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Old 02-04-2008, 11:53 AM   #1
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Question Should we be concerned?

My husband (age 54) was diagnosed with PC in April 2007 and had a RP that month. His PSA was 3.1, Gleason 6 (3+3), T2C with positive margins. His first PSA in July was 0.010. He then had radiation in Aug./Sept. as a clean up procedure and his next PSA in Nov. was 0.012. He just recently had another PSA and it is now 0.014. His urologist said this nothing to be alarmed with and just keep checking his PSA. Have any of you had something similar to this happen...and did it mean anything? Are these safe figures? At what point should we become concerned?

 
Old 02-04-2008, 04:22 PM   #2
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Re: Should we be concerned?

Quote:
Originally Posted by Sue58 View Post
My husband (age 54) was diagnosed with PC in April 2007 and had a RP that month. His PSA was 3.1, Gleason 6 (3+3), T2C with positive margins. His first PSA in July was 0.010. He then had radiation in Aug./Sept. as a clean up procedure and his next PSA in Nov. was 0.012. He just recently had another PSA and it is now 0.014. His urologist said this nothing to be alarmed with and just keep checking his PSA. Have any of you had something similar to this happen...and did it mean anything? Are these safe figures? At what point should we become concerned?
Hi Sue,

I've been on intermittent triple hormonal blockade as my sole therapy for over eight years and have used ultrasensitive PSA testing for much of the time that I have been "on therapy." Because of that I've paid close attention to use of ultrasensitive testing.

That first result is excellent, putting your husband in a group with low odds of recurrence. The slightly higher following results could be, in my opinion as a layman who has paid attention to this, the result of individual test variation from minor alterations in testing details to minor variations in the miniscule amount of PSA that your husband still produces. I know that for usual levels of PSA, a day-to-day variation of up to 15% can happen. Perhaps that also applies to very low ultrasensitive levels. Even a PSA of 0.02 is outstanding, even though the odds of recurrence are slightly higher, and your husband is well below that as he nears the first anniversary of his surgery. Maintaining a very low PSA becomes an increasingly more convincing indicator of cure as time goes on.

I went to the Government medical research website [url]www.pubmed.gov[/url] and searched for " shen s [au] AND ultrasensitive AND nadir AND 2005 [dp] ". I got an abstract of a paper on using the PSA ultrasensitive test nadir after RP to get an early warning of recurrence. Here's an excerpt from the results section: "... Relapse rates in men with a PSA nadir of less than 0.01 (423), 0.01 (75), 0.02 (19) and 0.04 or greater ng/ml (28) were 4%, 12%, 16% and 89%, respectively...." The numbers in parenthesis show the number of men in the study who fell into each category. Here's how they defined recurrence: "Biochemical relapse was defined as 2 consecutive increasing post-nadir PSA measurements of 0.1 ng/ml or greater." Judging by this research, your husband's odds of recurrence fall somewhere between 12% and 16%. Even then there's a very good chance it could be a very mild recurrence, possibly requiring no further therapy ever, or only mild therapy. Another study had somewhat similar findings, but the researchers lumped all men with PSAs from 0.01 to 0.05 together, so they picked up the higher risk men with PSAs of 0.04 and 0.05 as well as the lower risk men. To me that really muddies the picture. (Sakai I, 2006) As you can see, the risk really climbs when the PSA is 0.04 or higher. To me, if that happens, it's the time when I would get very serious about lifestyle tactics to prevent a clinically significant recurrence, if I had not gotten serious already. Those tactics include nutrition, diet, supplements, exercise and reducing stress.

(For anyone reading this who gets a conventional PSA result with a lower limit of <0.1, a result of <0.1 doesn't mean you are at higher risk. It just means you haven't yet had what is considered a clinically significant recurrence (reaching 0.2 for most researchers) and that you do not know your true PSA nadir. To me monitoring with a conventional PSA test instead of an ultrasensitive test is like fighting a war at night without putting on your night vision goggles, but I know that some patients and doctors are comfortable with that. )

Take care and good luck,

Jim

 
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Old 02-05-2008, 06:09 AM   #3
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Re: Should we be concerned?

Thanks, Jim, your information has been very helpful. Do we ask to have an ultrasensitive PSA test-I've never heard of that before? Also, what supplements would you recommend? Sue

Last edited by Sue58; 02-05-2008 at 06:49 AM.

 
Old 02-05-2008, 08:27 AM   #4
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Re: Should we be concerned?

