Now I'm really scared

Everything has been going so well for me. Now I just received the call
that my 6 week post -surgical PSA is 1. They want me to wait 6 more
weeks (a total of 3 months) before we check it again. Has anyone else
had this same experience and is it possible my PSA will continue to
drop after 6 weeks?

Thank you.

Mike

11/2006 Diagnosed with PCa at age 55
PSA 13.8 Gleason 6 (3+3) T1c
Asymptomatic No incontinence or ED
da Vinci RLRP performed Feb 20 2007
Queen's Medical Center O'ahu Hawaii
Two separate, bilateral foci present
Less than 5% prostate involvement
Gleason 6 (3+3) All margins clear
Multiple foci high grade PIN present
Both nerves spared
Minimal incontinence/no ED post-op
4/3/07 PSA 1
5/15/07 PSA...

<Maui Mike> wrote in message
news:7ja613du22eo5trk6u6bfv6ff2rdbkbts3@4ax.com...
> Everything has been going so well for me. Now I just received the call
> that my 6 week post -surgical PSA is 1. They want me to wait 6 more
> weeks (a total of 3 months) before we check it again. Has anyone else
> had this same experience and is it possible my PSA will continue to
> drop after 6 weeks?

As I understand it, the purpose of excising the prostate in almost every
case is to excise the cancer completely from your system. As such, the
expectation is a PSA of < 0.1 in one assay or <0.04 in a more sensitive
assay. But, unless I miss my guess, that is an expectation at three months
post surgery.

You went into the surgery with at least a 13.8 PSA. Unless someone more
knowledgeable about it than I (Leonard, ron, Steve, and many more) says
otherwise, I would not worry until the 3-month mark.

Furthermore, I would call and ask for verification as to 1.00 or 0.10. Is
it possible she said "point one"? I only ask because that seems to be a
common issue with new cancer patients.

--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05
Non Illegitimi Carborundum

On Apr 4, 6:38 am, "Steve Kramer" <skra...@cinci.rr.com> wrote:

> As I understand it, the purpose of excising the prostate in almost every
> case is to excise the cancer completely from your system. As such, the
> expectation is a PSA of < 0.1 in one assay or <0.04 in a more sensitive
> assay. But, unless I miss my guess, that is an expectation at three months
> post surgery.

Are you saying that it can take a few months for the PSA to flush out
of his system?

-kh

On Wed, 4 Apr 2007 06:38:45 -0400, "Steve Kramer"
<skramer@cinci.rr.com> wrote:

>As I understand it, the purpose of excising the prostate in almost every
>case is to excise the cancer completely from your system. As such, the
>expectation is a PSA of < 0.1 in one assay or <0.04 in a more sensitive
>assay. But, unless I miss my guess, that is an expectation at three months
>post surgery.


I think that's right. I met my surgeon at one month to check the
pathology results and a "how are you feeling". The first PSA check
was at 3 months and no suggestion that this might have been earlier. I
think someone here mentioned the decline of existing PSA in the blood
and that this would presumably be expected to take a while to disperse
needing an entire body blood-change - maybe 3 months is a safer
margin.

"no ED post-op "

Mike, are you be serious? You can get a spontaneous erection w/o
Viagra or stimulation? That would be a medical first in my memory.
Good for you!

Bill Denton
RP 2/12/02
PSA 1.6
Memphis

Hello Mike,
PSA has an half-life elimination rate of 2 to 3 days. Based on your
PSA pre-surgery (13.8 ng/ml) your PSA 6 weeks after surgery should be
undetectable. That said, do not wait another 6 weeks and simply have
the first result rechecked to validate the result. Should the PSA
result of 1.0 ng/ml be validated there is a high probability that the
cancer has not been eradicated (in spite of a pristine pathology
report).

You have reason to be worried. Act now to validate the result and use
the information to ease your mind. In case of proven surgical failure,
use this time to plan your strategy, but no need for immediate action.
There is always the possibility that benign tissue was left behind and
in such case PSA could remain high but stable. Wish you and family the
very best outcome.

