Is PSA reliable?: Please click on the... - Advanced Prostate...

Advanced Prostate Cancer

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Is PSA reliable?

markoch26 profile image
markoch26

Please click on the Harvard link for the PSA reliability:

health.harvard.edu/blog/is-...

Your feedback on your experiences of having constant blood work (PSA) will help us all as to whether it is best to go in accordance with PSA check. Will this help or worsen the disease when it comes to treatment? Overtreatment could kill us faster like too much chemotherapy will kill us faster because our body immune system will definitely go down the drain much faster. As a result, our white cells are destroyed until we are not able to defend ourselves any longer.

67 Replies

You are confusing PSA for initial detection, for which it is lousy, with PSA used to monitor progression for advanced prostate cancer, for which it is very good.

markoch26 profile image
markoch26 in reply to Tall_Allen

Thanks Tall Allen. Some can get as high as 5,000, but they don't feel any discomfort. But after they started treatment, that's when they started to feel weak and so forth. That's the result of the hormonal drug. Over 4 years ago, I was diagnosed with a PSA of 180. Now it's between 0.6 and 10 and I am still being treated with the frontline hormonal drugs, reluctantly heeding the doctor's call for chemo. I am feeling fine and strong with daily weightlifting to encounter the possibility of getting osteoporosis, having anti-cancer smoothies twice a day to have as much antioxidation in my body as possible to ward off free radicals, and getting my mind straight or right that PCa can be controlled to the extent that you never know for example "Oh it is now in my 10th year of treatment after the first diagnosis; I'm still alive and kicking". I guess chemo does more harm than good. I told my urologist that chemo will be my last resort.

The above stated is what I have been experiencing. It might not work for you and it is for reference only. Cheers from Taiwan!

Tall_Allen profile image
Tall_Allen in reply to markoch26

Chemo does the most good and has the fewest side effects when used early. When used as "the last resort" it does little good and has the worst side effects.

Zetabow profile image
Zetabow in reply to Tall_Allen

Something I'm finding out, first round of Chemo I had very positive outcome, not so good now I'm castrate resistant

elvismlv123 profile image
elvismlv123 in reply to Zetabow

Please clarify how you became castrate resistant...TY

Zetabow profile image
Zetabow in reply to elvismlv123

Not sure I could say how "exactly" as I'm not a Doctor. Everything they try stops working after a few months, Zytiga only lasted 3 months and now I'm back on Chemo.

elvismlv123 profile image
elvismlv123 in reply to Zetabow

Must know what zytiga is and what it does..ill check it for you...

elvismlv123 profile image
elvismlv123 in reply to Zetabow

Zytiga is an androgen deprivation therapy for those who are already castrate resistant In plain english...you were already castrate resistant which means drugs that reduce hormones do not control the cancer any longer.Castration is removing your testicles. It definitely kills testosterone because thats where testosterone is made. These days its not necessary to perform this stupid act.They use drugs which are very reliable to reduce Testosterone to extremely low numbers. Its called Medical castration. I dont think Zytiga is capable of doing this so they add prednisone. I took Zoladex shot in the stomach for 18 months. My T was .005.I take Finasteride and I know for a fact it suppresses DHEA and DHT. BTW t is not as bad as DHT...which is much more powerful than T. All these hormones can be detected in your blood and you should ask your doctor you want to know what those numbers are historically..if they are low or high but you want them suppressed.BTW Medical Castration is reversible after you stop taking the drug.Some people take LUPRON. Its been around forever and it works. With Zytiga you have to take prednisone which is a steroid but while its a good drug for certain things it cannot be taken too long.You have to build up and reduce slowly to get off of it.Please Please for the love of God when they offer something ask them what it does and what its for. Yes he has a degree which you dont but hes reading a book and he knows as much about it as you do.You want to separate the BS from the facts.I was on 150mgs per day of Casodex.5mg of Finasteride per day and a monthly shot of Zoladex.I had some hot flashes, slight memory fog and low libido.I still had a full time job at 66 years old. Ask me any thing you want and dont think anything is stupid.Im 17 years doing this......AN ANDROGEN IS A HORMONE.Theres a bunch of them ..not just one.

Zetabow profile image
Zetabow in reply to elvismlv123

I had Subcapsular orchiectomy last year, my Oncologist said with how aggressive my cancer is that the orchiectomy would likely give a better survival over ADT. I've seen some papers to confirm this but don't know how old they are.

