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Re: Recurrence

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Hello Bruce, I'm sorry to hear. I dont have an answer, but your post made me wonder - I have to ask, how can a person have a PSA with no P ?Bruce wrote: Had my Prostate removed in 1999,then did radiaton, PSA now up to .40 so it appears to have come back. Going in for a cat scan this week. Anyone had experience or knowledge on what type of treament options I may be facing? Thanksb

The more people I meet, the more I like my dog. __________________________________________________

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Hi Bruce: I had the prostatectomy in August 1998 with no radiation

afterwards. By March 2004, the PSA had " creeped " back up to .30 and at

that time my doctor started me on daily, 50 mg of Casodex. The PSA

almost immediately fell back to <0.10 and remained at that level so in

October 2005 the doctor stopped the Casodex. My last PSA in March 2006

showed a rise to 0.16 - my next PSA test will be in Sept 06. Whether

the doctor will want me to go back on the Casodex or something else

will be determined at that time, based on my situation. I am

optimistic that the March result was just a variation in the test. I

feel great.

Good luck.

> Had my Prostate removed in 1999,then did radiaton, PSA now up to .40

> so it appears to have come back. Going in for a cat scan this week.

> Anyone had experience or knowledge on what type of treament options I

> may be facing?

>

> Thanks

>

> b

>

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Hi

Good question, there are only two things that produce PSA, the Prostate Gland, or cancerous tumors that once were in there.

My goal is to be the kind of person my dog thinks I am.

Thanks

b

Re: Recurrence

Hello Bruce, I'm sorry to hear. I dont have an answer, but your post made me wonder - I have to ask, how can a person have a PSA with no P ?Bruce wrote:

Had my Prostate removed in 1999,then did radiaton, PSA now up to .40 so it appears to have come back. Going in for a cat scan this week. Anyone had experience or knowledge on what type of treament options I may be facing? Thanksb

The more people I meet, the more I like my dog.

__________________________________________________

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It normally means that the prostate cancer has metastasized to some

other area of the body. The PSA comes from that tumor.

Kathy

Re: Recurrence

Hello Bruce, I'm sorry to hear. I dont have an answer, but your post

made me wonder - I have to ask, how can a person have a PSA with no P ?

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>

> Had my Prostate removed in 1999,then did radiaton, PSA now up to .40

> so it appears to have come back. Going in for a cat scan this week.

> Anyone had experience or knowledge on what type of treament options I

> may be facing?

>

> Thanks

>

> b

>

PSA Alternative Names. prostate specific antigen test. Definition. The

PSA test is a blood test that is used to screen for the presence of

prostate cancer. Prostate specific antigen is a protein found in the

fluid portion of blood, called serum. ... The inflammation from

prostatitis causes PSA to leak into the bloodstream. This causes the PSA

level to be higher

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>

> Had my Prostate removed in 1999,then did radiaton, PSA now up

to .40

> so it appears to have come back. Going in for a cat scan this week.

> Anyone had experience or knowledge on what type of treament options

I

> may be facing?

>

> Thanks

>

> b

>

PSA

Alternative Names

prostate specific antigen test

Definition

The PSA test is a blood test that is used to screen for the presence

of prostate cancer. Prostate specific antigen is a protein found in

the fluid portion of blood, called serum. PSA is specific to the

prostate. No other human tissue or body part can make it. PSA levels

can be measured in an individual's serum. With this information,

doctors are able to screen for prostate cancer.

PSA is only present in men. PSA is present in all normal prostate

tissue. The normal prostate cell holds onto most of the PSA. Very

little leaks into the bloodstream. The small amount that leaks out is

what is measured by the blood test. Prostate cancer cells actually

have less PSA in each cell. However, the cancer cell tends to leak

more PSA into the bloodstream. Knowing this fact, experts developed a

range of expected values in patients with a normal prostate gland.

The PSA value should be less than 4.0. This number reflects the

belief that most men, roughly 95%, with normal prostate glands have a

PSA value of 4.0 or less. (See below for age-specific normal values.)

Almost any condition that affects the prostate can make the PSA rise.

Who is a candidate for the test?

