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PSA velocity

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Posted 11/11/2017 7:32 PM (GMT -5)
Hi, I'm new here and I'm hoping for some help figuring out my velocity.
Frankly I don't know how!
I'm 62.
2010 1.70
2014 3.79
7/17 5.78
15 days of Cipro
8/1 retest 4.40 free psa 8%
11/17 6.50

Do I count the 5.78?
It seems like it dropped because of the Cipro.
Thanks
Mark
Posted 11/11/2017 7:55 PM (GMT -5)
Hey Buffalo: Those more knowing than me will no doubt be along soon. All I can say is that PCA PSA moves slowly always increasing. Other PSA "drivers" can fluctuate up and down.

Roger
Posted 11/11/2017 8:01 PM (GMT -5)
Unless you have a UTI or a very large prostate, you're due for a biopsy. The signals aren't in your favor but the only way to rule them out is a biopsy. I recall having more anxiety just justifying and acknowledging that the biopsy necessary than the actual RP surgery. I recommend that you get it done. It's not a big deal. You might be sweating it for nothing.
Posted 11/11/2017 8:29 PM (GMT -5)
Yes I would use the post cipro number. The increase from 4.4 to 6.6 in such a short time dictates a biopsy. The bx itself is nothing to sweat over. But ignoring this high velocity isn’t prudent. I’m no doc so listen to your urologist!
Bob
Posted 11/11/2017 8:41 PM (GMT -5)
I did see a uro., he said my dre showed a "little bogginess" but no nodules or large mass which made me wonder if there was a small mass. lol The size was 40, I don't know if that's cc or grams. Can't remember.
He did schedule a biopsy for dec. I've just been reading a bit and came across velocity, somebody told me that pc was more of an upward trend. My seemed kind of steep.
Thank You both for your responses, I appreciate it.
Posted 11/11/2017 8:46 PM (GMT -5)
What is the bx Bob? I'm not up on all the acronyms yet, but I suspect I will be soon enough.
I guess you answered my velocity question.
Thanks
Posted 11/11/2017 8:51 PM (GMT -5)
Having a biopsy is a good idea...So now you just have to sweat it out until your pathology report comes back....Nothing you can do about it now so just put it out of your mind and hope for the best..
Posted 11/11/2017 9:00 PM (GMT -5)
Welcome to HW.

See the sticky threads at the top of the forum. There is one there that lists the acronyms used often on this site. BX=biopsy

PSA kinetics aren't really that useful in your situation. Cipro may have lowered your PSA. Still, PSA due to PC never drops, so that kind of drop may be due to prostatitis. Rapid rise and fall of PSA is more likely due to prostatitis. PC does behave that way.

Well there are worse things than a biopsy and there maybe something there.

Andrew
Posted 11/11/2017 9:02 PM (GMT -5)
Thanks Fairwind. Good advice.
Posted 11/11/2017 9:11 PM (GMT -5)
Thank You Andrew, when I saw the free psa I figured I should have the biopsy but the uro wanted to have another psa first. That was last Monday so he scheduled it after the dre and the 6.50 psa.
Posted 11/11/2017 9:47 PM (GMT -5)
For those who need a helpful tool to compute PSA doubling time, and also PSA velocity, this tool at MSKCC will do the job. Just enter the first and second PSA test dates and values and click "calculate".

/www.mskcc.org/nomograms/prostate/psa_doubling_time

Charles
Posted 11/11/2017 9:51 PM (GMT -5)
Thanks Charles.
Posted 11/12/2017 9:24 AM (GMT -5)
Buffalo
bx is short for biopsy just like dx = diagnosis , tx = treatment, rx = prescription .
Bob
Posted 11/12/2017 1:30 PM (GMT -5)
Thanks for the heads up Bob, and all the others as well.
Mark
Posted 11/16/2017 11:13 PM (GMT -5)
Hi Mark:

Just saw your post.

I would be concerned about your %free PSA.

Everyone is different, but over 25% is desirable for this number, so 8% is really low. Mine got as low as 7.5% and the prostatectomy pathology found 8% of my prostate was cancer. I am glad I didn't wait any longer. Things have turned out well.

So I agree with the others who suggest a biopsy. But follow your urologist's advice, obviously.

R-0.009
Posted 11/18/2017 11:24 AM (GMT -5)
Thanks Ro, I had the lab do the free psa after the cipro, the doctor hadn't ordered it, which kind of made me wonder a little. I guess I'll know soon enough!
Posted 11/18/2017 9:38 PM (GMT -5)
The BX tells the story.........at least as well as it can be told. With the multiple ???? you have the BX is the best way to go.
Posted 1/13/2018 11:15 AM (GMT -5)
Update
I had my biopsy in dec. They said it was Gleason 3+4. After meeting with the uro/surgeon I decided to get a second opinion at the cancer center where I live.
They re-read the biopsy and did a3t mri. The mri didn't show any spread in the pelvis but they disagreed with the original path report. My new doc ordered a prolaris genetic test, I'm waiting for the results now.
He's looking at brachy, and beam radiation as well as hormone therapy, depending on the prolaris test. The rad. Doesn't bother me, but the HT doesn't look very appealing.

