Are there any studies or evidence of how much PSA levels and PC correlate after the prostate is removed? My PSA level has been steady at 8 (eight). for 10 months (19 months after radical prostatectomy.) I have a PSA test monthly. No cancer symptoms at this time. The only studies I've seen are with respect to doubling times (going from 0.2 to a 0.4 causes alarm). Does a constant PSA mean that my PC is not growing/spreading or does it mean that my alternative supplements are keeping it down. (Or none of the above). I haven't seen anyone on this board in a similar situation. (Might have just missed it)
-- dale
04chris
It may be a mistake taking supplements to lower your PSA as this may mask a disease progression. Loma Linda is the closest treatment facility to you although there are several in Los Angles. I would call somebody immediately if it was me.
The Following User Says Thank You to harpman For This Useful Post: 04chris (03-10-2011)
Are there any studies or evidence that a supplement can mask a PSA reading? My limited understanding is that once the prostate is removed a PSA reading can only be effected by how much PC is in the body. Not sure how they are correlated. If the PC cells double will the PSA double -- or maybe there is some kind of exponential relationship? Like I said, I have a very limited understanding of this subject/relationship.
04chris
A rise to PSA 0.2 is after prostate cancer surgery is considered to indicate a failure. If your PSA is 8 after surgery that is a very serious situation. I can't believe that your doctor hasn't rushed you to a radiation treatment facility.
If you have cancer and you take supplements to lower your PSA that is not a cure. It does not stop the progression of the disease and if you delay salvage therapy because you PSA went down from a higher level to one that is still extreme for someone having surgery recently then you may lose the chance to be cured.
Dale, the only other reason that your PSA would be detectable after a prostatectomy besides cancer, is if some prostate tissue was left behind. Since your PSA has been 8 for so long, do you think that maybe this might be due to that? Either that, or very slow growing cancer. Have you had an ultra-sensitive PSA test done. ie 8.02, 8.12, 8.22 etc. which would show slow cancer growth? Since the number is quite high, this might also be the case.
Rhonda,
Thanks for the reply. I might have mislead in my statement that my PSA is level at 8. Actually it bounces around some (e.g., down to 6 back up to 10 now it's down to 8) It peaked at 25 about 13 months ago (6 months after RP) and has gone down since then to an average of around 8. I'd love to think there is some residual prostate tissue causing these strange results and the PC is gone -- most likely wishful thinking. I'd still like to find out the mathematical correlation between PSA and PC cancer cell count. This info might not exist.
Thanks again -- I'll hope for a big chunk of remaining prostate tissue pumping out PSA
A normal prostate would give you a PSA below 2.5 unless you were much older or had some other problem such as enlargement or infection. The doctor told me that maybe I had a piece of prostate tissue remaining after my recurrence at 0.08.
Dale, those numbers are puzzling. Are you on hormone therapy? Or did you have salvage radiation? I wonder if one of the experienced guys on the board might have some input.
Hi Dale,
I agree with Rhonda that something must have been left behind. Chunks of tissue can be left at the apex or around the neurovascular bundles if you had nerve-sparing surgery. And I agree with Harpman that there may be an infection (have you had a urinalysis lately?), and that salvage radiation may be a possibility. I have never seen a supplement have that big an effect on PSA that high. I agree that your case is unusual and if it were me, I would see a doctor at one of the top multi-disciplinary treatment centers. I guess the closest of the top 10 treatment centers to where you live would be at UCLA. Perhaps they can perform a DCE-MRI or one of the advanced imaging techniques to help figure out what's going on.
- Allen
Thanks everyone for the info.
I have not had radiation or hormone therapy. I've been taking about 19 different 'alternative' supplements -- sort of a shotgun approach. I'm hoping that a couple of the supplements will work (at least slow things down). The pomegranite studies look very promising (I'm taking a bunch of pomegranite powder in a very yuky smoothie each day). I will have a bone scan shortly. Depending on the results of this test I'll look into advanced imaging.
Just my humble opinion. With a PSA hovering around the number you've mentioned, I wouldn't rely on supplements alone. I'd be watching that PSA very closely and do something to lower that number.
I would suggest that you stop all supplements and see a Radiation Therapist immediately because you may be in a life threatening position and may be wasting precious time. Don't wait until your situation is hopeless.