RalphV, KT7P
pcainaz.org/phpbb



On Apr 3, 9:35 pm, Maui Mike wrote:
> Everything has been going so well for me. Now I just received the call
> that my 6 week post -surgical PSA is 1. They want me to wait 6 more
> weeks (a total of 3 months) before we check it again. Has anyone else
> had this same experience and is it possible my PSA will continue to
> drop after 6 weeks?
>
> Thank you.
>
> Mike
>
> 11/2006 Diagnosed with PCa at age 55
> PSA 13.8 Gleason 6 (3+3) T1c
> Asymptomatic No incontinence or ED
> da Vinci RLRP performed Feb 20 2007
> Queen's Medical Center O'ahu Hawaii
> Two separate, bilateral foci present
> Less than 5% prostate involvement
> Gleason 6 (3+3) All margins clear
> Multiple foci high grade PIN present
> Both nerves spared
> Minimal incontinence/no ED post-op
> 4/3/07 PSA 1
> 5/15/07 PSA...

On Apr 4, 12:35 am, Maui Mike wrote:
> ...is it possible my PSA will continue to
> drop after 6 weeks?

I surely hope so. However, I'm pretty sure that I read that six weeks
was the length of time it took to flush out the PSA -- but I can't
find it here in my office. I have Scardino's book here, but he only
mentions that it should be all gone in a 'few weeks', whatever that
means -- probably not twelve.

Mike, are you sure that the number was 1 and not 0.1? That just seems
incredibly high. If yours was 13.8 before removal, and if PSA is
proportional to the size of the prostate tissue, then a PSA of 1 would
mean either that they missed about 7% of the prostate tissue (7% ~
1/13.8) or that you have a lot of metastates. Neither of those sound
very likely.

The other thing about that number is that PSA results are usually
reported as "emm-point-enn" -- like 1.7 or 3.2 or something like
that. "1" without a point after it sounds odd.

You should give the uro a call and verify that result. And please let
us know. You and I are in the same cohort, so I'm rooting for you.

--charlie

<Maui Mike> wrote in message news:7ja613du22eo5trk6u6bfv6ff2rdbkbts3@4ax.com...

> ... my 6 week post -surgical PSA is 1. They want me to wait 6 more
> weeks (a total of 3 months) before we check it again. ...

Rats! That's not what anyone likes to hear.

As others have said, 1 is too high.

It is my understanding that radiation should not be
performed until several months after surgery because
the tissues won't heal properly from the surgery if
they are radiated too soon.

The fact that the margins were clear is also a little
disturbing. It might mean that the remaining prostate
tissue is elsewhere in the body. This is something to
ask about.

The best hope at this time may be that the surgeon
didn't do a great job and left some prostate tissue
behind in the prostate itself. It happens quite often
I think. If that happened, then there is a decent chance
that radiation will kill it.

I think it is a good idea to start now to line up a
radiation oncologist and get in the schedule for
treatment. If it takes a month or two to schedule
it, then you might be able to start the process now
and abort it if something happens to change your
mind (a drop in PSA or definite evidence of metastasis.)

Maybe you can ask for advanced testing, like the PET
scans that people are saying can detect metastatic
cancer before a bone scan can.

I know that this is frightening as hell, but no matter
what happens or how badly it turns out, you've still
got a bunch of years ahead of you, and there are
still a bunch of treatment options, even for metastatic
cancer, that might give you a bunch more, and the
number of treatment options seems to increase every
year or so.

Best of luck.

Alan

"ralphv" <ralphv_in_az@yahoo.com> wrote in message
news:1175698001.699059.73480@y80g2000hsf.googlegro ups.com...
> Hello Mike,
> PSA has an half-life elimination rate of 2 to 3 days. Based on your
> PSA pre-surgery (13.8 ng/ml) your PSA 6 weeks after surgery should be
> undetectable.

Well, that blows that theory out of the water.





