lupron) would always be part of your treatment. However, some surgeons doing open surgery do not like the sticky feeling caused by ADT when dissecting the tissues.

Best wishes and luck in your journey.

VGama 

 

contento
Posts: 48
Joined: Jul 2017

Xtim, trust your doctors at MD Anderson. When I was receiving my treatment there a few years ago my primary doctor at MD would present his/ her treatment plan to the Prostate team which consisted of the other radiation and Chemo oncologists  on the staff. So essentially your getting a second and a third opinion about your care. So if this protocol is still followed today i would have confidence in what they suggest. I agree with the above that maybe you misunderstood what was said. However if they can't find any evidence of spread surgery could be an option but from the info you provide your case appears to be a step above where I would be comfortable with that treatment. Specifically the high gleason, number of cores testing positive and the possibility of lymph node and seminal vessicle invasion. In fact I agree with Vasco that if surgery was suggested it must be to debulk the tumor. Good Luck Xtim.

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