what is the highest PSA that you are ware of where PC was still contained in the prostate?

[billyboy3]

I have a fellow who has a psa of 29, yet his doc is insistent that his cancer has not spread beyond his prostate. At our centre, we use the number of 5.5 as the highest level beyond which the cancer has likely spread beyond the prostate. Please send me your thoughts on what value is being used as of late. Thanks boys and stay well!

[Tall_Allen]

There is no such value. Some PC puts out more PSA, some less. A PSA of 29 is defined as "high risk," however.

[billyboy3 in reply to Tall_Allen]

Thanks TA. I recognize the limitation of the current psa test modality, as did Dr. Murphy, co-discover of the psa test. That said, what I am attempting to do is to respond to a fellow's very high psa-29 from 20 a year ago. At our own prostate/men's centre, we use a figure of 5.5 as a high point in terms of possible cure through surgery, with of course other supporting indicators.

That said, it would be interested and very valuable to know at what point can we predict/use the current psa as a stronger or weaker indicator. The answer would of course be in the results from men who underwent treatment at various psa's score and chart the resultant outcomes.

We thus need to have all men who have been cured respond to this question. Unfortunately, our system does NOT keep track of these results and I would guess that we see very few men on this site who have in fact been cured, so results of any size will be hard to get.

Hope this clears what I am seeking on this issue. Thanks.

[Tall_Allen in reply to billyboy3]

That 5.5 number has no basis in fact. I have been cured - my PSA was 7.3 when I was treated. The NCCN localized risk groups group PSA into 3 groups: 0-10 may be low risk (but may also be intermediate or high risk), 11-20 may be intermediate risk (but may also be high risk), 20+ is always high risk. You do not seem to want to understand that risk stratification is multidimensional.

[noirhole]

Mine was 8.4 and in Bones and lymph nodes. Never gone higher than 14 or lower than 2.5.

[Zetabow]

Mine was 1386 on initial blood test, down to 21 now after 2 months of Hormone treatment.

[CalBear74]

Has the prostate been measured? PSA should roughly correlate with the volume of the prostate. BPH therefore becomes a significant factor; however, that measure of volume is never a guarantee that 100% of the cells composing the prostate at any time are cancer free. As the number rises so do the probabilities of some mutated cells being present. Of course, biopsies hope to extract some of these cells, but it may not always happen in the early stages.

I am not an MD; this reflect's my AZ urologist's patient ed efforts years ago.

[Magnus1964]

29 is high but what you need to focus on is change and doubling time.

[tarhoosier]

I have a friend who had rising psa over a few years with several negative biopsies. When it reached 26 the urologist did a perineal biopsy, that is addressing the area between the scrotum and anus for biopsy access. Finally found the tumor. His surgery was successful and no return after 15 years. I cannot recall his gleason grade or score. Some of his psa may have been from prostatitis.

[George71]

billyboy3,

Apparently if the PSA is under 20 at the time of diagnosis the chances of being metastatic is less than 8%.

all other groups are under 5%.

PSA levels at initial cancer diagnosis were divided into four groups: 0.2 to 3.9, 4.0 to 10.0, 10.1 to 20, and greater than 20 ng/mL. The ratio of metastatic prostate cancer compared with total prostate cancer diagnoses was compared for each year according to group.

"The proportion of metastatic prostate cancer present at initial diagnosis increased over the 10-year period for every PSA group, with the most significant proportional increase observed in patients with PSA levels greater than 20 ng/mL, from 8.5% (2004) to 22.9% (2014) (Figure)"

clinicaloncology.com/Prosta...

[George71]

At the time of my biopsy my PSA was 10 -- my urologist said he had 2 patients with BPH -- and PSAs around 15 for 10 years and several biopsies were negative. He said he thought the chances of me even having cancer at all was 40% I had it -- 60% I did not.

[CreativeOne]

My PSA was 6.1 in 2001, slowly climbed to 38.7 in 2015. Needle biopsy August of 2015. 7 of 12 cores were 100% cancer and cancer was present in all other cores, to a lesser degree. Elected RRP surgery in 2015. pT3b M1 N0 Gleason 4+3=7 positive margins, and cancer present on bladder neck and urethra. PSA was never zero, and the doubling rate now is about 3.8 months, diagnosed as aggressive stage 4. Doctor recommended RT and ADT, but I chose to wait. After 4.5 years, I have only done diet changes and vitamin/mineral supplementations so far, but PSA was 8.23 in January of 2019. Started Banerji prostate cancer protocol of homeopathy January 23, 2019. PSA is due again in April (3 weeks from now) and we will see where my PSA is then, and I will decide what I want to do next.

[Big_Mcc in reply to CreativeOne]

Please give an update on your new PSA level when you have the results. Good luck

[CreativeOne in reply to Big_Mcc]

As of 10/21/2021 My PSA is 7.53 and it is now 3 years since the post you read. I had a cystoscopy done 8/24/2021. Dr. found many small prostate cancer tumors at the neck of my bladder, narrowing and restricting flow, but not progressing much beyond my surgery in 2015. So far, no signs of any metastasis to bone or site other than my bladder. I haven't had any scans of any type done. I still have declined ADT, RT, Chemo, etc. I've gotten comfortable with my supra-pubic catheter setup and have a quality of life I like. I continue to use homeopathy and some hemp CBD products, but no other meds other than a low dose of metoprolol for atrial fibrillation.

[Big_Mcc]

Hi. My PSA was 28.0 when diagnosed N0M0 yet it was already extracapsular and as such I was denied surgery and only offered EBRT June 2017 + ADT for 30 months. It was a take it or leave it choice and one Im still bitter about. I was defined as incurable on the basis of micromets. No idea how they knew micromets were present except possibly based on previous experience. PSA is now 4 and Im on the waiting list for next treatment. UK based. So yes, with a PSA of 29 his cancer may well be outside the prostate and apparently he may have micromets.

[Boywonder56]

Psa 12 at dx stg1v with mets....psa had doubled in 1mo....im in mangus camp...

[Mascouche]

Only a scan can determine if it is contained or spread out.