Hi seuell, - There is no question that you have definitely had a recurrence of your Prostate Cancer (PCa) and salvage radiation is considered the last chance for a possible "cure" of the disease. Unfortunately, it will only be potentially successfull if your recurrence is a "localized" one and is not already, more advanced, "systemic" disease.
This is often very difficult to determine, and since you give no post-operation details of pathology found and/or sequential monitoring PSA history, any recommendation as to secondary treatment would be pure guessing, rather than informed and thoughtful consultation.
Overall, Salvage Radiation is effective in about 50% of the cases in 5 year statistics and something less than that, in 10 year results, which reflects the problems with confidently identifying the source of a recurrence.
The probable reality is, that at 71 y/o, you need to decide whether the POTENTIAL for cure is sufficient to risk the POTENTIAL morbidity (side effects) of further "intent to cure" treatment. But this should be an INFORMED decision based upon the most reliable information available, about your SPECIFIC situation.
With an actuarial life expectancy of about 12.5 years, the question that needs to be posed, is it necessary to cure your disease or is it more logical, based on what you learn, to try and effectively CONTROL the now chronic disease until you will most likely die of some other fatal malady.
All of these considerations depend on such facts as the extent of any residual effects from your surgery, existing co-morbidities, general health and your present life style at 71. There is lots to think about and seeking guidance from the professionals, available to you, who have the availability of ALL your records is wise.
I would suggest that, in addition to your Urologist, you have consultations with a Radiological Oncologist and a Medical Oncologist, before deciding on your next treatment decision. Good luck! - John@newPCa.org (aka) az4peaksView Thread
Hi Jembost, - Although there is no need to panic, there is justification for reasonable concern because of the steady upward trend in consecutive readings.
For ball-park reference, in the AUA's PSA Best Practice Update in 2009, the age-specific PSA value medians (50% above/50% below) cited, were 0.7 ng/ml for men in their 40s, 0.9 ng/ml for men in their 50s, 1.2 for men in their 60s, and 1.5 for men in their 70s.
The first of the two most notable studies concerning PSA annual velocity indicated 0.75 ng/ml in any one year justified a Biopsy recommendation. The second and most recent Study indicated that 0.35 would be a more appropriate threshold, particularly in younger men (53 qualifies).
However, PSA results need to be weighed along with other diagnostic data in the medical record and a subjective judgment made as to its significance. The Doctor's recommendation to re-assess in a relatively short 3 month time frame would not appear to be an unreasonable suggestion, in my layman's opinion.
At the levels you quote, a Free PSA test would have questionable reliability. Both the manufacturer and the FDA approval state that it is intended for use in men with PSA levels between 4.0 and 10 ng/ml Total PSA results. More recent Studies have suggested an expanded reliability down to 2.5 ng/ml. Free PSA must be run on the same blood sample as the Total PSA, to which it relates and using the same manufacturer's complementary assay material.
If the next PSA continues the upward trend, you may wish to discuss the possibility of having a PCA3 Urine test to help clarify the PSA result (and any Free PSA result, if done). This would require an office visit, however, because it requires a vigorous massage of he Prostate prior to obtaining the Urine sample for submission to the Laboratory.
Good luck and I will be happy to answer any specific questions you may have. - John@newPCa.org (aka) az4peaksView Thread
Hi jc3737, - It depends on the quality and location of your research. Your initial Post refers to a statement by Richard Ablin, who CLAIMS to be the discoverer of PSA (Prostate Specific Antigen).
However, there is great debate as to whether what he discovered is the same element as what we know as PSA today and since PSA was originally a generic term, it could refer to any antigen thought to be exclusive to Prostate origination.
In fact, the antigen that is now identified as PSA has proven NOT to be EXCLUSIVELY specific to the Prostate but it is, by far, the most prolific producer of the element in the blood we now measure with commercial PSA assays. Since it is the only really clinically significant source of such measurable levels, the term PSA has remained in tact and a U.S. Patent was issued under that designation, but not to Ablin.
I have an interesting Paper that chronicles the complicated "discovery" of "PSA" and the varied contributors to its evolution into the worlds most widely used and clinically viable diagnostic marker for detecting Prostate abnormalities. However, the results, by themselves, are NOT Cancer specific.
I would be happy to E-mail this enlightening summary of relevant medical literature to anyone specifically requesting it to - John@newPCa.org (aka) az4peaks I wouldView Thread
Hi Flapwing, - You must not be in the United States (U.S.). It is customary in the U.S. to report PSA results in nanograms per millilitre (ng/ml), so the less familiar micrograms per litre (ug/L) is likely to confuse many but the most PSA knowedgeable readers.
To specifically answer your question, YES the 0.80 ug/L is MUCH higher than the usual clinically "undetectable" post-surgical Standard that is normally used with Total PSA assays, which is LESS THAN 0.1 (in either ng/ml or ug/L) on the "Standard" PSA test (<0.1ng/ml), which reports results to a sensitivity of tenths of a millilitre (ml).
When Hyper- or Ultra-Sensitive PSA assays (reporting in the Hundredths or Thousandths of a ml) are used, they can often report actual readings, but at such low levels of sensitivity that it INCREASES the potential for, often, clinically meaningless variations in such readings. Such insignificant variations can cause substantially increased, and often needless PSA anxiety on the part of many Patients.
