Re: 12 months PSA doubling time

[Guest guest]

** FWIW there are some comments inline. Sammy.

12 months PSA doubling time

>

>

> Hi everyone,

> I'm new to the group and don't even know whether I have PC. A

little

> more than two years ago, a routine physical revealed a PSA of 0.2

> ng/ml and a normal prostate as felt through DRE. Last week I had

> another physical and the DRE is also normal but the PSA has

increased

> to 0.9 ng/ml. The lab. and testing method is the same as last

time.

> My doctor isn't concerned but I am since the PSA doubling time

> (PSADT) is 12 months. My doctor didn't even care to compare the

> results of the recent physical to those of the last one. I have

read

> that PSADT is an important predictor of PC and have made an

> appointment to see a urologist. Besides, my father died of

> metastized PC at age 67. Can anyone give me advice of what

> else I should do? Should I dismiss the PSADT or investigate other

> possible causes?

>

> A little more info about me: I'm 41, 170cm, 51kg and take

wellbutrin

> 300mg/day for depression, temazepam 15mg/day for insomnia and

inject

> forteo daily for osteoporosis. I also take 5mg proscar/week to

> prevent hairloss. I have had hyperthyroidism and have been taking

> 0.2mg levothyroxine since 1995 to keep my TSH supressed. Recently,

my

> sex hormone levels were:

>

> Free T: L 3.3 ng/Dl (5-21)

> total T: H 893 ng/DL (241-827)

> Estradiol: 47 pg/ml (0-53)

> DHT: H 411.1 ng/Dl (25-99)

>

> Any input will be greatly appreciated.

> -ltkpn

>

>

>

>

>

>

[Guest guest]

Wow! Thank you very much. You know so much about PC and I saw that

your book has 5 stars on amazon. If the fast PSA velocity is not

proven to be unrelated to PC, it will be the first book on the topic

I'll read.

I saw the urologist today. I told him about the PSADT and about the

fact that I have to urinate frequently and sometimes with difficulty

although there is no pain. He made a DRE and told me that my

prostate is very small, way too small for me to suffer from BPH. He

wants to look inside my penis and at my bladder through some kind of

endoscopy. I should have asked him for the exact name of the

procedure, but the appointment went too fast. The procedure has been

scheduled for October 7 since he only does them on Thursday AM and I

will be on travel on each previous Thursday. He says he wants to

look for scar tissue that may cause my urination problems.

As far as the PSA is concerned, he ordered me to have it redone. I

made sure the blood sample will go to Quest diagnostics since that is

where the other two samples were titrated. I asked him about free

PSA testing and he told me, just as you told me in your reply, that

this test is only useful if PSA > 4ng/ml.

I should have asked him for a more accurate description of my

prostate size than " very small " . I will call to ask whether he had

guestimated the gland volume. I don't know how good this urologist

is. The appointment went quickly and I almost forgot to tell him

about the proscar. Is 5mg/week enough to alter the PSA reading?

Isn't the 50% rule of thumb only good for higher doses? I made sure

to tell him about my father's death from metastasized PC and he seems

to be taking it seriously.

I live in suburban land, near Washington DC. If it turns out I

have or am likely to have PC, I will want to see the best

specialist. With the NIH nearby, I assume there must be a good PC

specialist in the area. Can you please recommend one?

When the repeat PSA comes back, I'll ask the urologist whether I

should go on the antibiotic course. It's too bad my internist

neglected to order

a PSA last year. Assuming that the 0.9 ng/ml reading is confirmed, I

can't be sure whether the 0.2 reading of 2 years ago can be trusted.

Whatever the latest test says, I will want to have an estimate of my

prostate volume to check it against the 0.067 rule.

Regards

-ltkpn

> Well you're right on top of this despite being young, and it's a

good thing

> too since you have your family history as a risk factor.

>

> You're right to be concerned about a twelve month doubling time for

PSA.

> There is an aggressive form of prostate cancer that expresses very

little

> PSA, so the readings look normal even if disease is present. Your

negative

> DRE is encouraging, but some cancers do develop in regions of the

prostate

> that are not accessable via DRE, so this would certainly be

inconclusive in

> light of a steadily rising PSA.