I know what Zytiga does, just saying it stopped working only after a few months, everything they try with me now stops after a few months and I get a big PSA jump (300)

elvismlv123 profile image
elvismlv123 in reply to Zetabow

these drugs kills an enzyme that helps make the hormone..its not in any way dangerous.sometimes it blocks receptor cells so hormones cant get into the prostate. some people use intermittent therapy and it can prevent castrate resistance. Sometimes it is not a good idea to use continuous therapy.

Are we saying its contained in the prostate to be early? Meaning no mets? Chemo was never a good choice for PCa because PCa cells are slow growing unlike other cancers and PCa can effectively controlled by ADT. Its not so easy to make a determination about how one goes forward. I have been on AT since 2004 and it has suppressed whatever cancer I have. My prostate was reduced in size. My cancer responds very well to hormone deprivation. My T is 300. I know you are a pro at this and I like to add my two cents to add my perspective. Its MY Honest Opinion not a fact.

For me Finasteride 5mg daily suppresses DHT and DHEA.It doesnt just "mask" my PSA reading. It lowers it from 5 to 2.5. Thats me and it might not be you. But its my own verifiable result from constant blood testing.My cells are diploidal.

Not sure what you're talking about. Advanced PC means it's metastatic.

We were talking about early stages.Well that means NM and not advanced.I know this is an advanced cancer site.

I agree with TA, early is good. I started chemo a couple of months after diagnosis, and it helped enormously, as I have now been undetectable for over 3 years. What's in your smoothies?

Beetroot, lemon, broccoli sprouts and other cancer-fighting veggies, carrot, cranberries, onion, turmeric, pepper

Zetabow profile image
Zetabow in reply to tarzantass

tarzantass, all at same time?

I asked my Oncologist if some special diet would help, he said "that horse has left the stable, eat and drink whatever you like, enjoy life". lol

markoch26 profile image
markoch26 in reply to Zetabow

Yes, all in one blended by Vitamix blender

Zetabow profile image
Zetabow in reply to markoch26

Yuck lol

TomTom1111 profile image
TomTom1111 in reply to Zetabow

I have a Vitamix and no way would I create that concoction.

You said best yuck. lol

Im 17 years out and it was the initial PSA reading at Dx and along the way that helped me to be safe. I wouldnt say its bad at DX. But I would say it should be biopsied.

"Is PSA reliable ?" Yes and No. It depends what shade your Prostate cancer is .Every PCa has 3 type of cells in it (1) Fully Androgen Sensitive (2) Partly Androgen sensitive and (3) Fully Androgen resistant. Now, in different men. .the ratio of these type of cell may differ, e.g. on one extreme , one may have 99-1-0 and other extreme

one may have 5-5-90

In first group, PSA will be remarkably reliable biomarker. In second group, PSA can be deceptive as Androgen Resistant cells (esp High Gleason >8) either do not secrete PSA or secretes very small amount of PSA.

The benefit of Lupron like meds is best in group 1 type men. \

Docetaxyl Chemo kills all 3 types of cancer cells.

As you already know, with months and years, Androgen sensitive population start going lower and Androgen resistant population keep rising, Eventually, majority of cancer cell becoming Androgen resistant. This process of conversion from sensitive to resistant cell takes anywhere from 2 years to 20 years in different men. Slower the rate of conversion..longer one is likely to lives.

Docetaxyl chemo should be used early in people whose biomarkers and histology show lots of Androgen Resistant cells with high Gleason Grade. In men who has mostly Androgen sensitive ,high PSA producing low Gleason <8, Chemo should be delayed and used later to kill all 3 types when Androgen resistant cells arise in high numbers.

The above info is not a recommendation or prescription. It is only for information.

joeguy profile image
joeguy in reply to LearnAll

What is the test to determine how many cells are androgen sensitive vs resistant ??

LearnAll profile image
LearnAll in reply to joeguy

There is no direct test to know what percentage of prostate cancer cells are Androgen resistant.However, in indirect way, it can be estimated.

How low your PSA falls in first year of you being on Lupron like meds is very crucial number. It is also called as Nadir PSA.

So , say your PSA was 100 at the start and it fell down to 0.2 after 10 months. In this case, over 99% of your cancer cells are Androgen sensitive.

If you had starting PSA of 100 and it went only down to 5.0 then, a larger percentage of

your cancer cells are likely to be Androgen Independent/resistant from the beginning.

Remember, men progress at different rates from Androgen sensitive status to Androgen

Resistant status.

There are some other CLUES to Androgen Resistance such as Lytic type bone lesions, Visceral (organ) mets, high bone resorption biomarkers such as Urinary collagen telopeptide NTX, rising Lactate Dehydrogenase (LDH) and of course worsening physical performance and falling hemoglobin and Albumin.