--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05
Non Illegitimi Carborundum

"kh" <tchtic@yahoo.com> wrote in message
news:1175683446.245551.27110@n59g2000hsh.googlegro ups.com...
> On Apr 4, 6:38 am, "Steve Kramer" <skra...@cinci.rr.com> wrote:
>
>> As I understand it, the purpose of excising the prostate in almost every
>> case is to excise the cancer completely from your system. As such, the
>> expectation is a PSA of < 0.1 in one assay or <0.04 in a more sensitive
>> assay. But, unless I miss my guess, that is an expectation at three
>> months
>> post surgery.
>
> Are you saying that it can take a few months for the PSA to flush out
> of his system?

It makes sense that it has to flush out of your system. When you are tested
for PSA, it is your blood that is tested. Even when all the cancer is
contained within the prostate, the PSA registers. It is counterintuitive to
believe that the day your prostate is removed, suddenly all the PSA that was
in your blood disappears. Ergo, it takes some amount of time.

I'm only guessing at the three months because a lot of docs aren't testing
before three months... including mine.




--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05
Non Illegitimi Carborundum

"chasjac" <chjacobson@elmira.edu> wrote in message
news:1175709843.654838.273010@n59g2000hsh.googlegr oups.com...
> On Apr 4, 12:35 am, Maui Mike wrote:
>> ...is it possible my PSA will continue to
>> drop after 6 weeks?
>
> I surely hope so. However, I'm pretty sure that I read that six weeks
> was the length of time it took to flush out the PSA -- but I can't
> find it here in my office. I have Scardino's book here, but he only
> mentions that it should be all gone in a 'few weeks', whatever that
> means -- probably not twelve.

I think where the time frame comes from, is something I learned during
Diabetes classes of why Hemoglobin A1c (HbA1c or H1Ac), also called glycated
hemoglobin, is measured periodically, usually 3 months. to determine the
average blood-sugar level over the life span of the red blood cell, which is
about 8 to 10 weeks.
It may have something to do the life span of the red blood cells being
flushed and a fresh PSA reading obtained. If I recollect , my first post-op
Psa was at the 3 month mark..


Just my way of thinking , Thanks for listening.

Radical RPer (lurker)
portland, me
RRP 5-6-03
PSA since <.04
now Diabetic type 2

I'm not a doctor, but here are some speculations regarding
the timing of the PSA testing.

Testing much before 6 weeks is too early because it does
take some time for the PSA to flush. Using Ralph's number
of a PSA half-life of around 3 days, in six weeks (42 days),
the PSA should drop by a factor of 2 to the 14th power,
or 16,384. His initial PSA of 13.8 should decline to less
than .001, which would make it undetectable, if all prostate
tissue were removed.

So, assuming this was a good test and Mike's PSA sample
wasn't contaminated, confused with someone else,
inaccurately reported, or otherwise incompetently handled,
he still has a significant amount of prostate tissue in his
body. That's an important data point.

But it's too early to begin treatment. First of all, the surgical
trauma needs to heal before radiation can be attempted.
Second of all, it would be very useful to get at least two
readings so that we can see a trend. It would probably be
a mistake to begin either radiation or hormone therapy before
knowing whether the PSA is rising rapidly, slowly, or not at all.

Alan

On 4 Apr 2007 07:46:41 -0700, "ralphv" <ralphv_in_az@yahoo.com> wrote:

>PSA has an half-life elimination rate of 2 to 3 days.

Ahh! - thanks for that, in my shocking ignorance I thought it was just
something that faded away.

On Apr 4, 7:56 pm, "Steve Kramer" <skra...@cinci.rr.com> wrote:
....
> I'm only guessing at the three months because a lot of docs aren't testing
> before three months... including mine.

Makes sense. I appreciate RalphV's details too.

Doesn't some other organ produce PSA? Seems I read that somewhere.

Also, how much variation is there in the rate that it flushes out?
Could it be that some guys take much longer than others, that's why
there's a 3 month convention?

an update, hospital called and said that anesthesia kept me asleep and
that's why I pee'ed in bed.

-kh

"Maybe you can ask for advanced testing, like the PET scans that
people are saying can detect metastatic cancer before a bone scan
can."