>

> I would ask the doctor you're seeing to recheck the PSA using the

same assay

> and see if the elevation is due to lab error or other possible

situational

> variations.

>

> You would want to be tested to rule out elevation due to a bladder

> infection. Your urologist should know this, but so should you.

>

> You might want to consider a six week course of Cipro or other

antibiotic to

> rule out prostatitis, then recheck the PSA.

>

> If you can figure out the size of your prostate gland you could

calculate

> the amount of PSA that a prostate gland of your size would be

entitled to

> produce. You would multiply your gland size in cc's determined

ideally by

> endorectal MRI rather than by guestimate from DRE, by .066 to get

the amount

> of benign PSA. If you subtract the benign PSA from the total PSA,

you would

> get the amount of PSA that would be presumed to be produced by a

malignant

> process until proven otherwise. Enlarged glands produce more

normal PSA

> than small glands, so this could be useful information. You would

not be

> able to factor in the PSA leak since you have no Gleason score, but

if you

> did obtain a Gleason score via biopsy, validated by an expert in

prostate

> cancer pathology, you could do that calculation as well. This

information

> is in the Tools on the PCRI (Prostate Cancer Research Institute)

website at

> http://www.pcri.org.

>

> If your PSA was between four and ten, I would also ask that a free

PSA

> percentage test be done on the same blood sample. This may help to

> determine whether or not a biopsy is warranted. But at your low

level, it

> remains to be seen how relevant these results would be.

>

> I would chart your PSA's and if there is a steady upward climb,

keep track

> of the PSA doubling time and velocity. Rather than a biopsy right

now, you

> might want to have a color-doppler ultrasound or endorectal MRI

with or

> without spectroscopy to see if there is anything suspicious to

biopsy. Dr.

> Fred Lee in Michigan and Dr. Duke Bahn in Ventura, California are

expert

> ultrasonographers. Dr. Lee will biopsy only specific areas where

he sees

> something that might be a malignancy. MRI with spectroscopy is

available at

> UCSF. (But I'm told that at some facilities, you need to have had a

> previous negative biopsy before you can request these imaging

tests, and

> other facilities restrict the use of the equipment to patients who

are

> scheduled for treatment in their facilities.)

>

> If you do get to the point of having a biopsy, you need to be aware

that the

> material the pathologist looks at is likely to be distorted due to

your use

> of proscar. This makes prostate cancer found in biopsy samples

look more

> aggressive because of the way glandular tissue tends to cascade

when proscar

> or other androgen deprivation medications cause cells to die. The

more

> unlike normal glandular patterns look under the microscope, the more

> aggressive the cancer. You will have a variable to factor in when

the

> pathologist makes his subjective judgment, provided any malignancy

is found.

> You need to be sure to get a review by a pathologist who is expert

in

> analyzing this sort of biopsy sample and make sure that the

pathologist is

> made aware of your use of proscar.

>

> Let us know how this comes out.

>

> Donna Pogliano

> Co-author of " A Primer on Prostate Cancer, The Empowered Patient's

Guide "

>

> 12 months PSA doubling time

>

>

>

> Hi everyone,

> I'm new to the group and don't even know whether I have PC. A

little

> more than two years ago, a routine physical revealed a PSA of 0.2

> ng/ml and a normal prostate as felt through DRE. Last week I had

> another physical and the DRE is also normal but the PSA has

increased

> to 0.9 ng/ml. The lab. and testing method is the same as last

time.

> My doctor isn't concerned but I am since the PSA doubling time

> (PSADT) is 12 months. My doctor didn't even care to compare the

> results of the recent physical to those of the last one. I have

read

> that PSADT is an important predictor of PC and have made an

> appointment to see a urologist. Besides, my father died of

> metastized PC at age 67. Can anyone give me advice of what

> else I should do? Should I dismiss the PSADT or investigate other

> possible causes?

