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Old 08-10-2009, 12:16 PM   #1
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Max PSA Level

From all of the research I have done it appears that the min PSA level is 0 and the max is 10. Is this true?

 
Old 08-10-2009, 01:34 PM   #2
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Re: Max PSA Level

Quote:
Originally Posted by iflyim777 View Post
From all of the research I have done it appears that the min PSA level is 0 and the max is 10. Is this true?
Hi iflyim777 (Boeing 777 pilot?, Fed-X? - just guessing),

Your question takes me back to what I thought when I was getting and waiting for results of my first ever PSA test at age 56. My father had passed on from prostate cancer in his early 80s, and I had steeled myself for a score as high as 10.

The shocking result was 113.6 ! I've been dealing successfully with a challenging case of prostate cancer since then.

Ten is actually a meaningful threshold for treatment decision making analysis, with spread of cancer beyond the prostate capsule (a thin muscle like the rind of an orange around the prostate) unlikely if the PSA score is 10 or lower and a couple of other factors are favorable (Gleason score, clinical stage). A patient has a better shot at a cure when the cancer is still within the prostate capsule, and he also has a wider choice of treatment options.

However, PSA can also rise from some other causes, especially infection and benign growth associated with aging, and such causes are not linked to prostate cancer. Cancer can be spread beyond the capsule at lower PSA levels than 10, but that is considerably less likely, and the cancer may not have spread at much higher levels than 10, though that too is not so likely.

There are some patients with extremely high PSA levels, though that is not a good thing of course. I heard of one patient, who has since passed on due to prostate cancer, with a PSA in the 6,000s. I've read about several with PSAs in the low thousand's who have had amazing success with skillful treatment.

Yes to your first question, the lower limit is 0, but that too depends on what you mean by zero and on the class of PSA test (conventional vs. ultrasensitive). Typical conventional PSA tests used for screening for prostate cancer - the kind of test you are likely to have had if you had a routine exam - have a lower limit of, perhaps, .2, .1 or less than ("<") .1. However, some "ultrasensitive PSA" tests, which I've had more often than not, can reliably measure in a routine clinical setting with routine (but special) lab analysis to <0.01. With special procedures, at least one of these tests has a lower limit of <0.003 (or better), which is astounding!

That's probably a lot more than you wanted to know, but interesting I hope.

My first ever PSA result was extremely unusual for PSA tests done in the past, say, ten to fifteen years. Before that - before PSA screening tests came into wide use, patients were not diagnosed until cancers were often well advanced, and many of those early PSA scores in the early '90s were quite high.

Take care and good luck,

Jim

 
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Old 08-10-2009, 03:09 PM   #3
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Re: Max PSA Level

Quote:
Originally Posted by iflyim777 View Post
From all of the research I have done it appears that the min PSA level is 0 and the max is 10. Is this true?
Jim gave you an extremely thorough answer. I'll just add one thing, since you didn't really frame your question in a way that anything good or bad may be going on with your own PSA results. It's not always a high number that may lead to a greater probability of one's getting a diagnosis of prostate cancer (it's really the biopsy that would tell that), it can be a troublesome rate of increase signaling a possible problem. In my case, my PSA increased from 2.9 to 3.9 in a year, and that was enough to raise a red flag with my internist-- so I retested and it was 4.2. That's when I had a biopsy that did tell me that I had prostate cancer. So lots of factors to consider.

 
Old 08-11-2009, 08:54 AM   #4
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Re: Max PSA Level

Quote:
Originally Posted by IADT3since2000 View Post
Hi iflyim777 (Boeing 777 pilot?, Fed-X? - just guessing),

Your question takes me back to what I thought when I was getting and waiting for results of my first ever PSA test at age 56. My father had passed on from prostate cancer in his early 80s, and I had steeled myself for a score as high as 10.

The shocking result was 113.6 ! I've been dealing successfully with a challenging case of prostate cancer since then.

Ten is actually a meaningful threshold for treatment decision making analysis, with spread of cancer beyond the prostate capsule (a thin muscle like the rind of an orange around the prostate) unlikely if the PSA score is 10 or lower and a couple of other factors are favorable (Gleason score, clinical stage). A patient has a better shot at a cure when the cancer is still within the prostate capsule, and he also has a wider choice of treatment options.

However, PSA can also rise from some other causes, especially infection and benign growth associated with aging, and such causes are not linked to prostate cancer. Cancer can be spread beyond the capsule at lower PSA levels than 10, but that is considerably less likely, and the cancer may not have spread at much higher levels than 10, though that too is not so likely.