Does anyone have any experience w/ these? I am going to a new med-onc
at Dana Farber in a few weeks and he wanted a bone scan and CT, which
I had Tues. I happened to be touring the hospital last week and asked
a radiologist about the 18F Flouride PET/CT scan. He conferred w/ "the
guru" and said a bone scan was sufficient. Looking at the scan and
talking w/ the tech, it looked like there had been no change in the
last 3 years when my PSA went from .37 to 1.6. I hate to think it was
just another worthless test when something better was available.

Bill Denton
RP 2/12/02
PSA 1.6
Memphis

On Apr 5, 8:15 am, "Bill" <zeros...@midsouth.rr.com> wrote:
> "Maybe you can ask for advanced testing, like the PET scans that
> people are saying can detect metastatic cancer before a bone scan
> can."
>
> Does anyone have any experience w/ these? I am going to a new med-onc
> at Dana Farber in a few weeks and he wanted a bone scan and CT, which
> I had Tues. I happened to be touring the hospital last week and asked
> a radiologist about the 18F Flouride PET/CT scan. He conferred w/ "the
> guru" and said a bone scan was sufficient. Looking at the scan and
> talking w/ the tech, it looked like there had been no change in the
> last 3 years when my PSA went from .37 to 1.6. I hate to think it was
> just another worthless test when something better was available.
>
> Bill Denton
> RP 2/12/02
> PSA 1.6
> Memphis

Hi Bill...Here is a reference that compares the various scan
techniques for detecting bone mets.

J Nucl Med. 2006 Feb;47(2):287-297; Even-Sapir E, Metser U, Mishani E,
Lievshitz G, Lerman H, Leibovitch I.; The Detection of Bone Metastases
in Patients with High-Risk Prostate Cancer: 99mTc-MDP Planar Bone
Scintigraphy, Single- and Multi-Field-of-View SPECT, 18F-Fluoride PET,
and 18F-Fluoride PET/CT.

Here is a table that summarizes their findings...
sensitivity specificity positive pv negative
pv
planar BS 70% 57% 64% 55%,
spect BS 92% 82% 86% 90%,
18F PET 100% 62% 74% 100%
18F PET/CT 100% 100% 100% 100%

Here is a summary of what the various terms mean...

Test Positive Test Negative
Disease Present True Positive (TP) False Negative (FN)
Disease Absent False Positive (FP) True Negative (TN)

SENSITIVITY:
The Sensitivity of a test is the percentage of all patients with
disease present who have a positive test.

__TP___ = Sensitivity
TP + FN

SPECIFICITY:
The Specificity of a test is the percentage of all patients without
disease who have a negative test.

__TN___ = Specificity
FP + TN

PREDICTIVE VALUE:
The predictive value of a test is a measure of the times that the
value (positive or negative) is the true value, e.g. the percent of
all positive tests that are true positives is the Positive Predictive
Value.

__TP___ = Positive Predictive Value
TP + FP

__TN___ = Negative Predictive Value
FN + TN


....Best wishes and good health, ron

On Apr 5, 10:15 am, "Bill" <zeros...@midsouth.rr.com> wrote:

> "Maybe you can ask for advanced testing, like the PET scans that
> people are saying can detect metastatic cancer before a bone scan
> can."
>
> Does anyone have any experience w/ these?

As my PSA rose from 6.4 to 21, I had a PET-scan and Prostascint, these
did not pick up anything.

At PSA 21, I had a bone scan, it pickup up what the MRI revealed to be
a slight compression fracture of a vertebra.

My opinion is that these tests can be good but are far from perfect.
The PET-scan was at a local commercial imaging center. Johns Hopkins
did the Prostascint; they're top notch.

Inova's nuclear medicine department did the bone scan.

I think these tests are pushing the physical limits of the
technology.

-kh

"Radical RPer" <noone@maine.rr.com> wrote in message
news:461449a7$0$19443$4c368faf@roadrunner.com...