Quote:
Originally Posted by Sue58 View Post
Thanks, Jim, your information has been very helpful. Do we ask to have an ultrasensitive PSA test-I've never heard of that before? Also, what supplements would you recommend? Sue
Hi Sue,

Your husband is getting an ultrasensitive test already. So called "conventional" PSA test typically have a lower limit of just <0.1, so the doctors and patients are blind to any developments from <0.01 to 0.99. For most of the years since I was diagnosed in 1999, many doctors would not use the ultrasensitive tests, but that is changing. Now a lot of patients on the internet are reporting ultrasensitive test results and are able to tie in to the research that has been done. My hunch is that it may be a majority, maybe not of all patients, but among those who are active on the internet, who tend to be more empowered.

A lot of research has been done on nutrition and supplements for prostate cancer. Enough has been done that a handful of items have a persuasive amount of evidence - enough to act with confidence, in my opinion, but not enough to be fully conclusive, which to me means great confidence that the recommendation won't be reversed or neutralized at some point. I believe there is a broad consensus that no item has yet achieved the conclusive level of evidence, though we expect that to change for selenium and vitamin E in a few years based on a very large ongoing clinical trial ("SELECT").

I'll try to do a detailed post on this soon, but here's a quick look. I am neither a scientist nor doctor, though I have worked closely with scientists for most of my career (now retired), and I am in fairly close contact with some doctors I consider leaders in lifestyle tactics, particularly Dr. Charles Myers. (I am not one of his patients.) I find his information especially useful because he carefully documents the research support, and as a former NIH and U. of Virginia researcher/physician himself, he is particularly insightful. I also admire him for not "overdriving his headlights" and for his willingness to change his views when warranted by the evidence. You can view the research supporting each item by going to the Government web site [url]www.pubmed.gov[/url] and searching, as in "lycopene AND prostate cancer". If you want to limit the search to make it more manageable, click the "Limits" feture and activate the button to get only items with abstracts and for research done in humans (rather than lab or animal studies).

Some of this is easy, inexpensive, and apparently effective, based on what we know now. Some of it is hard, such as eliminating red meat. All of these elements stand independently, though some are synergistic with other elements, but the more we can do, the better.

In writing this, I saw that there is just too much information to put it into one post. Here's an example of what I think is what's needed just for vitamin D. I'll just list other key items and get to them later.

Item: Vitamin D3
Why: Most men diagnosed with prostate cancer are deficient in vitamin D. That statement is probably also true for most older women. Vitamin D has recently been recognized by the NIH as very important for prevention and support of treatment of many diseases, including prostate cancer, and it is important for maintaining (or restoring) bone density. (Many prostate cancer patients have deficient bone density at diagnosis.) The old recommendation of just 400 IU per day is now widely recognized as insufficient for adults. Toxicity until 1999 was thought to occur at a fairly low level, but this was based on poor analysis of scant evidence; it is now recognized that much higher levels of vitamin D are not only safe but needed. We can get enough vitamin D from the sun, manufactured via our skin, but most of us live too far north for that, and our skin does not work as well as a source as we get older. People with dark skin will probably need more. Many African Americans are deficient in vitamin D, especially if they live in the north.
Key Research Support: Much research has been done in recent years.
Leading edge view of need and dose: Perhaps the most important supplement for prostate cancer, per Dr. Charles Myers. Others also consider it very important. Recommended dose of 3,000 to 5,000 IU per day, though some physicians (e.g., Dr. Stephen Strum) are now recommending at least 5,000 IU per day, but based on monitoring. Keep dose under 10,000 per day. Aim for a 25-hydroxy vitamin D blood level from 50-80, not exceeding 100, with the upper end of the range ideal.
Conventional view of need and dose: This is changing upward. My impression is that many conventional doctors are now recommending 800 to 1,000 units, with up to 1,250 IU, for older patients, while they await official guidance.
Naysayers view: Just 400 IU per day, not exceeding 1,000 IU.
Good sources: A really good vitamin D3 supplement. It's hard to get enough from food, especially when fortified dairy products are not wise for prostate cancer patients. I know of one good supplement, but our board wisely prohibits what would be considered advertising. I'm sure none of us want to open that doorway to clutter and misinformation. Some D3 supplements do virtually nothing based on a report from one doctor who monitors his patients blood levels and vitamin D sources. Fish and fish oil provide some D3, and some is provided in other food.
Safe and toxic limits: Keep dose under 10,000 per day, and monitor blood level. Research has established that there appears to be little risk of dosing at lower levels, but there is a risk of complications when dosing exceeds 10,000 IU for an extended period. However, an FDA approved dose of up to 50,000 IU is available for patients who have a severe vitamin D deficiency.
Cautions: None other than excessive dosing that I'm aware of. (But I'm a layman, not a scientist or a physician.)
Other: Vitamin D should be monitored occasionally with a blood test that measures "25-hydroxy vitamin D" (vitamin D2), and once in a while for 1-25-dihydroxy vitamin D (vitamin D3) to make sure the kidneys are functioning properly to produce vitamin D. I was the first patient in my oncologist's practice of over a dozen physicians to have his vitamin D level monitored. Now the practice does it for many of its patients. My most recent test included a vitamin D panel that gave total vitamin D, vitamin D2, and vitamin D3. My previous test in December showed a level of 149, well above my target range. My doctor checked for hypercalcemia because of that, and I was clear. I ceased any vitamin D supplements, and my test a few weeks ago was 45. I'm now resuming the supplements but will track vitamin D more regularly.