Since you report your result to 2 decimal points, I ASSUME, that you had the more sensitive assay employed, but assuming the decimal point is in the correct location, the 0.8 result is unfavorably significant regardless of sensitivity level involved or how many zeroes are added BEHIND it.
If the the result had been found to be .08 or .008 ug/L, it would have been considered clinically "undetectable" and you would have been considered, presently, PCa free.
Free PSA is not usually employed for ROUTINE post-surgery PSA monitoring, as Total PSA is more indicative of recurrence, since Free PSA is usually not reliably accurate at such extremely low Total PSA readings.
I hope this has helped your (and other readers) understanding of post-surgery PSA monitoring and I will be happy to respond to any questions or clarifications desired. Good luck! - John@newPCa.org (aka) az4peaksView Thread
Hi AN239590, - We need to first know which PSA result has the correct decimal point. I am going to ASSUME that it is the 0.64 and that is about the desired average for a 45 year old man. The .064 that appears in the Subject line is probably a typo, but correct me if my assumption is wrong.
A Study by Dr. Catalona at Northwestern University Medical Center showed the following "median" (50% above & 50% below) levels found for men in the following age groups:
40's = 0.7 ng/ml 50's = 0.9 60's = 1.3 70's = 1.7
You seem to be very close to the median and that should be encouraging. Statistical hances are high, that you probably have a healthy Prostate, as yet relatively unaffected by BPH, which is the natural growth of the Prostate that occurs in nearly all men, in varying degrees, after the age of 40 y/o.
Unless you have some symptoms, you test pretty well at the present time. - John@newPCa.org (aka) az4peaksView Thread
Hi David Roy, - Since you apparently still have a Prostate, the rise in your PSA reading could come from any number of causes and could be temporary or more prolonged, depending on its actual origin.
Surgical procedures can vary widely in both scope and severity, depending upon the location and the extent of the specific case being treated, so it is impossible to know why you do no longer experience ejaculation upon orgasm.
To my knowledge, the colectomy and/or proctectomy, by themselves, would not normally affect the production and/or delivery of ejaculate, which are not part of the same excretory system, however it MAY well be that the extent of disease present may have prompted the excision or damaging of the vas-deferens or even the Prostate itself, but these factors are unknown from your Post.
In any event it is unlikely, in my layman's OPINION (I am not a Doctor) that ejaculation, or lack of it, is unlikely the cause of your PSA elevation, but the cause could still be benign (non-cancerous) rather than Cancerous, with Prostatitis (inflammation) being a real possibility.
Of course, it COULD also be Cancer and further investigation by your professional advisors is necessary to determine its actual source.
As Replicant suggested, you may wish to pose the question to Dr. Judd Moul (MD) on this site. who is much better prepared to answer your question with authority, than am I. Good luck! - John@newPCa.org (aka) az4peaks View Thread
Hi Anon, - It is difficult to address your question before you have the results of your Biopsy. In general, however, if you have Prostate Cancer (PCa), it is quite likely that it won't threaten your mortality for several years. In fact, depending on its Stage, it may even be cureable with appropriate treatment.
Of course, at this point, it is pure speculation as to whether you actually have PCa, in spite of your highly elevated PSA reading, but this should be more clearly defined after you have obtained the results of your Biopsy.
PSA blood tests are NOT Cancer specific and therefore, a Biopsy is necessary to determine the cause of the PSA elevation. Much more should be known soon and until then, just realize that PCa is often a slow growing disease and is usually very treatable, with high and prolonged survival rates.
Once more information is available, your specific situation can be better and more accurately addressed. Good luck! - John@newPCa.org (aka) az4peaksView Thread
Hi Mik, - Before deciding on treatment, I would suggest that you have the slides from your Biopsy sent, for a second opinion, to a recognized specialist in examining Prostate tissue. Johns Hopkins and Bostwick Laboratories are 2 that come to mind, but there are others, generally found at institutions with high enough volumes to justify such pathologic sub-specialization.
Once the subjective Gleason Scores are confirmed, you can more confidently move ahead in your INFORMED decision making. You have choices and you have time to make them but first you need to be comfortable that the status of the disease you have now is accurate. A map to a desired destination is not nearly as helpful, if you don't know where you are now located on it.
There is time to learn but anecdotal tales of what happened to other INDIVIDUAL patients, is not nearly as reliable or helpful, as is the cumulative evidence derived from published, peer-reviewed medical studies reporting results from groups of men, with similar disease characteristics.
We are all individually different which is why we can each be separately identified by DNA. In addition Prostate Cancers can vary as well, but you can learn about PCa and you have a reasonable time frame to do so. ALL treatments have POTENTIAL side effects (morbidity) but most are age sensitive and your younger age may well prove to be your greatest ally.
At 58 y/o you have an actuarial life expectancy of 22 years and that is the time period that needs to be considered, not the shorter term 5 to 10 years usually cited in medical studies. I will be happy to answer any specific questions you may have, if you desire. Good luck! - John@newPCa.org (aka) az4peaksView Thread