There are some patients with extremely high PSA levels, though that is not a good thing of course. I heard of one patient, who has since passed on due to prostate cancer, with a PSA in the 6,000s. I've read about several with PSAs in the low thousand's who have had amazing success with skillful treatment.

Yes to your first question, the lower limit is 0, but that too depends on what you mean by zero and on the class of PSA test (conventional vs. ultrasensitive). Typical conventional PSA tests used for screening for prostate cancer - the kind of test you are likely to have had if you had a routine exam - have a lower limit of, perhaps, .2, .1 or less than ("<") .1. However, some "ultrasensitive PSA" tests, which I've had more often than not, can reliably measure in a routine clinical setting with routine (but special) lab analysis to <0.01. With special procedures, at least one of these tests has a lower limit of <0.003 (or better), which is astounding!

That's probably a lot more than you wanted to know, but interesting I hope.

My first ever PSA result was extremely unusual for PSA tests done in the past, say, ten to fifteen years. Before that - before PSA screening tests came into wide use, patients were not diagnosed until cancers were often well advanced, and many of those early PSA scores in the early '90s were quite high.

Take care and good luck,

Jim
Jim,
Thank you for your quick and thorough reply. I am still reeling from my PSA of 50.9. I am 59 and this is the first time to have this test. I have had DRE's in the past that were OK so this was a surprise, to say the least!
Doug

 
Old 08-12-2009, 02:19 PM   #5
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Re: Max PSA Level

Quote:
Originally Posted by iflyim777 View Post
Jim,
Thank you for your quick and thorough reply. I am still reeling from my PSA of 50.9. I am 59 and this is the first time to have this test. I have had DRE's in the past that were OK so this was a surprise, to say the least!
Doug
Hi Doug,

Your high PSA sure takes me back to that late afternoon when I got my own first ever PSA result of 113.6. I thought I was perfectly healthy and in great shape as a regular racewalker, and my physical the previous Saturday had gone well. The doctor just said something like "your report came in, and it's not good," and pushed the report over to my side of the desk. For several seconds I could not find the PSA, as I looked for a number between 4 and 10. When I first saw that 113.6, I passed over it, thinking it some kind of serial or ID number. Then I realized what I was looking at, and I read the note at the bottom of the report, "Get appointment ASAP!"

My immediate thought when I saw that very high number was "It can't be as bad as it looks because I'm still breathing."

It was hard to tell my wife. As I recall it, she asked "Is everything fine?" as I opened the garage door to the kitchen, and I said something like "Not really. I've got some bad news."

However, back to your situation, there really is a chance that that high score is due to an infection rather than to prostate cancer. Was the DRE unremarkable again this time? Are you having any symptoms that might signal an infection, benign enlargement or prostate cancer?

I'm guessing that the PSA was ordered by a primary care doctor but that you already now have an appointment with a urologist.

When was the PSA done - how long ago? Even if there is just a short time between that test and your appointment, it would probably be wise to have another one. The fresh score and any difference in scores could be important clues to the rate of change in PSA, which is important, and it could also address the unlikely but real possibility of a lab error.

Obviously, if the PSA is truly 50 and it is caused by cancer, that's not good. But you and I are fortunate that there have been huge advances in prostate cancer treatment in the past decade or two, and there's a lot that can be done.

For instance, all that turmoil about my own diagnosis was back in December of 1999, nearly ten years ago, and I'm doing very well now on intermittent triple hormonal blockade therapy (no surgery, radiation, etc., which is unusual). (I'm resting up now from four hours of hard physical labor, tearing out four old deck stairs and replacing them with new stairs, in 90 degree heat. I've already removed and replaced the deck and landing planks, as well as four of the other stairs.)

Hope you have just an infection and will soon lose interest in the board. But if not, we are here to help!

Take care and hang in there,

Jim

 
Old 08-13-2009, 11:58 AM   #6
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Re: Max PSA Level

Thank you again Jim for all of the insightful information!!! I am still reeling from this "50" number. I am seeing a highly recommended Urologist this Tuesday and will have more info for you then. Also, my Internist did not do a DRE on my annual checkup so my info is VERY limited right now and my imagination gets the best of me from time to time.
It is interesting that you mentioned a prostate or urinary tract infection because I have been experiencing some of these symptoms for several years now. If I do have a UTI, how much could this elevate this PSA number? If you could cast some light on this it would help me connect some dots.
Thanks Jim!
Doug
PS. I am a pilot for Northwest or are we now Delta? ;-)

 
Old 08-13-2009, 03:32 PM   #7
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Re: Max PSA Level

Quote:
Originally Posted by iflyim777 View Post
Thank you again Jim for all of the insightful information!!! ...