> It may have something to do the life span of the red blood cells being
> flushed and a fresh PSA reading obtained. If I recollect , my first
> post-op Psa was at the 3 month mark..
>
> Radical RPer (lurker)
> portland, me
> RRP 5-6-03
> PSA since <.04
> now Diabetic type 2

Good to hear from you again, Owen. Great PSA!!!

Sorry about that diabetes crap. You've had enough to fight.





--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05
Non Illegitimi Carborundum

"Bill" <zerospam@midsouth.rr.com> wrote in message
news:1175782559.913174.280130@q75g2000hsh.googlegr oups.com...

> Does anyone have any experience w/ these? I am going to a new med-onc
> at Dana Farber in a few weeks and he wanted a bone scan and CT, which
> I had Tues. I happened to be touring the hospital last week and asked
> a radiologist about the 18F Flouride PET/CT scan. He conferred w/ "the
> guru" and said a bone scan was sufficient. Looking at the scan and
> talking w/ the tech, it looked like there had been no change in the
> last 3 years when my PSA went from .37 to 1.6. I hate to think it was
> just another worthless test when something better was available.

Paul Williams, M.D. just stopped by a day or two ago. It would be great if
he saw your question. If not, his email is N268ME@gmail.com.

Otherwise, I have seen several opinions about the PET when combined with CT
with specific reference to our disease (maybe one from Dr. Williams). If I
can recall correctly, the average opinion was that it is a fantastic
technology, to be sure, and that in the right hands, may be of some value.
There seems to be an expectation that it will become even better as
operators gather experience and feed it back to the manufacturers.

Alan,
The point I was trying to make is that Mike should have a retest ASAP
to validate that the result is not an analytical error. These are
common and before getting worried or scarred this possibility should
be eliminated. I have seen this happen often enough to alert people to
have the test rechecked. At his diagnosis PSA level, it all should be
gone by now. His pathology report is pristine and he had a non-
aggressive GS. All these point to an analytical error.

Like you said, even if the PSA is correct, at this point he first has
to heal from the surgical procedure before any salvage treatment could
be instituted. Let's hope this is one more human error and Mike's
prognosis is as good as his other results have been from his surgical
treatment.

RalphV
pcainaz.org/phpbb

On Apr 4, 8:52 pm, "Alan Meyer" <amey...@yahoo.com> wrote:
> I'm not a doctor, but here are some speculations regarding
> the timing of the PSA testing.
>
> Testing much before 6 weeks is too early because it does
> take some time for the PSA to flush. Using Ralph's number
> of a PSA half-life of around 3 days, in six weeks (42 days),
> the PSA should drop by a factor of 2 to the 14th power,
> or 16,384. His initial PSA of 13.8 should decline to less
> than .001, which would make it undetectable, if all prostate
> tissue were removed.
>
> So, assuming this was a good test and Mike's PSA sample
> wasn't contaminated, confused with someone else,
> inaccurately reported, or otherwise incompetently handled,
> he still has a significant amount of prostate tissue in his
> body. That's an important data point.
>
> But it's too early to begin treatment. First of all, the surgical
> trauma needs to heal before radiation can be attempted.
> Second of all, it would be very useful to get at least two
> readings so that we can see a trend. It would probably be
> a mistake to begin either radiation or hormone therapy before
> knowing whether the PSA is rising rapidly, slowly, or not at all.
>
> Alan

On Apr 5, 6:29 pm, PCAi...@gmail.com wrote:

> The point I was trying to make is that Mike should have a retest ASAP
> to validate that the result is not an analytical error.
....

A good point. I agree with it.