1. PROSTATE, LEFT BASE, BIOPSY:

- BENIGN PROSTATIC TISSUE.


2. PROSTATE, LEFT MID, BIOPSY:

- PROSTATIC ADENOCARCINOMA, GLEASON SCORE: 3+4=7 (GRADE GROUP 2)
- PERCENTAGE OF GLEASON SCORE 4: 20%
- TOTAL NUMBER OF CORES IDENTIFIED: 2
- TOTAL NUMBER OF CORES WITH CARCINOMA: 1
- PERCENTAGE OF TISSUE WITH CARCINOMA: 2%
- LINEAR AMOUNT OF TISSUE WITH CARCINOMA: 2MM
- PERINEURAL INVASION: NOT IDENTIFIED


3. PROSTATE, LEFT APEX, BIOPSY:

- PROSTATIC ADENOCARCINOMA, GLEASON SCORE: 4+3=7 (GRADE GROUP 3)
- PERCENTAGE OF GLEASON SCORE 4: 80%
- TOTAL NUMBER OF CORES IDENTIFIED: 2
- TOTAL NUMBER OF CORES WITH CARCINOMA: 1
- PERCENTAGE OF TISSUE WITH CARCINOMA: 20%
- LINEAR AMOUNT OF TISSUE WITH CARCINOMA: 7MM
- PERINEURAL INVASION: NOT IDENTIFIED


4. PROSTATE, RIGHT BASE, BIOPSY:

- BENIGN PROSTATIC TISSUE.


5. PROSTATE, RIGHT MID, BIOPSY:

- BENIGN PROSTATIC TISSUE.
01/04/18 NL/DS
Posted 1/13/2018 12:00 PM (GMT -5)
Sorry to hear that your biopsy had some positive findings.

A triple play of HT, Brachy, and beam radiation is a serious regimen that I usually see used for Grade Groups 4 and 5. But, that combination offers a high chance of curing your cancer, and that is most important.
Posted 1/13/2018 12:37 PM (GMT -5)
I think the big concern is the part 4 being at the apex, I guess there's a greater chance for migration there.
Thanks for your response AS.
Posted 1/23/2018 10:17 PM (GMT -5)
3tmri

FINDINGS:
Prostate volume: The prostate measures 3.9 x 4.6 x 4.9 cm (AP x LR x SI), for a total volume of 46 cc.

There is a moderately T2 hypointense lesion in the left lateral and anterolateral peripheral zone of the base and mid gland. The lesion extends into the adjacent central zone and measures up to 1.8 cm (series 11 images 14 and 15). This lesion is hypointense on the ADC map and exhibits hyperintense signal on the high b value diffusion-weighted imaging. There is also corresponding early arterial enhancement.
T2W: PI-RADS 5
DWI/ADC: PI-RADS 5
DCE: Early arterial enhancement.

Seminal vesicles: The seminal vesicles are asymmetric with under distention of the left seminal vesicles and which may be secondary to scarring from prior inflammation or treatment. No contiguity with the prostate tumor.

Extraprostatic spread: There is greater than 1 cm of peripheral glandular abutment which is concerning for extraprostatic spread.

Median lobe: None.

URINARY BLADDER: There is mild diffuse bladder wall thickening.

LYMPH NODES: No lymphadenopathy.

OTHER INCIDENTAL FINDINGS: No aggressive osseous findings. There is moderate degenerative disc disease at L4-L5.

Prolaris score 5.8

I can't seem to find anything online that explains the 5.8.
I know it's a poor number but I'd like to know if it is predictive of recurrence and out metastisis.
Thanks
Mark
Posted 1/24/2018 2:55 AM (GMT -5)
I think the 5.8 means that your cancer is considerably more aggressive than an ordinary intermediate risk cancer. It's a good indication that brachy boost therapy may be a good option for you to consider.
Posted 1/24/2018 7:14 AM (GMT -5)
Thanks for your response Allen.


By brachy boost do you mean hdr brachytherapy?
Posted 1/24/2018 12:07 PM (GMT -5)
Brachy boost means external beam radiation to a wider area plus a brachytherapy boost to the prostate. The brachytherapy part may be either HDR brachytherapy or LDR brachytherapy. It's a way of increasing the cancer-killing in the prostate.

/pcnrv.blogspot.com/2017/05/brachy-boost-therapy-should-be-reserved.html


It's usually given along with ADT for a short time, although in many studies it did not seem to confer any additional benefit:

/pcnrv.blogspot.com/2017/05/brachy-boost-therapy-should-be-reserved.html
Posted 1/24/2018 10:36 PM (GMT -5)
Thanks, I was confused about that.
I'm thinking I might go with just seeds.
The hormone therapy won't allow me to work (fatigue).
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