IADT3since2000

Hello Real Player,

PSA numbers can get really high - into the thousands, but that is not good! There are two main causes of high PSA numbers, as you may know, an infection or inflammation and/or prostate cancer.

An infection or inflammation can drive PSA into the 50s, though my layman's impression is that that is not usual. In fact, I once heard a doctor I respect (though a doctor who referred prostate cancer cases to others) report a case of a man whose PSA kept rising until it reached around 200, yet the increase turned out to be due to a treatable infection. When his doctors finally found the cause, they were able to eliminate the infection and bring the PSA down to normal.

A negative biopsy, while a most welcome result, does not guarantee there is no cancer. It just means that cancer was not found in any of the samples. In the US these days, ten or twelve cores are typically taken with the guidance of ultrasound imagery, which makes finding any cancer somewhat more likely than without such imagery.

There are some other tests and indicators that can often help clarify the picture. One is the fairly new PCA3Plus test. I doubt there is a lab in Thailand that can handle it, but it is based on a urine sample following an "attentive" digital rectal exam (DRE) and the sample can be sent anywhere, including to the US. I've heard one of the key doctors involved with the test say that the samples do well through air shipment. If there is cancer there, the test result is highly likely to be positive. Another test - widely available, is known as the "free PSA" test. If the result is within or beyond a certain range, prostate cancer is more or less likely. These tests help indicate whether another biopsy would be wise.

Indicators basically involve signs or symptoms of infection. Testing the PSA response after use of an antibiotic that often controls prostate infection is a common tactic. However, it's often hard for the doctor to find an antibiotic that will work; sometimes none will work, even though cancer is never found and the cause of the PSA behavior is almost certainly due to infection. A PSA score that moves around a lot, including downward, is more typical of infection vs. cancer, but the tests need to be the same and done at the same lab as there is significant variation between kinds of PSA tests and labs. I'm guessing that you had your tests run at different hospitals to gain assurance the result was not due just to a fluke or sloppy practice at the first hospital. Such normal testing variation could explain your result of over 60 that dropped to 50, but that result is still somewhat encouraging, though nothing meriting a celebration as I see it as a School of Hard Knocks educated layman. On the other hand, it takes a substantial amount of cancer to generate a PSA of 50 or 60, and, since 2 cancer cells become 4, then 4 become 8, then 8 become 16, and 16 become 32 as each one splits in a fairly constant amount of time, you would expect to see a fairly rapid and steady exponential rise in the PSA if cancer is behind the score, something you have not yet seen in your PSA results.

If another biopsy seems wise, then there are some advanced biopsy techniques as options. One is the color Doppler ultrasound guided biopsy. That is highly effective, but the problem is that there are few facilities with the special kind of color Doppler ultrasound equipment as well as doctors with the expertise to use it well. A "saturation" biopsy can be done, under a general anesthetic if needed, with many more cores taken. At the upper end, as many as 40 to more than 100 cores, depending on the size of the prostate, would be taken to cover every 5 mm. Such intense saturation biopsies are highly reliable, but less intense saturation biopsies - such as 18 to 24 cores, can also be performed, and favorable studies have been published about reliability of results with such less intense saturation biopsies. I don't have any knowledge about the state of medicine in Thailand, but Indonesia has a growing reputation for some first rate medical centers.

I've had an active interest in PSA testing ever since getting my first ever result back in December 1999. I thought the upper limit for PSA tests was about 10, and I had braced myself for a score above 4, then the widely accepted threshold for concern. My score was 113.6, which I hadn't thought was possible. My high score turned out to be due to cancer, but yours might well not be.)

Keep on top of this! Work with the doctors to find out what is going on.

By the way, while my cancer is considered incurable by current technology, I'm doing remarkably well at nearly the nine year point and expect to continue doing well. There are some good treatment options available. Try to keep your spirits up and enjoy life while you sort this out!

Good luck and take care,

Jim