MORE ON PSA LEVELS AND CONTAINMENT IN PROSTATE

[billyboy3]

Thanks guys, and I know of the various webs contained in interpreting metastasis by having only a psa test result, but that said, there has to be a line of some kind where the cancer has spread outside the prostate-by however means that happens ( thru the capsule, by tracking during biopsy, etc. ) an as of now, an unknown.

That said, if we received sufficient responses, we could use these to provide a guideline of sorts, to predict metastasis. We have used a psa of 5.5 as a good indicator of the stage of the disease, i.e. has it already metastasized, thereby reducing some treatment options, especially for those who might not survive the treatment options.

It would make less sense to have the prostate removed, if in fact it had already spread, although there is debate on the advantages of removing as much of the cancer as possible, which would occur during removal and/or radiation treatments, and leave behind a lower grade of cancer.

So much is yet unknown of our disease but please provide input into the levels, especially lower ones, where a cure was made possible by removal of the prostate.

In simple terms, I want to know of all cases where a cure was had where the psa level was higher than 5.5 and surgery was done. I am particularly interested in pc's where there was a much higher psa and a cure still resulted.

Hope this explains my search into a better answer to this important question.

I knew Gerald Murphy, Dr. now deceased, who was one of the two pioneers who discovered the psa test, which he admitted was only a start and needed much more refinement, but still today, it is the guideline for treatment.

Thanks

[Tall_Allen]

You are trying to put too much value on PSA alone. There are 3 main variables used to characterize the risk of recurrence of localized prostate cancer - PSA, Gleason grade and Stage. Secondary risk factors include age, % positive cores, PNI, etc. Here's a couple of good nomograms you can use that incorporates some of the main risk factors and predict the probability that it is contained:

mskcc.org/nomograms/prostat...

hopkinsmedicine.org/brady-u...

[spinosa]

I can't speak to "cure" - how can anyone? My oncologist speaks in terms of "management" of the disease, and I think that's correct. When diagnosed, my PSA was 8.5 - I was given Casodex prior to surgery to shrink the tumor, and the day before surgery it was down to 3.5. But, post-op pathology revealed a stage 3 lesion...not so good, and Gleason 7. For 12 years, I had PSA "less then 0.04 - I began to think I might be cured. Alas, in year 13, my PSA began to slow rise: 0.06; 0.08; .12; .14; .16; .18 - then, it see-sawed between .12 and .16 for most of 3 years. Suddenly, in year 15 (post-op), PSA hit .2 - time to do something. I opted for IMRT treatment, and I'm one year "out" and less then .09. My oncologist says...he doesn't think it will come back -but, if it does, he says, "we can manage it" for years. He bet me a beer I'd live to 80, without pain or too much trouble. We'll see. The point is - you examine the options, educate yourself (many near-experts here, for SURE!) and make the best decision you can about treatment. I'm sure many men ARE cured...but, clearly, I'm not one of them, since I failed before. Anyway...

[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...

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.