The American Cancer Society and the American Urological Association

recommend that men over age 50 have a yearly PSA. They should also

have a rectal examination of the prostate. High-risk groups should

begin screening at age 40 to 45. Men with a family history of the

disease and African Americans fall into this category.

How is the test performed?

A simple blood test is all that is needed.

What is involved in preparation for the test?

If possible, the patient should not ejaculate for 48 hours before a

PSA test. If ejaculation has occurred and the PSA is elevated, it

might be necessary to repeat the test.

Infections or inflammation of the prostate gland, called prostatitis,

can also elevate PSA levels. Therefore, patients need to inform their

doctors of any urinary symptoms that might exist. These may include

pain with urination, urgency to urinate or discharge from the penis.

The inflammation from prostatitis causes PSA to leak into the

bloodstream. This causes the PSA level to be higher than normal.

Some patients will experience a rise in PSA if the test is taken

after a simple rectal exam. If this is the case, the PSA test may

have to be repeated.

The most common noncancerous cause of elevated PSA levels is benign

prostate hyperplasia (BPH). As men age, the prostate normally

enlarges. This becomes more apparent after age 50. The most common

symptom with BPH is difficulty urinating. About 80% of men will

develop some symptoms of BPH in their lifetime. BPH is not cancer and

will not lead to cancer. However, BPH may cause a false elevation of

PSA values.

What do the test results mean?

When evaluating PSA results, the doctor must also take into account

the results of the rectal exam, the patient's age, previous PSA

results, and prostatic size. For example, findings on a rectal exam

must be looked into even if the PSA result is normal.

Recent studies have suggested that the 4.0 level may be too high for

younger men and too low for older men. Many researchers now use the

following levels rather than the 4.0 used in the past. However, more

time is needed to assure that these levels are more accurate.

age 40 to 50, normal range is 0 to 2.5

age 50 to 60, normal range is 0 to 3.5

age 60 to 70, normal range is 0 to 4.5

age 70 to 80, normal range is 0 to 6.5

If the rectal exam is normal then the following recommendations are

suggested:

PSA of 4 or less. If the PSA level has been measured for the first

time and is less than 4, repeat testing is recommended on a yearly

basis. (This number may be dependent on age. See above for normal

values).

PSA between 4 and 10. If the PSA level is greater than 4 but less

than 10, a diagnostic ultrasound of the prostate is recommended. If

the ultrasound shows no suspicious areas, the prostate can be

monitored through regular testing and exams. Another option is to

take random biopsies from various parts of the prostate. If

observation alone is used, the PSA should be repeated in 4 to 6

months and no later than a year. If the ultrasound shows a suspicious

area, then biopsy of the area needs to be performed. This can be done

at the time of the ultrasound. The patient will need to take

antibiotics ahead of time.

PSA greater than 10. If the PSA is greater than 10, diagnostic

ultrasound of the prostate with biopsies is the recommended course.

If the ultrasound shows no suspicious areas, then random biopsies of

the prostate are taken. If the ultrasound shows suspicious areas,

then biopsies of the areas along with random biopsies need to be done.

If previous PSA values are available, test results will be evaluated

differently. The PSA level almost always rises if cancer is growing.

Any PSA level that is rising is suspicious. However, a high PSA level

may not mean that cancer is present. For example, a male with a

stable PSA of 8 over a three-year period (8,8,8) is probably at less

risk than a male with a PSA of 2, 4, and 6 over the same time frame.

This is because the second patient's rising levels suggest growth.

This makes it suspicious for cancer. If the first patient had a

negative biopsy when the first high PSA value occurred, there may be

no need to repeat the biopsies. If the PSA level jumped to 10 or 15

for no apparent reason, then repeat ultrasound and biopsies would be

called for. Recent studies suggest that either a 20% rise or a

measurable rise of 0.75 in PSA in one year should prompt a closer

look. Ultrasound and biopsy may be needed.

Author: T. Moran, MD

Date Written: 01/14/00

Reviewer: Eileen McLaughlin, RN, BSN

Date Reviewed: 05/04/01

Contributors

Potential conflict of interest information for reviewers available on

request

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