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Cancer: Prostate Message Board

Psa velocity


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Old 11-09-2017, 08:20 PM   #1
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Psa velocity

I'm having trouble figuring out how to compute my velocity.
2010 1.70
2014 3.79
7/17 5.78
After 15 days of cipro 4.40, free psa 8%
Retest 11/6/17 6.50
Do I use the 5.78?
It seems like it was high because of infection, he tested my urine after the cipro and it was clean before the 4.40 retest.
Thanks
Mark

 
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Old 11-13-2017, 07:34 PM   #2
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Re: Psa velocity

It makes sense to me to use the 4.4 value as the higher value appears to have been elevated due to an infection that responded to Cipro.

That said, I'm a little puzzled by that free PSA of 8% at the same time as the 4.4 test. Free PSA is affected similarly by both infection and cancer (but not BPH), and I'm thinking there still may be some infection that the Cipro is not handling, possibly an additional, different microbe. That could explain the later increase to 6.5.

However, it is possible of course that cancer could also be contributing at least in part to the increase. In these circumstances I have heard that doctors sometimes try additional drugs or tests to try to smoke out any remaining bacteria. I have also heard, especially in the past several years, that doctors will order a "multiparametric MRI" to assist in spotting infection or cancer. Has your doctor talked at all about a mpMRI?

Last edited by IADT3since2000; 11-13-2017 at 07:36 PM. Reason: Minor change just after posting.

 
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Old 11-13-2017, 08:08 PM   #3
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Re: Psa velocity

No he hasn't, I think he suspects cancer.

Last edited by 716; 11-13-2017 at 08:11 PM.

 
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Old 11-13-2017, 08:17 PM   #4
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Re: Psa velocity

The actual test results say that if my psa is between 4 and 10 and I have a free psa below 10% then I have a 56% chance of having pc.

 
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Old 11-14-2017, 05:06 AM   #5
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Re: Psa velocity

Quote:
Originally Posted by 716 View Post
The actual test results say that if my psa is between 4 and 10 and I have a free psa below 10% then I have a 56% chance of having pc.
The added element here is that you have pretty good evidence that you had and may still have some degree of infection. I'm fairly confident that the information with the test result does not separate patients who might have infection from those that do or likely do.

What this means practically is (1) that your personal odds are likely lower than 56%, but (2) high enough that further workup is warranted, such as one or more of the emerging blood tests, an mpMRI, or even a biopsy.

Good luck as you get this sorted out.

 
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Old 11-14-2017, 10:29 AM   #6
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Re: Psa velocity

I've got a biopsy scheduled fire the 4th.
Thank You for your suggestions.
Is that mpmri useful only before a biopsy?

 
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Old 11-14-2017, 10:46 AM   #7
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Re: Psa velocity

The mpMRI is also useful to decide on managing the cancer after a biopsy. It can help decide whether active surveillance, used mainly for lower risk cases with only Gleason 6 cancer but also some favorable risk Gleason 3+4=7 cancers (and even some higher risk cancers where patient insistence with risk acceptance or the existence of serious other health conditions), is appropriate, whether radiation or surgery are sound options, and whether other approaches might work, such as primary androgen deprivation (aka hormonal) therapy or one of the "focal" therapy techniques that are not used so much in the US but that look promising elsewhere.

Be sure to get an understanding with the doctor or his staff to ensure he or she will anesthetize the area first (numbing agents) and also whether they have assessed the need for special infection prevention measures. Usually a short course of Cipro is used to prevent infection and does a fine job, but in some areas there are bacteria that are resistant to Cipro, and that means that different protection is needed. This is very likely not an issue if you are going to a well-respected major center, but it is more likely to be a problem if you are in the hands of a urologist who does not do much work with prostate cancer.

Good luck with your biopsy.

Last edited by IADT3since2000; 11-14-2017 at 10:46 AM. Reason: Added a few words right after posting.

 
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Old 11-14-2017, 08:03 PM   #8
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Re: Psa velocity

He gave me a scrip for cipro and took a sample to see if I have the other bacteria.
He also gave me other preparation info. and said as I was leaving, if your smart you will follow the instructions!
If the original cipro lowered my psa from 5.78 to 4.40 wouldn't it also have had a positive affect on the free psa? Wouldn't that then suggest that the free psa is more accurate?
Thanks for your response, I do appreciate your advice.

Last edited by 716; 11-14-2017 at 08:05 PM.

 
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Old 11-15-2017, 05:50 PM   #9
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Re: Psa velocity

Yes, it would make the PSA more accurate, and likely the free PSA more accurate also.

However, it is possible that you still have infection due to either (1) insufficient dosage or duration of Cipro to completely wipe out the germ causing the problem, or (2) existence of another germ that is also causing infection. Either situation could still account for the low, suspicious free PSA percentage.

It's good you are getting further workup - in this case a biopsy - to reveal key clues.

 
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Old 11-15-2017, 09:00 PM   #10
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Re: Psa velocity

Not really looking forward to that, but I can't seem to figure a way out of it.
My father called it the "joys of aging".

Last edited by 716; 11-15-2017 at 09:04 PM.

 
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Old 11-16-2017, 05:54 AM   #11
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Re: Psa velocity

Yes, and you can claim at least associate membership in the Prostate Cancer Club, with all the rights, honors and privileges!

 
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Old 11-16-2017, 07:09 PM   #12
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Re: Psa velocity

Lol, that got me!

 
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Old 12-05-2017, 07:23 PM   #13
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Re: Psa velocity

I got my biopsy yesterday. He did a sonogram first which showed a "lower or lighter density near the apex", can't remember how he phrased it.
He said it looked like cancer but I won't have the report until Monday. Someone told me that's the good end to get it at, but from what I'm reading it sounds as if it's the site that's most likely to have positive margins and to have spread outside of the prostate. Is that right?
Thanks
Mark

 
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Old 12-11-2017, 10:34 PM   #14
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Re: Psa velocity

Biopsy Results
Left mid. Adenocarcinoma 1 of 2 cores involved 2% gleason 6 (3+3) length mm 18 (5%) 19
Left apex 1 of 2 22 % gleason 7 (3+4) length mm 17 ,20 (40%)
Part c has 20% pattern 4
Gleason score grade group 2

 
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Old 12-05-2018, 09:41 PM   #15
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Re: Psa velocity

I got a second opinion on my biopsy.
They upgraded it to gleason 4+3.
3t mri 2 centimeter lesion with 1 centimeter abutment concerning for extroprostatic extension.
Prolaris score 5.8
I decided on sbrt. No hormones, doctor wanted seeds and hormones.
Psa before treatment was 4.9
Sept. 2.04
Nov. 2.22

I can't find any info on the Prolaris score. The scale stops at 2., 59% chance of mortality within 9.5 years
But nothing for the higher numbers, just that the rate doubles for each higher number.
What's the point of having the higher numbers? A 3 would mean more than 100% chance of mortality within 9.5 years. Why have a 4 5 6 or 7?

 
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