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    Old 01-29-2009, 02:57 PM   #1
    Scub
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    Biopsy But PSA Only 0.4

    I visited a Urologist today, who confirms I have an "irregularity" on my prostate. The gland is not enlarged and I'm 59 with no family history and apparently good eating and health habits. I've read that some cancers can exist without PSA indications, mine is 0.4, but these are in a "minority". I have a biopsy booked for March 4. I hope in the meantime I can learn to stop thinking about just this. Has anybody else had a similar experience ? I have some little benign bumps on various points of my skin. Can these things occur on your inner organs ?
    With thanks, Steve

     
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    Old 01-29-2009, 06:10 PM   #2
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    Re: Biopsy But PSA Only 0.4

    Quote:
    Originally Posted by Scub View Post
    ..I visited a Urologist today, who confirms I have an "irregularity" on my prostate. The gland is not enlarged and I'm 59 with no family history..... I've read that some cancers can exist without PSA indications, mine is 0.4, but these are in a "minority". I have a biopsy booked for March 4. I hope in the meantime I can learn to stop thinking about just this...
    I don't know what I can add to responses made by me and others to your earlier posts on this, except to say that's an extremely low PSA. I would think you have good reasons to be optimistic and shouldn't drive yourself crazy over the next several weeks. The biopsy is probably being done just out of an abundance of caution. What did the doctor indicate to you as to the likelihood of this being anything other than benign?

     
    Old 01-30-2009, 08:16 AM   #3
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    Re: Biopsy But PSA Only 0.4

    Thanks Daff. I probably shouldn't have wasted your time with my post as you have already told me the options. But it was a bad day...it won't stop snowing and the drive was perilous and I felt rather glum when I made it home. The doctor didn't seem to want to waste time discussing possible outcomes and I don't blame him as there were many other clients waiting for his opinion. I feel a bit more optimistic this morning and will just have to learn to be patient. I certainly have more symapthy for what others are going through after joining this forum. I must admit the whole PSA thing has me baffled.
    Thanks again, Steve

     
    Old 01-30-2009, 08:55 AM   #4
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    Re: Biopsy But PSA Only 0.4

    Not a problem and not a waste of time. All this is stressful as it's so new and "mysterious". You're quite forgiving of your doctor though-- seems like he could have given you a little guidance. Anyways, odds are strongly in your favor I'd say, so try to stay positive.

     
    Old 01-30-2009, 01:20 PM   #5
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    Re: Biopsy But PSA Only 0.4

    Hi Daff. I caught a t.v. news report about a Prostate Cancer study that was made in British Columbia, Canada. I thought you would be interested, but don't know how to include the link. If you Google "BC Cancer Agency " and then check the "What's New" section, you'll see the report. The TV news story said 1000 men were given Brachytherapy and only one showed any signs of cancer after long term watching. I'm not sure the actual story matches those numbers, but the results are pretty impressive. If I do have cancer, this sounds like a good way to go.
    Steve

     
    Old 01-30-2009, 01:29 PM   #6
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    Re: Biopsy But PSA Only 0.4

    Steve- sounds like you're already feeling more positive. Always good to stay current about developments and treatments, but it's quite early for you. There are definitely a lot of alternative choices to surgery, which is usually what the urologists want to do. (As far as detailing info on websites, that's not allowed per the posting rules set up for this board.)

     
    Old 02-03-2009, 05:46 PM   #7
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    Re: Biopsy But PSA Only 0.4

    Hey all, Da Vinci robot 1/30/2009
    Gleason 3+3=6 determined after a TURP in July 08
    PSA 0.43
    Biopsy Nov 2008
    One of 12 cores 1% positive
    negative DRE

    I am 54 retired ,,robotic surgery 5 days ago,,I am already feeling some surges or sensations of an erection so I don't know if that translates into me getting a full erection or not,, perhaps some one could shed some light on this for me.
    What really bothers me is that the pathology came back on my prostate and showed no cancer,,,I have 2 reports showing me I had cancer in my prostate. IS this common ,, did the surgon leave it behind?? He told me I had the smallest prostate he had ever seen and the sugery was extremly difficult. I ask if the cancer was left behind and he said ,,No, he did a biopsy of my prostate and my prostate is now gone. I suppose next I wait for the PSA .. Will it typicly be .00 after a prostectomy?? Some one please help.
    Bill

     
    Old 02-04-2009, 01:02 PM   #8
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    Re: Biopsy But PSA Only 0.4

    Quote:
    Originally Posted by Scub View Post
    Hi Daff. I caught a t.v. news report about a Prostate Cancer study that was made in British Columbia, Canada. I thought you would be interested, but don't know how to include the link. ... The TV news story said 1000 men were given Brachytherapy and only one showed any signs of cancer after long term watching. I'm not sure the actual story matches those numbers, but the results are pretty impressive...
    Steve
    Hi Steve and daff,

    There's a way we can sometimes access these stories that is acceptable on the board, provided we make some reasonably good guesses, the story is based on a medical research paper that has been published in a mainline research journal, as is often the case, and we have a little luck.