If you put a combination of all these factors together, you will be able to estimate degree of Androgen Sensitivity in your PCa. Need to take a composite picture.

joeguy profile image
joeguy in reply to LearnAll

I have been castrate resistant for the last couple of years. Firmagon and Eligard alone were never able to get my PSA lower than about 2.0. It wasnt until Xtandi was added that I got to undetectable. I am currently experimenting with Nubeqa as a mono-therapy..... so far, so good.

dockam profile image
dockam in reply to LearnAll

Sounds like what I experienced with my #stageivpca journey that began in 01/2015 with PSA at 840.2, GL7, mets to L ureter nodes. ADT(Lupron/Casodex) to start in 2015 and the first of 15 Taxotere chemos began 2 weeks later. Nadir at 0.1 in the Summer of 2017, then PSA started to rise up to 10.8 in 10/2018.

Abiraterone and then Xtandi failed in 2020.

Probably that the Androgen Sensitive PCa died at first and then the remaining Resistant ones were left.

An initial Axumin scan showed a hotspot in the pararectal fat pad of the prostate. A second Axumin last Fall showed that the spot had resolved, but then there were two 1 cm iliac nodes involved, maybe those were Androgen resistant.

Just completed another round of six Taxotere sessions and those iliac spots were back to normal and the PSA at 3.1, which is the lowest point since 04/2018

Fight on y'all

Randy

Hey markoch26!

Your Harvard link. At a yearly physical the new doctor said that he wasn't ordering a PSA test. He said the "insurance companies" feeling that the test, was usually reliable but often elevated for other reasons having a result above the normal range which caused undue concern and "stress" for men. He suggested skipping the test for one year.

In my mind the words "insurance companies" stuck. I was surprised the "insurance companies" were so concerned about my mental state--and this doctor too! "Don't worry--Be Happy!" Hmm--I was paying a nice premium for a policy with a company that was so concerned about my mental state that they wanted to protect me from perhaps bad news? Wasn't that nice! I have taken the liberty to pull some stats out of the air --just guessing now-- -- About 50% of subscribers are men? About 50% of the men an of an age for a yearly PSA test. That leaves about 25% of the subscribers--now if the insurer has been paying for a yearly test for those men and now they are tested every other year--the insurer will save 50% of the yearly cost of PSA testing if only 12.5% of the men have that test. The every other year schedule! $$$

The doctor is speaking as these thoughts go through my mind. I tell him it is my MONEY that pays the premiums and I want the PSA test. The doctor points out that in 14 years there has been no deviation. My MONEY--order the test! He capitulates. My numbers multiplied by over 5X in 12 months. I was diagnosed with a Gleason 8, T1c tumor.

I am using the keyboard eight years later. How many men weren't so insistent? Where are they?

A link-copy all between the lines:

________________________________________________________________________________________________

With PSA Test Out of Favor, Cases of Advanced Prostate ...

medicinenet.com/script/main...

________________________________________________________________________________________________

An excerpt form the article:

"WEDNESDAY, May 20, 2020 (HealthDay News) -- Prostate cancer screening guidelines have been evolving for more than a decade, but new research suggests that recommendations against routine prostate cancer testing may have come at a steep price -- more men getting diagnosed with advanced prostate cancers."

Currumpaw

TomTom1111 profile image
TomTom1111 in reply to Currumpaw

At what age were you diagnosed because even with the psa guidelines changes every man should get a yearly psa starting at age 55. Stress or no stress.

I was 53 when diagnosed G9 with p3tbN1M0 after RP. And that was by pure chance. If I had waited until 55...M0 would have been M1.

Currumpaw profile image
Currumpaw in reply to TomTom1111

Hey Tomtom1111!

I was 62. I had very thorough physicals for the previous 14 years which included a PSA test. As a part of my job at a pharmaceutical plant I was required to be a member of the emergency response team, (HAZ MAT response), and Confined Space Rescue. It was necessary to enter various types of vessels for inspections and cleanings. We trained for all types of PPE including Level A, the space suit type. We were trained by a company specializing in only that type of training. They train fire departments and federal responders as well on honing skills to respond to an act of terrorism.

The yearly physical was done on site at the company clinic. Hearing, vision, an EKG, pulmonary testing, blood, urine were done. My PSA had been stable for 14 years. The only deviation was in the "Susan" years. Poor baby. As well as inheriting 20% of a third generation family business she inherited anti phospholipid lupus. She died in her 40's. There was a little spike in my PSA at that time.