You're welcome. That's what the board is for, and we're glad to help!

It is interesting that you mentioned a prostate or urinary tract infection because I have been experiencing some of these symptoms for several years now. If I do have a UTI, how much could this elevate this PSA number? If you could cast some light on this it would help me connect some dots.
...
I've heard that UTIs can raise PSA all by themselves to around 50, but I don't know how common that is. I heard of one case where the PSA rose to around 200 before the offending bacterium was found; the patient's PSA then dropped back to normal.

One thing you can do is to check out www.pubmed.gov, a site we can use on this board because it is sponsored by the Government (our taxpayer dollars doing priceless work via the NIH's National Library of Medicine). I just did a search and got 35 hits using the search string " urinary tract infection AND prostate specific antigen NOT prostate cancer " (without the quotes). Here's the citation for one, hit #8 as of this evening (will stay there until another relevant study is published that fits the search) which happens to have a link to the free article in PubMed:

Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis.
Etienne M, Chavanet P, Sibert L, Michel F, Levesque H, Lorcerie B, Doucet J, Pfitzenmeyer P, Caron F.
BMC Infect Dis. 2008 Jan 30;8:12.

If you go to the paper and search for PSA, as I did, you find that the average (median) value of PSA in their fairly good sized study (hundreds of patients) was 17, with a range from 0 to 415. Unfortunately, they did not show a graph of PSA values.

Hit #29 is a smaller, older study of 31 men with this citation:
Prostate specific antigen in urinary tract infection.
Bell CR, Natale S, McInerney PD, Hammonds JC.
Br J Gen Pract. 1998 Feb;48(427):1005-6.

It doesn't have an abstract, but PubMed offers a free link to this brief paper also. They reported the average PSA in their group was 24, with a range from 5.4 to 100. They noted that the PSAs returned to normal or close to normal fairly quickly when the infections were resolved.

Those looked like the most helpful papers to me.

Take care,

Jim

 
Old 08-19-2009, 03:49 PM   #8
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Re: Max PSA Level

Hello again Jim,
I saw a urologist yesterday and he ran some tests and performed a DPE. His diagnosis is chronic prostatitis. I have had very mild symptoms of this for at least 6 years and had no idea that they were related. This Dr helped me connect the dots and relieve my fears and anxieties. He prescribed a 3 drug, 30 day course of meds to eradicate this. Also, on the DRE, the only item of concern was a "very small bump" on the top of my prostate of which he wants to biopsy. I have read that these biopsies can have some risks associated with them. What course of action would you recommend?

Doug

 
Old 11-07-2009, 04:49 AM   #9
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Re: Max PSA Level

My husband's PSA levels have been steadily going up for the past 2 years. He had a biopsy done about a year ago when it went up from 2.1 to 3.8 with them finding no cancer. Now his last blood test revealed that it has risen to 4.3. He has to go back again in Feb for another test. We're worried because his dad passed away 3 years ago from what started out as prostate cancer and eventually spread. Any literature/books that can be recommended would be appreciated. I think we're bracing ourselves for now for not IF he gets cancer, but WHEN will he get cancer. By the way, he's 53. I've been reading on this message board of all the different ways to diagnose cancer but I think our urologist has only done a PSA test and rectal exam.

 
Old 11-07-2009, 06:56 PM   #10
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Re: Max PSA Level

Hi fishinggirl,

I'm responding to your post today, the post right before this one, about your husband's rising PSA and your worry because his dad died of prostate cancer that spread.

Welcome to the board! I'm sorry you have a reason to be here, but I hope we will be able to help with information and support. By the way, I'm a fellow survivor, though pretty savvy as I near the tenth year point, but with no enrolled medical education.

First of all, it is very important that you and your husband come to understand that prostate cancer in 2009 is not the same as our father's and grandfather's prostate cancers. It is still not a cake walk - hope that comes some day, but there have been great advances in so many facets of the disease - prevention, screening, diagnosis, staging, decision making to choose an approach, treatments (prominently including the option of active surveillance for truly low-risk men), nutrition/diet/supplements and lifestyle support of treated patients, handling side effects, dealing with recurrences, support and education groups, and research. Did you know that 99% of prostate cancer patients are alive five years after diagnosis, and that 90% are alive ten years after diagnosis? Did you know that truly low-risk disease can be handled very well by putting the cancer on a strict probation regimen? Did you know that cure rates using a variety of treatments are around 90% or better for low-risk disease, and close to 100% for very low-risk disease treated by expert doctors?