None of us are doctors here, and that certainly includes me - no enrolled medical education ever. Please keep that in mind when reading a few thoughts on your most recent post, quoted in part here.
Quote:
Originally Posted by 04chris
... I've been taking about 19 different 'alternative' supplements -- sort of a shotgun approach. I'm hoping that a couple of the supplements will work (at least slow things down). The pomegranite studies look very promising .... I will have a bone scan shortly. Depending on the results of this test I'll look into advanced imaging.
Thanks again
First - about the supplements: I'm convinced that supplements can have a dramatic effect on prostate cancer, and some research is supporting that, while not conclusively proving it yet. In the first (UCLA)pomegranate study, the average PSA doubling time went from 15 months to 54 months at the two year point; moreover, PSA levels actually fell for some of the men! I think it is possible that you are getting that kind of benefit. I read that harpman thought you should stop all supplements. My own layman's opinion is that the odds favor continuing them, but harpman might be right.
Second - as other responders have indicated, that high PSA level after your RP is worrisome. It's possible the supplements are not actually doing enough. I'm very glad you will be getting a bone scan, even though the odds are extremely good that it will not show anything, based on your PSA level. That could be because existing bone mets do not yet occupy enough bone - around 10% - to show up on the scan.
There is a newly available scan that is outstanding for catching spread in lymph nodes. It is known as feraheme, and it is being done by Sand Lake Imaging in Orlando, Florida. It involves technology closely similar to the Combidex scan that was available in the Netherlands until about a year or two ago. (I learned more about this scan at the recent IMPaCT conference, though the scan was not developed under the DoD program.) However, until now only two doctors - Michael Dattoli (Sarasota, FL) and Charles "Snuffy" Myers (Free Union, VA, outside Charlottesville) - have been authorized to send patients to the facility. That restriction was done to make sure the process was providing sound results and to provide rigorous data for a study to be published. I'm not sure if more doctors may now send patients. Drs. Mark Scholz and Richard Lam who practice not too far from you at Marina del Rey (around LA) may now be sending patients too. My impression is that the Sand Lake approach would pick up spread to the nodes even if the PSA was as low as yours is now, or even lower.
If I remember correctly, a rapid rise in PSA after a prostatectomy can indicate a local recurrence in the area of the prostate bed, rather than a recurrence at a distant metastatic site. As for some healthy prostate tissue being left and accounting for the PSA, I've never heard of such a high PSA being associated with that. (On the other hand, in the past two weeks I learned of a man whose surgeon had really botched the job, leaving half the prostate. That would not happen if you had an experienced surgeon.)
Chris,
There is a definate relationship between psa and size of the tumor. You can find these mathamatical relationships in "Primer on Prostate Cancer" by Dr Stephen Strum. Given this relationship there should be very little psa after surgery and any benign prostate tissue would have to be exceptionally large to generate a psa of 25 or even 8. (.066 X prostate size is cc). Your high psa indicates a large amount of cancer somewhere. With that high of a psa it would unusual to have it locally in the bed so a radiologist would not be the best person to diagnois where the psa is coming from.
This is a very unusual case and needs a top notch medical detective to help understand what is really going on. If you are in the LA area I would definately see Dr Mark Scholz in Marina Del Rey as he is most likely the best doctor to figure this unusual case out.
JohnT
Jim
I suggested to 04chris that he stop the supplements until he has a consultation and the doctor ascertains what his present condition is. I'm going on the assumption that if your prostate cancer is curable you don't really want to delay treatment to slow down you PSA doubling time whatever it is as. If you spend enough time slowing PSA doubling time down you will lose your chance for a cure. Patients who have a failed RP are usually directed to some form of radiation therapy and/or hormone therapy immediately upon the failure becoming evident. I agree with Johnt1 that the best course is to seek treatment.
I'm responding to your post #17 regarding 04chris's case with a different viewpoint. You wrote in part:
Quote:
Originally Posted by harpman
Jim
I suggested to 04chris that he stop the supplements until he has a consultation and the doctor ascertains what his present condition is. I'm going on the assumption that if your prostate cancer is curable you don't really want to delay treatment to slow down you PSA doubling time whatever it is as. If you spend enough time slowing PSA doubling time down you will lose your chance for a cure. Patients who have a failed RP are usually directed to some form of radiation therapy and/or hormone therapy immediately upon the failure becoming evident. I agree with Johnt1 that the best course is to seek treatment.