Alan

On Apr 4, 11:52 pm, "Alan Meyer" <amey...@yahoo.com> wrote:
> I'm not a doctor, but here are some speculations regarding
> the timing of the PSA testing.
>
> Testing much before 6 weeks is too early because it does
> take some time for the PSA to flush. Using Ralph's number
> of a PSAhalf-lifeof around 3 days, in six weeks (42 days),
> the PSA should drop by a factor of 2 to the 14th power,
> or 16,384. His initial PSA of 13.8 should decline to less
> than .001, which would make it undetectable, if all prostate
> tissue were removed.
>
> So, assuming this was a good test and Mike's PSA sample
> wasn't contaminated, confused with someone else,
> inaccurately reported, or otherwise incompetently handled,
> he still has a significant amount of prostate tissue in his
> body. That's an important data point.
>
> But it's too early to begin treatment. First of all, the surgical
> trauma needs to heal before radiation can be attempted.
> Second of all, it would be very useful to get at least two
> readings so that we can see a trend. It would probably be
> a mistake to begin either radiation or hormone therapy before
> knowing whether the PSA is rising rapidly, slowly, or not at all.


This 1996 article, Gleave et al indicates that inflammation
as well as half-life are determining factors when to test. They say
"The half-life of serum PSA was determined by Stamey et al.
[31] using the Yang
assay to be 2.2 +/- 0.8 days, and by Oesterling et al. [39]
using the Hybritech assay to be 3.2 +/- 0.1 days. These
determinations of PSA clearance were made from data obtained
from patients in the postoperative period after radical
prostatectomy. Clearance of PSA from the serum follows an
exponential decay pattern characteristic of first-order
elimination kinetics, as indicated by the straight line
obtained when the natural logs of serum PSA values are
plotted as a function of time. Because of the relatively
long half-life of PSA, coupled with slow resolution of
inflammation following biopsy or prostatitis, it may take
several months for serum PSA to reach its baseline after
transurethral prostatic resection (TURP), biopsy, or
infection. This is particularly important in assessing
elevated PSA levels in patients with resolving prostatitis
or after surgery, where reevaluation of serum PSA levels is
generally performed after 3 months."

http://web.archive.org/web/200504021...np4/paper.html


In a 2003 article, Swanson says there are widely varying
estimates on PSA half life in the literature:
"The need for proper, albeit simple, quantitative modeling
can be illustrated by the example of trying to determine the
half-life of PSA following radical prostatectomy. A search
on MEDLINE reveals at least a dozen articles on the topic
(eg, Bjork et al,6 Haab et al,7 Lein et al,8 Partin et al,9
Ravery et al,10 Richardson et al,11 Semjonow et al,12 and
van Straalen et al13). In these articles, we find that the
calculated half-life of PSA can range from minutes to days.
Clearly, this range cannot reflect the same process. Closer
examination of these articles reveals that each group of
investigators fits the serum dynamics of PSA after surgery
to a different curve."

http://www.amath.washington.edu/~swanson/ajcp.pdf

---
The Palpable Prostate
http://palpable-prostate.blogspot.com

Thanks, Ron; that report is the reason I asked the radiologist about
it, and when I went in to get my scans Tues. I left a copy for him.
It's really frustrating to constantly be more up on developments than
doctors in practice. Of course, they don't have this forum or the time
to monitor it.

