Hello everyone. This community has provided vital info that has helped in my father's treatment, for which I am eternally grateful.
I have a question about undetectable PSA. What is the ideal PSA value for someone who still has his prostate to declare that someone is in complete remission.
I know PSA is just one aspect and there are other factors involved, but still, what should be the ideal value?
My father's current PSA: 0.414 ng/ml
If your father gets hormone therapy, this PSA value does not indicate complete remission. It just shows that the ADT is working.
A PSMA PET/CT will show whether there is any detectable tumor.
Thank you for asking romil, because I have the same question. I chose RT over RP. My psa seems to be leveling out at .10. My question is, should those of us who still have our prostate expect to land on a higher nadir than someone who has had RP?
Expectation with successful RP is PSA is undetectable. For us RT folks it’s complicated if we are also are on ADT. We will not truly know our nadir until we complete ADT. You will have some residual PSA one you reach your stable nadir post ADT and to add to the fun you may see a PSA bounce as your PSA stabilizes to your new PSA normal.
Tall_Allen can you please provide some info here?
My own understanding is that any specific "ideal value" (which may vary from man to man, with or without prostate intact) is far less important than how PSA moves over time, and how fast it moves.
[Realize, too, there are rarer forms of PC that do not express PSA. So the duration of remission cannot reliably be predicted by PSA readings alone.]
My analogy would be, looking at the thermometer at any given moment may tell you how comfortable or uncomfortable the air temp is right now, but the value you read in no way constitutes anything close to a weather forecast!
Lower is better of course. But you haven't given any info by which anyone can answer your question. What is his current diagnosis? What treatments has he had in the past? What is he taking currently?
In my case after four treatments at the university of Heidelberg of AC-225 and LU-177 my PSA has been <o.o14 for fourteen months without any ADT. But PSMA and Axumin scans show some uptake in the prostate and a small spot outside. Recommended treatment by a RO is radiation ( of course ), high T by OC and when do I start ADT again ? Doing new blood test this wend. Should I wait for signs of progression or take some action now. Feels great no ADT. Thanks
If you have new radiographic progression, that would be a good time to end your vacation.
Someone who has fully intact Prostate the ideal PSA need not be 0.2 or less. Even if you have prostate cancer, the normal cells in prostate still continues to secrete PSA general formula is : If prostate size is ..say 30 cc, PSA up to 3.0 can be considered OK.
In men ,who had Radiation, it gets difficult because we do not know what percentage of his Prostate has gotten burnt. So, if prostate tissue left unburnt is 50%, then divide by factor of 2, and that gives estimate of normal PSA.
There are men whose prostate cancer cells churn out lot of PSA. and then there are men whose prostate cancer cells produce little PSA. As a general rule, low PSA producing cancer cells are very deformed and thus, more aggressive. These low PSA producing cancer cells are civilians who left their normal jobs and became full time criminals ...on the other hand, ,high PSA producing cells are still doing their regular jobs with some mischievious activities on the side.
That is the explanation for men living longer even if they started with high PSA (sometimes in 100s or even 1000s. Men with very low PSA but lot of mets are ones whose life span is rather short. In nutshell, high PSA producing cancer cells are less aggressive than low PSA producing cancer cells.
For my sanity I'm going to start repeating that last paragraph and will follow with "that's my story and I'm sticking with it "! lol.
Although my high PSA (1621) at dx was probably a result of living with PC for many years before seeing a Dr.
Let me give you a bigger mantra "" It is not important how high PSA was initially.....what really matters is how low PSA falls in first year of ADT" Its well established that first year Nadir PSA is a very good prognostic sign.
There are men on this forum who started with 3000+ PSA and are still alive after many years...
Yes TTN (Time to Nadir) may be of prognostic value. Ideally over 12 months and a nadir <0.2
ncbi.nlm.nih.gov/pmc/articl...
ascopubs.org/doi/abs/10.120...
medscape.com/viewarticle/82...
goldjournal.net/article/S00...
In my case, the nadir hit in the Summer of 2017 at 0.1 from 840.2 in 12/01/2014 - made 7 years with the beast in me.
Live long and Prosper
Fight on
Randy
Yep, having been here a couple years I’ve been well aware of “the time to nadir”.
Since I didn’t do so well in that department, I try not to focus on it much. lol.
Initiation of Lupron and chemo brought me from PSA 1600 down to about 100 in about 5 or 6 months.
After about 8 months I got down to 8 or 9 and stayed there for almost a year before shot up to 40 and started Zytiga.
Been about 5 months on Zytiga and doing well. Last PSA 2.4 and of course I still have my prostate.
Is that your mantra or was it published somewhere?
I go by the "Lower nadir PSA value and longer time to nadir PSA after the initiation of PADT correlate with lower progression to CRPC and higher overall survival." found in one of the links dockam listed. Short version is the "tortoise vs the hare" (slow and steady)
are you saying that the PSA test is even less accurate for finding aggressive cancer......since more aggressive cells produce little PSA? are you sure about that? My understanding was that higher PSA values are related to greater chance of finding aggressive cancer??
Love the analogy...laymens terms
How aggressive a man's prostate cancer depends on many different factors.. not just PSA.Some important factors which indicate highly aggressive variants are (1) Gleason grade 8 or higher. (2) Presence of markers of neuro endocrine variant such as Chromogranin A, Neuron specific enolase etc. (3) Strong family history of prostate cancer (4) Presence Germline mutations such as BRCA 2, BRCA 1,ATM etc. (5) presence of visceral (organ) mets (6) PSA nadir higher than 4.0. (7) many comorbid medical conditions and low performance status. And many more factors.
The best method for diagnosing aggressive prostate cancer is the biopsy and that needs to be done with guidance. Mine was done using the system that the Brachy Boost uses.Then the samples are graded using the Gleason Scoring system. This looks at the actual cells to see how differentiated they are from normal prostate cells.
Scores in the 8, 9, 10 are aggressive. Often some samples will be lower than that but the number that doctors use are the high ones.
I am in my 7th year of aggressive pca, radiation, brachy boost, 24 months lupron. PSA NADIR was 0.18. 18th month off lupron psa rose to2.1. ADT for 20 months until it failed. Psa doubled twice in 3 months. Now on Nubeqa and psa 0.03 for two months in a row. (I have it testd monthly for peace of mind)
Gleason 9 with one small rib met on Dx. One yr of Lupron + Zytiga and Radiation. 1st yr off all treatment. Oncologist said if PSA hit 1, then we look to do something. He did say "since I still have a prostate, PSA should level off"
I would think .0000000000000000000000000000000000000000000000000001
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 12/03/2021 10:10 PM EST
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