Bob
In general, I see your point, but 04chris's PSA is now hovering around 8, which is well past the point when salvage RT is ideal for a recurrence. As I understand it, the ideal time for RT is when the PSA has not exceeded 1.0, with some evidence that the lower it is, the better, though I suspect that waiting until it at least exceeds 0.2 is okay, as that is the commonly recognized threshold for a clinically significant recurrence.
On the other hand, with the new Feraheme scan at Sand Lake Imaging that can pinpoint cancer as small as 3mm in specific, well-located lymph nodes, that concept may be changing, with some men having mets in just a few nodes or bone sites now having a late shot at a cure. However, I doubt that even this new development would significantly affect the following approach.
There is a strong movement among some major prostate cancer experts to try to avoid treatment for recurrences that are mild, and they have done enough research to get a pretty good handle on what is mild and what is not. One of the leading centers in this is the famed James Buchan Brady Urological Institute at Johns Hopkins, home for some of the best prostate cancer surgeons and researchers. I think you will be encouraged at the advance in the state-of-the-art for assessing recurrences after surgery if you look at their key publications. In essence, they have discovered that you can look at just three factors and get an excellent handle on whether most recurrences are mild - many are - or serious. They look at PSA doubling time after recurrence, whether the recurring patient's PSA hit 0.2 within or after three years from surgery, and whether the Gleason score for the pathology result from surgery was less than 8 or 8 and higher. Here's the citation for the initial study that excited doctors and the recurrence community:
JAMA. 2005 Jul 27;294(4):433-9.
Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy.
Freedland SJ, Humphreys EB, Mangold LA, Eisenberger M, Dorey FJ, Walsh PC, Partin AW.
If you search for it in www.pubmed.gov, you will also find a free link to the complete paper. PubMed also gives leads to a number of related and more recent articles. Dr. Freedland moved in the past couple of years from Johns Hopkins to Duke, and I believe he is continuing this line of research with both his old and new associates.
I don't want to "spoil the movie" for you by spelling it all out, but, if a man has a recurrence with a PSA doubling time greater than 15 months, had the recurrence more than three years after his surgery, and had a pathological Gleason score less than 8, the chances are very strong that his recurrence is mild. When those three stars don't all align so nicely, the cancer is more aggressive, but still fairly mild for many of the combinations. I'm hoping you will take a look at the research and let us know what you think about it.
Fortunately, 04chris has been rather successful in controlling that PSA doubling time, which is by far the most important factor in the Freedland approach. He describes that in his past posts.
Jim
Each case is different and the individual has to make their own choice as to how they will proceed. My bias is plainly against watchful waiting and using hormones and supplements when a cure is possible. Not everyone agrees with my opinion but it is based on my experience as a patient and from watching close relatives die a truly miserable deaths that I know were avoidable in some cases.
Thanks for the dialogue and information. The one thing I notice at the Prostate Support Group I attend is how few men show up before treatment and how little information men actually have before making a very important decision. My surgeon told me if he cut it out I had a high probability of a cure but if I chose radiation I had five to thirteen years to live.
bob
04 chris is not doing watchful waiting. Instead he has a surveillance program going and a prostate cancer lifestyle program that helps foster dormancy of the cancer.
I too am not fond of watchful waiting, but that approach essentially involves waiting docily to see if you will be clobbered by the cancer. In stark contrast, active surveillance involves very active monitoring of the cancer to determine whether it is the insignificant variety or the dangerous kind, with timely intervention in time to give an excellent shot at a cure if the cancer proves dangerous. Around 2000, no one knew if active surveillance would work. Now we know that it does. That's a sea change.
As for the surgeon, he might have been right back in the days when inadequate doses of external beam radiation were being used. Fortunately, that too changed around the early 2000s, and doses fully capable of neutralizing the cancer as effectively as surgery are now delivered with fairly low toxicity. Many surgeons still like to quote the old statistics to scare patients. I have personally heard them do it in talks, but, when called on it, they don't have a leg to stand on.
