PSA Value Confusion

[GSDF]

Hello friends -

I'm a bit confused with PSA values. I know that clinically, for my age, with prostate gland fully intact the "normal" reading for PSA is considered normal at <4.

I started out with a very high PSA at dx with 480 but after 6 months of Degaralix and now going on nearly 6 months Xtandi, I'm down to PSA of 2.

Instinctively, I feel that I should be continuing and knocking it all the way down to "undetectable". However, my common sense is seemingly suggesting to me that perhaps by having my prostate gland still fully intact and now my PSA being below the "normal" reading of 4 or less, that perhaps the PSA I have now of 2 is actually below "normal" for me because that reading could solely be coming from the prostate tissue of the gland itself and not cancer? If so, am I fighting nature by continuing with trying to suppress a normal reading? Would a scan help determine this?

[Hidden]

Hello GSDF! I too ,still have a prostate ..mines been radiated and stripped of all testosterone for over seven yrs . Psa<.1 and 3 T ,only. 4.0 Psa is for a normal man without pc . My high Psa was 20 .. you’ve made a great drop. Keep kicking it . I too would do what’s needed to go under the wire now . I hate this blasted numbers game that we all play ! Good luck ! ✌️

[MrG68]

Normal isn’t a word I’d be using tbh. Some people have PCa with below 4 and some people don’t have PCa around 10! People are different. The test itself is subject to all kinds of errors which compounds the confusion of a single absolute value. There’s also MULTIPLE reasons why the PSA can be higher or lower giving misleading absolute values.

Consider monitoring a time series of psa values and draw a best fit line. IMO that will give you a much better indication of the PCa. The gradient of the line should be a better representation.

Edit: I think it’s worth pointing out that the value of 4 was made up arbitrarily for people with prostates so they could screen them. Regardless of your stage or whatever, you will have a psa value. There may be cases after some treatments where it’s so low that it’s not detectable. Having your PSA stay stable and not increase is a win scenario. You could have a very high PSA but of it never increased that indicates the cancer is not progressing. Your aim should be to die with it as opposed to from it.

[Tall_Allen]

The "normal" reading you are quoting is for untreated men without PCa, it doesn't apply to you. Degarelix+Xtandi would bring your PSA down to undetectable levels if your only sources of PSA were benign prostate tissue and hormone-sensitive PCa. Unfortunately, some of your PCa is no longer hormone sensitive, so it soon may be time to move onto other systemic therapies like docetaxel or Xofigo or both. Discuss with your oncologist.

[Schwah in reply to Tall_Allen]

I know what you say is true because I have 60% of a healthy prostate and I’ve twice used Zytega and Lupron to get to .02 PSA. What I do not understand is why those drugs wipe out PSA from benign prostate tissue. It doesn’t seem logical to me.

Schwah.

[Tall_Allen in reply to Schwah]

If your prostate were completely healthy, PSA would be undetectable in serum, as it is in an 18 year old man. PSA is expressed by all prostate tissue. But it only detected in serum when there is some abnormal occurrence like inflammation, overgrowth of tissue or veins, mechanical disruption from urinary retention, bike riding or sex, or cancer. Hormone therapy prevents AR activation, so that prostate tissue (benign or cancer) can't grow. When it can't grow, it atrophies from disuse. Less tissue and less abnormal tissue ->less PSA.

[GSDF in reply to Tall_Allen]

Oh is that right.... Interesting....

[tango65]

Request radiographic studies to see if there is progression of the cancer. If there is you will have to discuss further treatment.

[GSDF]

I see!....I thank y'all for your time and input!

Blessings

GSDF

[Huzzah1]

I have never had a "High" PCA reading. My PCA was 3.5 at the time of DX with G9 and mets to local lymph nodes. It came down to .1 within 2 months of starting ADT.

[GSDF in reply to Huzzah1]

Oh my! ... Thank you for this Huz..

[Scout4answers]

I think a PSMA a scan would give you the answer you are seeking.