PSA

Howard, I'd would list you as "stable" for 9 months...which is as good as it gets.

Howard - I'm in the same boat with you. Detectable and hopefully stable for a very long time.

I've got another PSA coming up in a couple of weeks. Here's hoping and praying for both of us.

Jon

Howard,

You didn't add your signature, but I assume these PSAs are post prostatectomy. You are stable so far, but the question is how long will that continue? Contrary to myths that circulate on the internet, there are no benign sources of PSA that are that high this long after surgery.

Does Benign Prostatic Tissue Contribute to Measurable PSA Levels After Radical Prostatectomy?
"retained benign prostatic elements are an unlikely source of elevated PSA levels in men who have undergone radical prostatectomy."

So there is some cancer still there. Only you can decide what you do about it. For now, like most GS 3+4, it is indolent. It may stay indolent for a long time, or it may get active. Whatever you decide, I hope you will continue to monitor it frequently.

- Allen

I was told exactly the same thing as the article by my guy, Dr. Oliver Sartor at Tulane 2 days ago. He says they rarely ever see a situation where residual healthy prostate tissue after prostatectomy causes a PSA reading more than undetectable.

Tall Allen said...
Howard,

You didn't add your signature, but I assume these PSAs are post prostatectomy. You are stable so far, but the question is how long will that continue? Contrary to myths that circulate on the internet, there are no benign sources of PSA that are that high this long after surgery.

Does Benign Prostatic Tissue Contribute to Measurable PSA Levels After Radical Prostatectomy?
"retained benign prostatic elements are an unlikely source of elevated PSA levels in men who have undergone radical prostatectomy."

So there is some cancer still there. Only you can decide what you do about it. For now, like most GS 3+4, it is indolent. It may stay indolent for a long time, or it may get active. Whatever you decide, I hope you will continue to monitor it frequently.

- Allen

Gemlin, your post is indeed a perfect illustration of how internet myths are propagated. If you follow the footnotes (#20 and #21) in the quote you offered, you'll see that they refer to studies from 1998 and 2000. In footnote #20, they found PSA in tissue samples, not serum, far from the prostate. In footnote #21, the authors (the lead author, Herbert Lepor at NYU, is the same as in the 2009 study I quoted), they did indeed find benign prostate tissue in frozen sections taken at the time of prostatectomy, and those sections may be left behind, but that bears no relation to increasing PSA, as Lepor wrote 11 years later:"retained benign prostatic elements are an unlikely source of elevated PSA levels in men who have undergone radical prostatectomy."

Cut prostate tissue always releases PSA into the serum. The serum half-life is 2-3 days, so all the PSA from benign tissue is gone after a few weeks. There is a contribution to serum PSA from non-prostatic tissue, but it is on the order of 0.003 - nowhere close to 0.03.

The cause of the detectable rising PSA is altogether a different matter from what one ought to do about it. While it's clear that the cause is cancer (not benign tissue) left behind, that does not mean that the cancer will necessarily progress. Just as about half of men stay on active surveillance for 20 years without progression, living with known cancer, it is possible that some can live with cancer left behind after a prostatectomy. With active surveillance, we can biopsy untreated cancer to detect early progression, but that is difficult to do in all the periprostatic tissues. We know that if we wait for official biochemical recurrence (0.2) or clinical signs of progression, we have a greater likelihood of missing the curative stage before it is too late. One tool we can use is the one Koulikov et al. suggest: look for (1) PSA above 0.03 and (2) two subsequent increases in PSA and/or (3)PSA velocity of 0.05 ng/ml/yr or greater. But that is far from perfect - 37% did not progress in the next 7 years. And 6% of those with low stable PSA did progress. Another tool may be the Decipher test that predicts cancer that won't metastasize in the next 5 years. No one can say with certainty that it's safe to wait, and no one can predict overtreatment. It remains a difficult decision with no easy answers.

- Allen

Allen said...
Cut prostate tissue always releases PSA into the serum. The serum half-life is 2-3 days, so all the PSA from benign tissue is gone after a few weeks. There is a contribution to serum PSA from non-prostatic tissue, but it is on the order of 0.003 - nowhere close to 0.03

I believed, with the misconception, it was benign tissue left behind but my uro said the exactly the same thing at the last visit. You still have cancer but the hope is it will remain indolent. As a (4+3) GS7 the odds aren't in my favor. Will my favorable surgical pathology save me from future treatment? Who knows. The wait and see is something we suffer from and it sucks for all.

Jon