I feel that 40 is the latest age when men should first be tested. Really, men should have a PSA test at 30 to establish a baseline, begin a history of their PSA. If all is well, then retest at the age of 35, then again at 40. Does it make sense that a man's PSA trend from the age of 30 may save his life. A doctor will have a reference which shows the trend of his PSA. The two early tests at the ages of 30 and 35 would only cost about $100. That might eliminate the first test causing a doctor to say--"Your PSA is a little high, maybe a biopsy should be done. I'd recommend it."

There I was, sitting in front of a doctor, recommended and one of the founders of the medical group, who was telling me that the insurance companies were concerned about my stress. That, as my PSA had been stable for 14 years, there was really no need for testing. As I said before. I wrote checks not to hear that there was no need to monitor my health because people I didn't know--would never meet--were concerned about my stress! I mentioned numbers before. As I sat listening to the doctor I was thinking that some people in a boardroom somewhere hatched this and had pushed it with somewhat legitimate arguments. Screw that! I paid for the test upfront with the premium checks!

I would advise men to even pay for their PSA at a lab if their doctor refuses to order one.

Currumpaw

TomTom1111 profile image
TomTom1111 in reply to Currumpaw

Hey Currumpaw,

I work as a sw consultant at McNeil Consumer Products in Fort Washington. Pa. I'm assuming you must have cleaned a few aerators in your time. At 62, PSA yearly should be done without question....let me or you worry about the stress.

How are you doing now? July 14 will be my last eligard injection and I think I can end the Zytiga too. I've been .1 or less since Jan 2020 and last Oct my ultra psa was <0.01....so for the time being things are going well for me.

So far I've had the following treatments, June 2019 - RRP,

July 2019 ADT + Casodex.

September 2019..Munich, Germany for Octoberfest..got totally blasted for 3 nights in a row. That is unbelievable lager.

Oct 2019 started IMRT wt Pelvic region. Nov 2019 started Zytiga. So I think that qualifies as the kitchen sink protocol.

For initial detection we need to start pressing doctors for this:

ncbi.nlm.nih.gov/pmc/articl...

In my case...initial PSA probably saved me from a worse fate. When my primary referred me to Urology to discuss a biopsy, etc. (PSA 3.8 and blood in semen, enlarged Prostate and history of undifferentiated cells).. Urology Dept. Head talked me out of a biopsy. 18 months later at 4.6 PSA...and same symptoms...they tried again. Due to my PSA being over 4...I fought for it. Diagnosis from same Uro 2 weeksks later..* You got cancer and it is bad...it didn't happen overnight". Gleason 9...turned out to be T2N1M0...stage 4. Thank God I had PSA to hang my hat on.

Boywonder56 profile image
Boywonder56 in reply to JPnSD

It was blood in seamen that got my attention...psa was lil over 4....but went from 4 to 12.5 at dx 2 mos later..gl9 ductal cribiform/ hystology..

JPnSD profile image
JPnSD in reply to Boywonder56

And both my primary and urologist dismissed the blood in my semen as "nothing to worry about".

There is controversy about PSA but it does tell us about progression of PCa. Some patients choose to deny it as a marker. I want to know what my PSA is as frequently as possible. I know the meds I take lower it significantly. It has saved many lives.

Under treatment also kills. If my psa had been taken before I was 66 years old, I might not have Stage IV Prostate Cancer so soon. High psa led to biopsy, bone scan and cat scan. And then lupron, xgeva and 8 cycles chemo, 3 years and 8 months xtandi, etc. They didn't even count the bone mets, just said extensive. Abdominal mets went "away" immediately and I no longer soaked my pillow in sweat, urinating was no longer agony. I am sure my doctor of 17 years was having his psa monitored. Not monitoring psa is very simple: "You can pay me now, or you can pay me a lot more later."

TomTom1111 profile image
TomTom1111 in reply to monte1111

You did meet j-o-h-n. I think that evens out the negatives.

monte1111 profile image
monte1111 in reply to TomTom1111

I guess. I did meet j-o-h-n. The Joke Snatcher. Are you on his staff? He just can't possibly think up these groaners all by himself. Kaliber is probably involved. Did I tell you I got hammered?

TomTom1111 profile image
TomTom1111 in reply to monte1111

Hammered as in drunk or as in nailed?

I can't take any credit for j-o-h-n's jokes. Kaliber..that's the 64k?

monte1111 profile image
monte1111 in reply to TomTom1111

Hammered as in banished. Kaliber is either packing or has his hammer with him. The hammer is probably packing too. So, yeah.... .32 plus .32 equals .64 I'm glad you can't take any credit for j-o-h-n's jokes, you would probably be filing for bankruptcy.