Other main recommendations - overview:

Lycone (mainly we get it from cooked or processed tomato products) about 30 mg/day, in several doses)
Vitamin E 200 IU/day (especially containing gamma tocopherol)
Selenium 200 mcg/day unless you live in areas with high soil selenium (mainly Nebraska and the Dakotas). Recently a mild concern developed that it might slightly increase the risk of insulin resistance or diabetes, though the same trial indicated a huge advantage against prostate cancer)
Green tea (especially with a few drops of lemon juice and with no dairy or soy milk)
Soy 200 mg/day
Fish oil 3,000-4,000 IU/day (a source of omega 3s that men can metabolize)
Fish, especially oily fish like salmon (ditto)
Red wine (2 glasses/day, but of course not if there's a risk of alcoholism)
Avoid red meat (mainly due to arachidonic acid and animal protein; also fat)
Avoid dairy products (probably due mainly to casein protein)
Avoid flaxseed oil and canola oil (high in alpha linolenic acid). This comes as a surprise to many of us. Flaxseed oil (and perhaps canola too) are fine for women, especially younger women, and appear to help prevent breast cancer. This oil may also benefit patients with heart trouble. However, men do not metabolize it well, and older women also seem to have a problem metabolizing it.
Neutral as of now for ground flaxseed (Caution due to research on the oil, but some promising research demonstrating a potential benefit)


Here's the list I'm working with for each item. Should anything be added, like side effects of an excessive amount?

Item:
Why:
Key Research Support:
Leading edge view of need and dose:
Conventional view of need and dose:
Naysayers view:
Good Sources:
Safe and toxic limits:
Cautions:
Other:

Take care,

Jim

 
Old 02-05-2008, 09:56 AM   #5
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able5 HB User
Re: Should we be concerned?

Quote:
Originally Posted by Sue58 View Post
My husband (age 54) was diagnosed with PC in April 2007 and had a RP that month. His PSA was 3.1, Gleason 6 (3+3), T2C with positive margins. His first PSA in July was 0.010. He then had radiation in Aug./Sept. as a clean up procedure and his next PSA in Nov. was 0.012. He just recently had another PSA and it is now 0.014. His urologist said this nothing to be alarmed with and just keep checking his PSA. Have any of you had something similar to this happen...and did it mean anything? Are these safe figures? At what point should we become concerned?

I've had no similar experience...

Here's my experience concerning post-op PSA readings...

After my surgery I asked my urologist the threshold where he would be concerned about my post-op PSA readings and his response was that he does not get too concerned until he sees a PSA reading above .02

Hope this is helpful.
__________________
robotic LRP; Jan2007

Last edited by able5; 02-05-2008 at 09:57 AM.

 
Old 02-05-2008, 12:08 PM   #6
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Re: Should we be concerned?

Quote:
Originally Posted by able5 View Post
I've had no similar experience that you mention...

Briefly, here's "my personal experience" concerning post-op PSA readings...

After my surgery I asked my urologist the threshold where he would be concerned about my post-op PSA readings and his response was that he does not begin to get too concerned until he sees a PSA reading above .02

Simple as that!

Hope my comments are helpful.
__________________
robotic LRP; Jan2007

Last edited by able5; 02-05-2008 at 01:18 PM.

 
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