PSA and Metastasis

No, but I may or may not be able answer a question reference that point. Actually I will tell you what I know, not much but, There are strains of PCA, usually aggressive which do not release/putout psa. Ergo they can metatasise/advanced cancer " silently " ,therefore, paraphrase, no grounds for rise in psa. Logo

Click the SEARCH link and type-> Mestastasis  to find four other threads.

Here is some more on variants, and two that mention Gleason 6 patients and easily confused clinicians for finding these types. Exactly why patients should employ expert pathologists (few experts exist) and use expert oncologists who test for low psa but possible disease progression and markers that are useable.

You can google search PCa variants and find more info these days:
www.propath.com/newsletters.../500-variants-of-prostate-carcinoma  
www.jama.ama-assn.org/content/306/13/1431.1.full

Partial info from propath link:
VARIANTS OF PROSTATE CARCINOMA by Bahram Robert Oliai, M.D.

Although the overwhelming majority of prostate cancers are acinar adenocarcinomas, behaving in accordance to their various Gleason scores, peculiar variants account for 5-10% of prostatic carcinomas (4,9). Additionally, there are some variants of acinar adenocarcinoma (psuedohyperplastic and foamy gland carcinoma) which tend to confuse both clinicians and pathologists for various reasons. Given the previously mentioned statistics, we are bound to run into these unusual cases at some time in our career. ===================================
(do read the rest of his info on some nasty variants like: Small cell, Mucinious, Singet ring, and such.)  I am most curious about the state of the art of average pathologists and what they actually can decipher.

Post Edited (zufus) : 11/11/2011 6:11:33 AM (GMT-7)

Thank you for this thread topic.

This has been a concern of mine since the detection of my prostate cancer after a biopsy on (Friday) November 13, 2009. I had been following my PSA for a few years without much concern as it was well below 4. During a free screening DRE in September (Prostat Caner awareness month) I was told that they felt and abnormal prostate and scheduled a biopsy. My PSA at the time was 2.2 and stable. Refer to my signature to see progression. After determining that it was likely caused by Agent Orange and after surgery and radiation locally by civilian doctors I signed up to be followed by the Veterans Doctor. No family history with 6 brothers a father and 6 uncles never having a problem. Now approaching two years and after deciding to educate myself on forums I decided to see the Surgeon that performed the DaVinci RP. I hadn't seen him for a year.

I felt it wise to speak with him to confirm my concerns. With pT3b stage cancer I was not comfortable that the VA's PSA test is only carried out to .X decimal and they only considered a .2 PSA reading as a recurrence. I noticed that the PSA tests with the civilian doctor was carried out to .XX and thought that with the more sensitive test I might be able to see a trend early enough to do something about potential mets. My civilian doctor agreed and said that if he had the stage of cancer that I have with a PSA of 2.2 pre RP he would have the same concerns. I had them draw blood for a PSA test and I am scheduled for a bone scan on Wednesday, 11/16/11. I also submitted a Urine Fish Test (bladder cancer test) as one was performed 18 months ago and came back positive only to come back negative several months later. This is a test that the VA does not do.

I am very thankful for the VA's help and I'm not complaining about them at all however because of the posts that I have read online, being my own advocate is, I believe, the most important lesson that I've learned on the forums. Thank you for listening to my rant as it certainly helps to converse with others that are going down the same road.

Cherokee6

The VA found my PCa in July 2011, so far the care I've received has been just this short of amazing.

At this point I'm not concerned with .X or .XX sensitivity. What else have you found in your experience that the VA does not do that you think is needed?

Being our own advocates is vital, it is here on healing well that I learned and continue to learn

Bud

Radad,
I see that you were in the USAF during the same time I was. To answer your question about the VA, I think that they do a great job with what they have, I just don't think they are using or can use the latest technology available and decisions are based on the masses without regard to the individual case. I also find the last half my previous sentance applies to the civilian counterparts as well but if you educate yourself with knowledge it is easier to guide your treatment in the civilian world than in a military world. I am trying to get ahead of the mets as soon as possible but once it occurs I have no problem going to the VA for treatment while keeping an eye on what might be available in the civilian world.
It's amazing to me that some people with bone mets have such pain and others nothing. Good luck on your journey.

Cherokee6

mr bill said...
A few weeks ago, as I recall, there was a post concernig the correlation between PSA and Mestastasis. In any event it eluded to the fact that not all Metastasis or advanced PCa is also grounds for a raise in PSA. Does anyone recall where that post may be?

Mr Bill, sorry that I don't recall that specific thread you asked about, but I have some stats which might be helpful.

Bone mets with low (under 10 ng/mL) PSA are rare, but they do happen about 2% of the time. 

On the other end of the spectrum, a PSA of 100 ng/mL is generally considered to be the "round number" where bone mets are considered to be likely; the positive predictive value for PSA=100 is 74%.

These stats are from the Wolfe study titled, "Prostate-specific antigen as a marker of bone metastasis in patients with prostate cancer."

By the way, the 2% rate for bone mets in low PSA patients also happens to be only slightly lower than the occurrence frequency of a variant of aggressive PC known to secrete only low levels of PSA (but have a high Gleason score).  In my opinion, this infrequently occurring PC variant, and our current inability to precisely screen for it in specific, is the primary root cause of much PC over-diagnosis and over-treatment.

 

Hopefully, this provides the answer you were looking for...

"...Bone mets with low (under 10 ng/mL) PSA are rare, but they do happen about 2% of the time... "
--------

Most of these 2%ers are high gleason, but I've seen some gleason 6s.

Cherokee-

I have been doing the HT thing for 6 months.  Not sure what the future holds for me as far as treatment.  I have conflicting plans between 2 of my doctors.  One says one more shot...another says 2 years total.

To break the tie and to get another expert's opinion, I will be visiting Dr. Myers in a few weeks.  Will keep you posted.

Since your PSA was so low going into your surgery, have you considered getting an ultrasensitive PSA.

Thanks,

Jerry L. 

jT,

Interesting. Can they do that 2 years since biopsy and/or surgery?

Wonder if insurance pays for that.

Thanks.