    The key is going to a site that we are authorized to use on this board because it is sponsored by the US Government: [url]www.pubmed.gov[/url]. An advantage of going to the site is that, if we find the source paper, we get access to the actual facts, which are all too often misunderstood by reporters.

    Here's what you can do to find the story behind your post, using PubMed. You need a search string to sort through all the millions of medical papers in the database. Well, we know that the paper involves "prostate cancer" and "brachytherapy;" it is also highly likely that it was published very recently, so we can plug in 2009 as the year of publication, with a bracketed dp after it to show that 2009 is a year and not a number: " 2009 [dp] ". Since the researchers were located in British Columbia, it was highly likely they were from the pre-eminent prostate cancer center in Vancouver, so we can add Vancouver to the string. Then we use the connector word AND, capitalized to show that it is a connector and not part of the text we are searching for, to link the clues. We get this:

    " prostate cancer AND brachytherapy AND 2009 [dp] AND Vancouver "

    Clicking "Go" yields just one paper, and it is obviously the one we want; plus, since there was only one paper that satisfied the search thread, PubMed gave us the text of the abstract. If there is more than one paper listed without giving the text of the abstract, you click on the blue hypertext list of authors of each paper and then view the abstract if there is one. By the way, I tried the search without adding Vancouver at the end and got 29 hits, with the desired paper being the second one listed as of today.

    Here is my markup of an excerpt of the abstract for this paper. Thanks for pointing it out.

    This paper adds to the growing body of evidence for the effectiveness of brachytherapy. While more sophisticated versions of brachytherapy and combinations are practiced, for instance by Dr. Michael Dattoli and by the Radiation Clinics of Georgia, this paper shows that results with this simpler method are quite respectable.

    Urology. 2009 Jan 23. [Epub ahead of print]
    Population-based Study of Biochemical and Survival Outcomes After Permanent (125)I Brachytherapy for Low- and Intermediate-risk Prostate Cancer.
    Morris WJ, Keyes M, Palma D, Spadinger I, McKenzie MR, Agranovich A, Pickles T, Liu M, Kwan W, Wu J, Berthelet E, Pai H.

    British Columbia Cancer Centre, Vancouver, British Columbia, Canada.

    OBJECTIVES: To analyze the biochemical and survival outcomes after permanent low-dose-rate prostate brachytherapy in a large, consecutive, population-based cohort of patients. METHODS: A total of 1006 consecutive implants were performed from July 20, 1998 to October 23, 2003 for men with low-risk and "low-tier" intermediate-risk prostate cancer... Most patients (65%) had received 6 months of androgen deprivation therapy. Supplemental external beam radiotherapy was not used. ... RESULTS: The median patient age at treatment was 66 years. The median [meaning average: half less; half more] follow-up was 54 months for biochemical outcomes and 66 months for survival. The actuarial [meaning projected] freedom from biochemical recurrence rate [essentially meaning the rate for no unacceptable increase in PSA, in another word, success] was 95.6% +/- 1.6% at 5 years and 94.0% +/- 2.2% at 7 years. On multivariate analysis, the pretreatment prostate-specific antigen level (P = .03 [meaning unlikely to be due to chance using the usual assumptions]) and androgen deprivation therapy use (P = .04 [again meaning unlikely to be due to chance using the usual assumptions]) were predictive of the freedom from biochemical recurrence. [In other words, if you had a lower PSA before treatment, or if you had androgen deprivation therapy, otherwise known as hormonal therapy, before treatment with seeds, success was more likely.] The actuarial [meaning projected] rates of distant metastasis and disease-specific death at 5 years were both <1%. The overall survival rate at 5 years was 95.2% +/- 1.4% and was 93.4% +/- 1.8% at 7 years. On multivariate analysis, only age was predictive of overall survival (P = .011). [In other words, it appeared you would live as long with prostate cancer under their treatment as if you had not had prostate cancer.] CONCLUSIONS: When consistently planned and delivered, low-dose-rate brachytherapy, without supplemental external beam radiotherapy or intraoperative planning [meaning, without adjusting the placement of later seeds depending on checking how the seeds were actually being placed during the procedure, I think.], can produce cancer-specific outcomes for men with low- and "low-tier" intermediate-risk prostate cancer at least equal to that produced by dose-escalated external beam radiotherapy or surgical prostatectomy.

    Pretty cool, right?

    Jim

     
    Old 02-04-2009, 01:27 PM   #9
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    Re: Biopsy But PSA Only 0.4

    Quote:
    Originally Posted by Brute290 View Post
    ...I suppose next I wait for the PSA .. Will it typicly be .00 after a prostectomy?? Some one please help.
    Bill
    Hi Bill,

    Welcome to the board! (By the way, you are making me really envious with those wonderfully favorable diagnostic numbers!)

    There are two classes of PSA tests that can be used to track success. The older class is known as "conventional," and the newer is known as "ultrasensitive."