>

> A little more info about me: I'm 41, 170cm, 51kg and take

wellbutrin

> 300mg/day for depression, temazepam 15mg/day for insomnia and

inject

> forteo daily for osteoporosis. I also take 5mg proscar/week to

> prevent hairloss. I have had hyperthyroidism and have been taking

> 0.2mg levothyroxine since 1995 to keep my TSH supressed. Recently,

my

> sex hormone levels were:

>

> Free T: L 3.3 ng/Dl (5-21)

> total T: H 893 ng/DL (241-827)

> Estradiol: 47 pg/ml (0-53)

> DHT: H 411.1 ng/Dl (25-99)

>

> Any input will be greatly appreciated.

> -ltkpn

>

>

>

>

>

>

>

>

>

[Guest guest]

ltkpn--- I live in laurel, had a nsrp in January at Hopkins. If you wish to talk drop me a line.

Brad

> >Reply-To: ProstateCancerSupport >To: ProstateCancerSupport >Subject: Re: 12 months PSA doubling time >Date: Fri, 10 Sep 2004 22:38:06 -0000 > >Wow! Thank you very much. You know so much about PC and I saw that >your book has 5 stars on amazon. If the fast PSA velocity is not >proven to be unrelated to PC, it will be the first book on the topic >I'll read. > >I saw the urologist today. I told him about the PSADT and about the >fact that I have to urinate frequently and sometimes with difficulty >although there is no pain. He made a DRE and told me that my >prostate is very small, way too small for me to suffer from BPH. He >wants to look inside my penis and at my bladder through some kind of >endoscopy. I should have asked him for the exact name of the >procedure, but the appointment went too fast. The procedure has been >scheduled for October 7 since he only does them on Thursday AM and I >will be on travel on each previous Thursday. He says he wants to >look for scar tissue that may cause my urination problems. > >As far as the PSA is concerned, he ordered me to have it redone. I >made sure the blood sample will go to Quest diagnostics since that is >where the other two samples were titrated. I asked him about free >PSA testing and he told me, just as you told me in your reply, that >this test is only useful if PSA > 4ng/ml. > >I should have asked him for a more accurate description of my >prostate size than "very small". I will call to ask whether he had >guestimated the gland volume. I don't know how good this urologist >is. The appointment went quickly and I almost forgot to tell him >about the proscar. Is 5mg/week enough to alter the PSA reading? >Isn't the 50% rule of thumb only good for higher doses? I made sure >to tell him about my father's death from metastasized PC and he seems >to be taking it seriously. > >I live in suburban land, near Washington DC. If it turns out I >have or am likely to have PC, I will want to see the best >specialist. With the NIH nearby, I assume there must be a good PC >specialist in the area. Can you please recommend one? > >When the repeat PSA comes back, I'll ask the urologist whether I >should go on the antibiotic course. It's too bad my internist >neglected to order >a PSA last year. Assuming that the 0.9 ng/ml reading is confirmed, I >can't be sure whether the 0.2 reading of 2 years ago can be trusted. >Whatever the latest test says, I will want to have an estimate of my >prostate volume to check it against the 0.067 rule. >Regards >-ltkpn > > > > > > > > Well you're right on top of this despite being young, and it's a >good thing > > too since you have your family history as a risk factor. > > > > You're right to be concerned about a twelve month doubling time for >PSA. > > There is an aggressive form of prostate cancer that expresses very >little > > PSA, so the readings look normal even if disease is present. Your >negative > > DRE is encouraging, but some cancers do develop in regions of the >prostate > > that are not accessable via DRE, so this would certainly be >inconclusive in > > light of a steadily rising PSA. > > > > I would ask the doctor you're seeing to recheck the PSA using the >same assay > > and see if the elevation is due to lab error or other possible >situational > > variations. > > > > You would want to be tested to rule out elevation due to a bladder > > infection. Your urologist should know this, but so should you. > > > > You might want to consider a six week course of Cipro or other >antibiotic to > > rule out prostatitis, then recheck the PSA. > > > > If you can figure out the size of your prostate gland you could >calculate > > the amount of PSA that a prostate gland of your size would be >entitled to > > produce. You would multiply your gland size in cc's determined >ideally by > > endorectal MRI rather than by