TomTom1111 profile image
TomTom1111 in reply to monte1111

You did tell me you met the hammer 🔨. I didn't know your were banished? Was is nice where you were banished too?Did they offer covid discounts?

I did get a covid decal! I was banished to anywhere but their vicinity. I think it was the "have ice chest, will travel" and the "I'll bring my lawn chair and we can swill brew in your front yard" that did it. I didn't say anything despicable like "Hey, I'll bring some cottage cheese over"

TomTom1111 profile image
TomTom1111 in reply to monte1111

Well you can swill beer and eat cottage cheese on my front yard. You'll make a nice lawn ornament

monte1111 profile image
monte1111 in reply to TomTom1111

Nowhere near the lawn g-n-o-m-e or the lawn j-o-h-n please.

j-o-h-n profile image
j-o-h-n in reply to monte1111

A room full of Capuchin monkey comedy writers...No one else....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 04/30/2021 11:42 PM DST

monte1111 profile image
monte1111 in reply to j-o-h-n

All that organ grinding must drive you crazy. Pun unintended.

j-o-h-n profile image
j-o-h-n in reply to monte1111

Pun well taken.

youtube.com/watch?v=cn8kN0y...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/01/2021 5:06 PM DST

monte1111 profile image
monte1111 in reply to j-o-h-n

Congratulations. Your monkee's are grinding it out as usual. Congrats to the grinder who kept a straight face. You made me a believer.

TomTom1111 profile image
TomTom1111 in reply to monte1111

You 2 need to serve up popcorn with this Circus act 🎪.

monte1111 profile image
monte1111 in reply to TomTom1111

Just lost $100 on the Kentucky Derby. One more item off the bucket list. I actually feel good. The popcorn is later.

TomTom1111 profile image
TomTom1111 in reply to monte1111

Well. I know you didn't pick the winner. Which horse did Monte have his 100 riding on?

monte1111 profile image
monte1111 in reply to TomTom1111

Known Agenda. Will be Unknown Agenda soon.

TomTom1111 profile image
TomTom1111 in reply to monte1111

Too bad the horse's name wasn't Monkey Grinder

monte1111 profile image
monte1111 in reply to TomTom1111

Clicking like doesn't seem to work anymore. Oh, well.

TomTom1111 profile image
TomTom1111 in reply to monte1111

It is acting weird...I'd say there was a gremlin at work but j-o-h-n in on this site.

Is it me or does the wife of that guy( Joe Tillotson) who just passed look a a dead ringer for Monica Lewinski?

monte1111 profile image
monte1111 in reply to TomTom1111

She was stunningly beautiful. I remember Monica as a Plain Jane with a Stain.

TomTom1111 profile image
TomTom1111 in reply to monte1111

Monica today, not 1997

monte1111 profile image
monte1111 in reply to TomTom1111

Yes she does. BillBill111111111111111111111 was very busy.

TomTom1111 profile image
TomTom1111 in reply to monte1111

At our expense.

monte1111 profile image
monte1111 in reply to TomTom1111

It was better than t.v. O.K. I didn't watch t.v. back then. It was about then, any sane man decided not to accept the presidency. Hey Teachers, leave those kids alone.....

TomTom1111 profile image
TomTom1111 in reply to monte1111

There is something wrong with this we-site...likes don't work and replies aren't getting linked with the post.

TomTom1111 profile image
TomTom1111 in reply to monte1111

Replies are acting goofy too

After a refresh, it renders correctly...same with likes

monte1111 profile image
monte1111 in reply to TomTom1111

j-o-h-n is hacking us

TomTom1111 profile image
TomTom1111 in reply to monte1111

It's not a gremlin. Process of elimination.

I tried to make a chart superimposing my white blood cells over PSA, this is best I can do. But it shows quite conclusively, that in my case, they are unrelated. It seems they were related back in 2015, both rising similarly, but upon taking Lupron with Casodex in Jan-Jun 2016, both PSA and WBC fell to <.01 and normal. But as PSA rose, somewhat exponentially, while on vacation, WBC did not. I can only explain that was due to my high lycopene diet, (which had limited or no effect on PSA), which I began in earnest at about Jan. 2016. The later Lupron shots were with Xtandi, also Ogavix pills with Xtandi since Feb. Will test again in Mid-May.

chart PSA vs. WBC

oh...back on topic.....that was just starting to get good.....j-o-h-n....as a organ grinding lawn ornament....and the hammers chasing kal ...yellling " you traded my lawn jockey for what"

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