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My Active Surveillance. started 3/2009

hopeful and opt...
Posts: 2226
Joined: Apr 2009

PSA lowered to 4.2 while Free PSA is 21. 

Dr. prescribed alfuzosin hcl er 10mg tab apo  to abate frequent urination during the night.

Dr. wants to perform another biopsy this summer, to survey the area around the 3+4=7 found this past summer.ng p

This will be number 7 biopsy in 9 years (getting very old).

Here is a medical history concerning Prostate Cancer:

"Active Surveillance 

Diagnosed 3/2009 for 66 birthday
By chance doc found a lipoma in the cavity , not on the prostate(which turned out to be non cancerous)
PSA's had been at 2.26/2.27 for a few years
Biopsy 3/09 Gleason 3+3=6 2 of 12 cores positive- 5 percent involvement in each
second opinion john hopkins
4/09 MRI(tesla 1.5) with spectroscopy, no nodule involvement, staged t1
Aureon molecular test on biopsy, 97 percent chance will not progressin next 8 years
PSA Jan 2.2, JUly 2.5 free 16, November 2.6, February 2010 2.0

Entered in a research study for active surveillance .
PSA , 5/24/10....2.6 free 19
June 2010 ...MRI(tesla 3.0)
June 2010.....Three dimensional targeted biopsy ( based on MRI and ultrasound ability from this biopsy)......15 cores of which 3 are targeted....no cancer found.
second opinion confirm no cancer
January, 2011 PSA 2.5 free 25
March, 2011 PCA3 result 8.3 
June, 2011, MRI(Tesla 3.0)
June, 2011 .....Three dimensional targeted biopsy ( based on MRI and ultrasound ability from this biopsy)......17 cores of which 6 are targeted....no cancer found
psa june 10, 2011 3.6 free 18
psa Dec 16, 2011 4.2 free 14
psa mar12, 2012 3.9 free 17
psa june 12,2012 4.1 free 15 d3 26 normal 30-100
psa 10/5/2012 4.3 free psa 16 
psa 6/13/13 3.8. free 22%
mri 6/6/2013 3.0Tesla
6/13/2013 biopsy, 15 cores, 3 targeted and 12 systematic
1 systematic positive... 40% involvement 3+3=6
2 targeted positive 10% 3=3=6 and 20% 3+3=6
Second opinion Johns Hopkins, 
1 systematic 30% involvement 3+3=6
Targeted 10% 3+3=6 (no change)
10% 3+4=7 (upgraded)
GENE TEST...Genomic Health oncotype DX low risk patient, likelihood of favorable pathology 74%, freedom from high grade disease 84%, freedom from non organ confined disease 80% ...Oncotype DX uses rt-pcr to determine the expression of 17 genes in tumor tissue. Oncotype DX is calculated from the gene expression results and ranges from 0 to 100.
The criteria for the Genomic test is based on a prospectively-designed validation study of biopsy tissue form 388 patients with localized prostate cancer meeting the NCCN Very Low, Low and Intermediate risk criteria
11/24/13 Dexa Bone Density test, for base line.
1/24/14 PSA 4.1 Free 20
8/14/14 PSA 5.4 Free 24
8/14/14 Targeted biopsy of areas surrounding last years positive cores. 17 cores taken, one of which showed a 3+3=6, less than five percent involvement. two cores: focal high grade prostatic intraepithelial (HGPIN) Another core showed no tissue present. 
3/09/2015 PSA 4.4 Free 18
10/19/2015 PSA 8.0 Free 20 Rode bike before PSA, redo on
10/26/2015 PSA 5.9 
4/19/2016 PSA 4.7 Free 19 
8/3/2016 3T MRI with contrast. Suspicious lesion, 3 on 5 point scale.
8/10/2016 Three dimensional targeted biopsy
8/17/2016 Targeted biopsy, Artemis 

Total 19 cores taken

Positive Prostate Biopsy Cores in Target Biopsies:
(these cores were prior positives in systematic biopsies)

Gleason 3+4=7 4mm (5 % Gleason pattern 4) occupying 30% of biopsy tissue

Gleason Grade 3+3=6 involving 1 of 2 cores, measuring 1 mm, occupying 5% of biopsy tissue

Gleason Grade 3+3=6 invoving 1 of 1 core, measuring 2.5 mm, occupying 10% of biopsy tissue

Positive Biopsy Cores in Systematic Biopsies 

None

March 4, 2017
PSA 4.2
Free PSA 21"

VascodaGama's picture
VascodaGama
Posts: 3045
Joined: Nov 2010

Ira, I am confused. Older guys tend to have higher levels of PSA but yours is going down. How do you manage that?

Regarding frequency, I was suffering too (4 times waking up at night) but now I sleep well since I started daily mirabegrom 25 mg (Betmiga).

Best wishes for continued success.

VG  

hopeful and opt...
Posts: 2226
Joined: Apr 2009

This time around, I made a point not to exercise with a stationary bike, and also took it easy with everything else.

Also I've been really watching my diet, and have avoided oils in my diet. I notice that there are oils in almost all processed or restaurant foods. I continue to eat a whole food, veggie based diet with some fish.

At any rate, the above is what I've been doing. I think that at the least it is heart healthy, and it may  have an effect on PSA levels.(Thinking about this, Dean Ornish some years back saw PSA levels drop from a small sample of patients who ate veggie, exercised and reduced stress).

Hopeful and Opitimistic

 

VascodaGama's picture
VascodaGama
Posts: 3045
Joined: Nov 2010

The numbers are the same as 3 years ago in both; fPSA (just under the 25%) and the PSA. The curve seen within the 36 months could relate to biorhythms a slight infection at some occasion or inflammation due to prostate massage (from whatever reason including biking). Food also influences the endocrine system directly affecting the lipds and levels of the PSA.

Since diagnosed with renal deficiency I also changed habits and diets. The most significant aspect is that of sleeping more than 8 hours daily. I can feel the difference. I wonder if this also affects the PSA in those guys with the gland in place.
I have been trying to figure out if my newer blood pressure medication Lercanidipine has any effect in the PSA too. This is metabolized via the CYP3A4, the same enzyme used by statins to lower cholesterol. Lower stuff means lower testosterone, and lower T can take the bandit to hibernation. I am eager to know about my present level of PSA.

VG

Old Salt
Posts: 720
Joined: Aug 2014

Eight years by now; that's great!

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