Your husband's doctor is touching the usual bases: PSA, DRE and biopsy. Since you are in Michigan, you can't be that far from Dr. Fred Lee, who I believe is also currently in Michigan. Dr. Lee is one of the nation's few experts in a technique known as color Doppler ultrasound (CDU) guided biopsy. It is much more likely to find cancer, if it is there, than a standard Trans Rectal Ultra Sound (TRUS) guided biopsy, and CDU also gives a good indicator of the size, extent and shape of the cancer, especially important when the cancer has a high Gleason score, indicating aggressiveness. Such cancers are often not the nice, neat, compact ball-shaped "Gleason 6 or lower" tumors that have a chance of showing up on TRUS; rather, they are shaped more like octopusses, and the tentacles are typically missed by TRUS, so I've heard in talks. CDU biopsies work their magic by using Doppler to indicate where there are newly growing blood vessels to support tumor tissue. They return a red signal, and where there is red indicates the boundary of the cancer. It's not perfect, but quite good, clearly better than TRUS. It would probably be worth a little extra effort to get a CDU biopsy, especially as the first biopsy turned up negative.

A couple of other tests can also help. One has been used for years. It's known as a "free PSA" test, and the percentage of "free PSA" in the result helps indicate the likelihood (or not) of prostate cancer. It is sometimes thrown off by infection, but infection is a bit less likely in view of your husband's pattern of PSA increase. Another fairly new test is known as the PCAPlus test. It can be quite helpful, especially where there have been previous negative biopsies. There have been a number of posts about it on this board, which you can find by searching.

Another tactic is known as finasteride challenge, or alternately Avodart challenge, depending on the drug used. Both drugs have been approved for benign prostate enlargement (BPH), and they shrink the prostate, thereby lowering the PSA by about 50%, unless there is cancer. Cancer will usually prevent the PSA from dropping that far by the six month point. Dr. Eric Klein, a very well known urologist from the Cleveland Clinic, not too far from you, has described use of the challenge technique.

A man at risk for prostate cancer actually gets a double benefit from using finasteride or Avodart. Not only do the drugs help with BPH (and with assessing the risk of PC through the challenge technique), but they also lower the risk of prostate cancer by about 25%. That has been proven in gold-standard type clinical trials (long, large, placebo-controlled, double-blind, randomized Phase III clinical trials). Both are very mild drugs for most of us, though about 10% to 20% of patients lose some interest in sex and may develop some ED, both side effects which generally disappear when the drugs are stopped. (For the rest of us, libido and EF may actually improve some when we are on the drugs.) However, for a couple still interested in child bearing, sperm banking is advised, and the woman must not handle the pills in order to eliminate risk to an unborn child.

Are you familiar with the nutrition and lifestyle tactics to help counter the risks of prostate cancer? The thread titled "Nutrition & lifestyle tactics - books, resources and a quick summary", started 3/6/2008, will get you started. Some of the tactics are easy, such as having a belt or two of tomato juice or V8 daily, or some other food that provides lycopene. Some of the tactics may be hard, especially in Michigan, such as avoiding red meat, egg yolks and dairy products. This is serious stuff, and can cause some hard adjustments in our habits. For instance, earlier this week at a prostate cancer support group meeting an expert in nutrition and prostate cancer described bacon as probably the worst food for a potential or current prostate cancer patient. There's a lot of medical research to back up these tactics, though none of it is absolutely conclusive as yet.

Mild medications appear to be helpful, and statin drugs should be added to the finasteride and Avodart mentioned above, especially for a man at higher risk of the disease, like your husband. Statin drugs do not appear to cut down on the percent of us who get the disease, but they do appear to cut down a lot on the risk of death from prostate cancer, especially when a man passes the three year point on a statin. At least one of the statins, simvastatin, is really cheap now that it is a generic drug: my insurer pays just 20c per pill, and I get it free because it is a generic.

I strongly recommend you get the book "A Primer on Prostate Cancer - The Empowered Patient's Guide," 2nd rev. 2005, Dr. Stephen B. Strum, MD, and Donna Pogliano. It will answer many questions.

I hope this helps, and I wish you and your husband good luck.

Take care,

Jim

 
Old 11-08-2009, 04:38 PM   #11
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Re: Max PSA Level

Thanks so much for all the information Jim. I will certainly forward this on to my husband. I'm glad your treatment was so successful, as it give me hope that there is still a life after being diagnosed with the big "C" word.

Hope you continue to live a long and healthy life.

Peggy

 
Old 11-08-2009, 04:55 PM   #12
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Re: Max PSA Level

Peggy,

You're welcome. Please come back to the board if you or your husband have any questions.

Good luck,

Jim

 
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