guestimate from DRE, by .066 to get >the amount > > of benign PSA. If you subtract the benign PSA from the total PSA, >you would > > get the amount of PSA that would be presumed to be produced by a >malignant > > process until proven otherwise. Enlarged glands produce more >normal PSA > > than small glands, so this could be useful information. You would >not be > > able to factor in the PSA leak since you have no Gleason score, but >if you > > did obtain a Gleason score via biopsy, validated by an expert in >prostate > > cancer pathology, you could do that calculation as well. This >information > > is in the Tools on the PCRI (Prostate Cancer Research Institute) >website at > > http://www.pcri.org. > > > > If your PSA was between four and ten, I would also ask that a free >PSA > > percentage test be done on the same blood sample. This may help to > > determine whether or not a biopsy is warranted. But at your low >level, it > > remains to be seen how relevant these results would be. > > > > I would chart your PSA's and if there is a steady upward climb, >keep track > > of the PSA doubling time and velocity. Rather than a biopsy right >now, you > > might want to have a color-doppler ultrasound or endorectal MRI >with or > > without spectroscopy to see if there is anything suspicious to >biopsy. Dr. > > Fred Lee in Michigan and Dr. Duke Bahn in Ventura, California are >expert > > ultrasonographers. Dr. Lee will biopsy only specific areas where >he sees > > something that might be a malignancy. MRI with spectroscopy is >available at > > UCSF. (But I'm told that at some facilities, you need to have had a > > previous negative biopsy before you can request these imaging >tests, and > > other facilities restrict the use of the equipment to patients who >are > > scheduled for treatment in their facilities.) > > > > If you do get to the point of having a biopsy, you need to be aware >that the > > material the pathologist looks at is likely to be distorted due to >your use > > of proscar. This makes prostate cancer found in biopsy samples >look more > > aggressive because of the way glandular tissue tends to cascade >when proscar > > or other androgen deprivation medications cause cells to die. The >more > > unlike normal glandular patterns look under the microscope, the more > > aggressive the cancer. You will have a variable to factor in when >the > > pathologist makes his subjective judgment, provided any malignancy >is found. > > You need to be sure to get a review by a pathologist who is expert >in > > analyzing this sort of biopsy sample and make sure that the >pathologist is > > made aware of your use of proscar. > > > > Let us know how this comes out. > > > > Donna Pogliano > > Co-author of "A Primer on Prostate Cancer, The Empowered Patient's >Guide" > > > > 12 months PSA doubling time > > > > > > > > Hi everyone, > > I'm new to the group and don't even know whether I have PC. A >little > > more than two years ago, a routine physical revealed a PSA of 0.2 > > ng/ml and a normal prostate as felt through DRE. Last week I had > > another physical and the DRE is also normal but the PSA has >increased > > to 0.9 ng/ml. The lab. and testing method is the same as last >time. > > My doctor isn't concerned but I am since the PSA doubling time > > (PSADT) is 12 months. My doctor didn't even care to compare the > > results of the recent physical to those of the last one. I have >read > > that PSADT is an important predictor of PC and have made an > > appointment to see a urologist. Besides, my father died of > > metastized PC at age 67. Can anyone give me advice of what > > else I should do? Should I dismiss the PSADT or investigate other > > possible causes? > > > > A little more info about me: I'm 41, 170cm, 51kg and take >wellbutrin > > 300mg/day for depression, temazepam 15mg/day for insomnia and >inject > > forteo daily for osteoporosis. I also take 5mg proscar/week to > > prevent hairloss. I have had hyperthyroidism and have been taking > > 0.2mg levothyroxine since 1995 to keep my TSH supressed. Recently, >my > > sex hormone levels were: > > > > Free T: L 3.3 ng/Dl (5-21) > > total T: H 893 ng/DL (241-827) > > Estradiol: 47 pg/ml (0-53) > > DHT: H 411.1 ng/Dl (25-99) > > > > Any input will be greatly appreciated. > > -ltkpn > > > > > > > > > > > > > > > > > >

[Guest guest]

> ltkpn--- I live in laurel, had a nsrp in January at Hopkins. If

you wish to talk drop me a line.

> Brad

Brad,

Thanks. It's good to know someone in the area. I'm in College

Park, working at NASA GSFC.

-ltkpn