    For most of us, I'm convinced that ultrasensitive testing is the way to go, as some such tests can reliably find and report PSAs as low as less than (<) 0.01. In fact, in special settings, with special procedures, some can go as low as 0.001, but we don't know yet if that kind of detail helps at all or is worth the added effort. But there is research demonstrating the value of knowing if your post RP PSA is <0.01, or 0.01, or 0.02, or 0.03, or 0.04, or 0.05 and higher. If the PSA is <0.01, the chance of a recurrence is extremely remote. The chance is still very low but increasing through 0.03; 0.04 is sort of no-man's land, and if the PSA is 0.05, the odds are that sooner or later the patient's PSA will pass the agreed upon line for calling it an official, significant recurrence, which is 0.2. An exception is that sometimes a bit of healthy prostate tissue is left with no cancer; then, the PSA may be above 0.03 but followup tests will show a stable PSA without the telltale increasing trend that confirms a recurrence.

    Conventional tests, in contrast, used to give PSA only as low as 0.2; then they improved to 0.1, and now to <0.1, but without telling you how much less. Conventional tests are still used for monitoring by many physicians, though increasingly ultrasenstive tests are being used. A key advantage with ultrasensitive tests is that you get many months of early warning and can take early and more timely countermeasures.

    However, your case statistics are so good that it is already highly unlikely that you will have a recurrence. If you want followup with ultrasensitive testing, discuss that with your doctor ahead of time, and make sure you get one of the ultrasensitive tests that has a lower limit of <0.01. (I believe that some ultrasensitive tests only go to < 0.04, 0.04, or <0.05, and that means you wouldn't have some of the detail that could be reassuring.)

    I can't help on the biopsy question. I would like to learn more about just how a post surgery biopsy is done, especially how much of the prostate is actually put under the microscope and assessed.

    Good luck,

    Jim

     
    Old 02-05-2009, 09:17 AM   #10
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    Re: Biopsy But PSA Only 0.4

    Thanks, Jim. I doubt I'm capable of such a detailed search but I get the idea. I'm sorry if I broke the rules. I have a bad habit of speed reading regulations and not completely getting the drift. I'll be more careful in future ! I am glad there appears to be favourable news around and hope that if I do have cancer, these successful proceedures are available to me. I'm not sure what options I'll have under government health care, but first things first...I have to wait for a biopsy ! I appreciate your time and knowledge. I realize how little I know !

    Steve

     
    Old 02-05-2009, 09:44 AM   #11
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    Re: Biopsy But PSA Only 0.4

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi Bill,

    Welcome to the board! (By the way, you are making me really envious with those wonderfully favorable diagnostic numbers!)

    There are two classes of PSA tests that can be used to track success. The older class is known as "conventional," and the newer is known as "ultrasensitive."

    For most of us, I'm convinced that ultrasensitive testing is the way to go, as some such tests can reliably find and report PSAs as low as less than (<) 0.01. In fact, in special settings, with special procedures, some can go as low as 0.001, but we don't know yet if that kind of detail helps at all or is worth the added effort. But there is research demonstrating the value of knowing if your post RP PSA is <0.01, or 0.01, or 0.02, or 0.03, or 0.04, or 0.05 and higher. If the PSA is <0.01, the chance of a recurrence is extremely remote. The chance is still very low but increasing through 0.03; 0.04 is sort of no-man's land, and if the PSA is 0.05, the odds are that sooner or later the patient's PSA will pass the agreed upon line for calling it an official, significant recurrence, which is 0.2. An exception is that sometimes a bit of healthy prostate tissue is left with no cancer; then, the PSA may be above 0.03 but followup tests will show a stable PSA without the telltale increasing trend that confirms a recurrence.

    Conventional tests, in contrast, used to give PSA only as low as 0.2; then they improved to 0.1, and now to <0.1, but without telling you how much less. Conventional tests are still used for monitoring by many physicians, though increasingly ultrasenstive tests are being used. A key advantage with ultrasensitive tests is that you get many months of early warning and can take early and more timely countermeasures.

    However, your case statistics are so good that it is already highly unlikely that you will have a recurrence. If you want followup with ultrasensitive testing, discuss that with your doctor ahead of time, and make sure you get one of the ultrasensitive tests that has a lower limit of <0.01. (I believe that some ultrasensitive tests only go to < 0.04, 0.04, or <0.05, and that means you wouldn't have some of the detail that could be reassuring.)

    I can't help on the biopsy question. I would like to learn more about just how a post surgery biopsy is done, especially how much of the prostate is actually put under the microscope and assessed.

    Good luck,

    Jim
    I wish I knew how to get those quote excerpts,,thanks Jim that helps me allot and gives me good info going in. I think my lack of experience on here sort of disables me a bit to post in the proper places. Have you or anyone you know had a similar case. Possitive biopsies and then no cancer in the prostate? Very puzzling. As to the procedure of a post opt pathotholgy, apparently the prostate is sliced , then samples taken from each slice. How many samples is unknown to me , I would use speculative logic and guess 3 end-middle-end, but then again I don't realy know. Everyone keeps telling me "your numbers are so low don't worry about it" but if he left cancer inside me then what difference does it make how low my numbers are ,,I still have cancer.

     
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