Questions about PSA drop

I have a question that was posed to me by a friend, and I find it interesting and curious. There may not even be an answer

So the background is, this friend was diagnosed with PC about 9-10 months ago, after biopsy, which was prompted by a PSA of 6.1

I don't have all the details but it was G7 originally (4+3), downgraded by Epstein to (3+4). To be complete, the biopsy showed all on the right side. And he then changed to a new URO who did an MRI (6 months after the biopsy, and I believe the PSA at that time was still around 6.1) which showed cancer on left side only, so contradictory. Uro then wanted to do another biopsy which my friend objected to and so it was not done.

My friend began, after doing a lit of reading, to take a bunch of supplements, and the next PSA reading, 3 months later, was down to 4.8. 3 months later another PSA it was 4.9. The Uro is ok with him just doing AS for now, which I'm a little surprised at considering it wasn't even a G6, and I expressed my concern to my friend, but it's his call. Dr just said to him, if your happy then it's fine with me. Same Uro as me, practices integrative medicine, and is an AS believer (I'm not going back to him for other reasons)

Anyway, the question is this....

It's usually presumed, post diagnosis, that if PSA is rising, that the cancer is likely on the move, right? So what if the PSA falls? Do you presume the Cancer is receding? Without treatment? Doesn't compute to me. Unless you consider Supplements ALONE to be valid treatment. (Which I don't, but that's me)

Any thoughts on this? Aside from th fact that with GLeason pattern 4 cells, my friend is not being smart?

Ok, I guess I missed something I didn't realize that. And is 3+4 is considered intermediate risk, maybe AS is considered ok? Still not sure it makes sense. But back to my original question, what is the significance of the PSA drop.

I'm guessing maybe the 6.1 was a fluke?

Prato, a number of AS programs are now accepting patients with 3 +4. Re the PSA scores, we have seen many cases on this forum where PSA stabilized after diagnosis especially with diet changes.

One thing I can suggest re your friend is to remember the "active" in AS. If the uro is simply "watching" that's not good enough. Most of the expert AS programs will have a defined regime of testing that is important. The data shows that if treatment is needed later for your friend then the cure will be just as effective as if he had not chosen AS...but only if he follows a good AS protocol.

There was an excellent video from Dr. Klotz re AS that was posted on HW some months ago. You can probably find this via our search or simple Google and find it. Your friend might find that enlightening.

Jim

FWIW, my PSA dropped 12.5% from in about two months. I had a 4.5 at my doctor's office (owned by hospital), and then went in for a free screening at said hospital and it came back as a 4.0. Another three weeks later at my biopsy (different hospital) the PSA was again 4.0. That drop you speak of is more like 25-30% so I don't know what to make of it.

Does patient age have any/much determination in whether to pursue AS? I would think so. All three docs I consulted with ruled that out in my case.

Prat:

I think the idea behind AS is that you are constantly and carefully monitoring the situation. So, if it is worse tha a G6, the constant monitoring will pick that up.

For me, it would be too much of a concern. Of course, this was one of the many reasons that I chose surgery: to find out exactly what the situation is.

Each to his own!

Mel

Prato, Mel is exactly right in his first sentence. Additionally, studies have shown that with that proper monitoring the curative results of a later treatment are the same as if treated sooner.

I think what you are looking for is certainty but that just does not exist in our disease; you can be certain of some things but not in totality. You seem to have chosen surgery because of your need for certainty of knowledge about the pathology as well as the quicker gratification of PSA drops. That's a personal choice that involves trade offs. For me I was willing to forego the certainty of pathology and willing to experience more gradual PSA reductions in exchange for a less invasive procedure and a reduced chance of side effects.

This is why treatment choice is so personal...you are willing to risk SE's for earlier certainty but I was not...different personalities react dramatically different to the same set of facts.

Jim

Doug...yes, I know and didn't intend any offense to our friend Prat. Was simply responding to his musings about risk...

Jim

On the PSA movement - there are many sources of PSA and PSA kinetics are not at all useful in the diagnosis. As Jim said, GS3+4s are included in some AS programs where they track with advanced imaging (mpMRI or CDUS). Klotz advocates for it, Epstein probably not so much, but even he may come around as evidence accumulates.