Bill Denton
RP 2/12/02
PSA 1.6
Memphis

On Apr 6, 7:12 am, "A. Black" <xuv...@gmail.com> wrote:
> On Apr 4, 11:52 pm, "Alan Meyer" <amey...@yahoo.com> wrote:
>
>
>
>
>
> > I'm not a doctor, but here are some speculations regarding
> > the timing of the PSA testing.
>
> > Testing much before 6 weeks is too early because it does
> > take some time for the PSA to flush. Using Ralph's number
> > of a PSAhalf-lifeof around 3 days, in six weeks (42 days),
> > the PSA should drop by a factor of 2 to the 14th power,
> > or 16,384. His initial PSA of 13.8 should decline to less
> > than .001, which would make it undetectable, if all prostate
> > tissue were removed.
>
> > So, assuming this was a good test and Mike's PSA sample
> > wasn't contaminated, confused with someone else,
> > inaccurately reported, or otherwise incompetently handled,
> > he still has a significant amount of prostate tissue in his
> > body. That's an important data point.
>
> > But it's too early to begin treatment. First of all, the surgical
> > trauma needs to heal before radiation can be attempted.
> > Second of all, it would be very useful to get at least two
> > readings so that we can see a trend. It would probably be
> > a mistake to begin either radiation or hormone therapy before
> > knowing whether the PSA is rising rapidly, slowly, or not at all.
>
> This 1996 article, Gleave et al indicates that inflammation
> as well as half-life are determining factors when to test. They say
> "The half-life of serum PSA was determined by Stamey et al.
> [31] using the Yang
> assay to be 2.2 +/- 0.8 days, and by Oesterling et al. [39]
> using the Hybritech assay to be 3.2 +/- 0.1 days. These
> determinations of PSA clearance were made from data obtained
> from patients in the postoperative period after radical
> prostatectomy. Clearance of PSA from the serum follows an
> exponential decay pattern characteristic of first-order
> elimination kinetics, as indicated by the straight line
> obtained when the natural logs of serum PSA values are
> plotted as a function of time. Because of the relatively
> long half-life of PSA, coupled with slow resolution of
> inflammation following biopsy or prostatitis, it may take
> several months for serum PSA to reach its baseline after
> transurethral prostatic resection (TURP), biopsy, or
> infection. This is particularly important in assessing
> elevated PSA levels in patients with resolving prostatitis
> or after surgery, where reevaluation of serum PSA levels is
> generally performed after 3 months."
>
> http://web.archive.org/web/200504021...ostatepointers...
>
> In a 2003 article, Swanson says there are widely varying
> estimates on PSA half life in the literature:
> "The need for proper, albeit simple, quantitative modeling
> can be illustrated by the example of trying to determine the
> half-life of PSA following radical prostatectomy. A search
> on MEDLINE reveals at least a dozen articles on the topic
> (eg, Bjork et al,6 Haab et al,7 Lein et al,8 Partin et al,9
> Ravery et al,10 Richardson et al,11 Semjonow et al,12 and
> van Straalen et al13). In these articles, we find that the
> calculated half-life of PSA can range from minutes to days.
> Clearly, this range cannot reflect the same process. Closer
> examination of these articles reveals that each group of
> investigators fits the serum dynamics of PSA after surgery
> to a different curve."
>
> http://www.amath.washington.edu/~swanson/ajcp.pdf
>
> ---
> The Palpable Prostatehttp://palpable-prostate.blogspot.com- Hide quoted text -
>
> - Show quoted text -

I haven't read all of those references, but in both of the papers
noted below, the authors point out that post-RP PSA decay is
"biphasic". This means that the kinetics change during the PSA decay
process. For the first few hours the PSA elimination half-life is
measured in hours. After this phase, a longer half-life, on the order
of days takes over. Partin also notes an initial infusion of PSA
during the first hour post-op, so your PSA may initially increase a
bit over the pre-op baseline before it begins to decay...Best wishes
and good health, ron

Urology. 1999 Apr;53(4):722-30; Serum half-life time determination of
free and total prostate-specific antigen following radical
prostatectomy--a critical assessment; Brandle E, Hautmann O, Bachem M,
Kleinschmidt K, Gottfried HW, Grunert A, Hautmann RE.

Prostate Suppl. 1996;7:35-9; Clearance rate of serum-free and total
PSA following radical retropubic prostatectomy; Partin AW, Piantadosi
S, Subong EN, Kelly CA, Hortopan S, Chan DW, Wolfert RL, Rittenhouse
HG, Carter HB.

"ron" <oitbso@yahoo.com> wrote in message
news:1175788997.672578.149820@p77g2000hsh.googlegr oups.com...
> ...
> Here is a table that summarizes their findings...
> sensitivity specificity positive pv negative
> ...
> 18F PET/CT 100% 100% 100% 100%

That's amazing! If I understand it correctly, it's saying that
18F-Fluoride PET/CT scans are 100% accurate at detecting
bone mets.

Did I understand it correctly?

Shouldn't everyone be using this technique?

Alan

"A. Black" <xuvt99@gmail.com> wrote in message
news:1175865173.629391.180740@y80g2000hsf.googlegr oups.com...
> ...
> This 1996 article, Gleave et al indicates that inflammation
> as well as half-life are determining factors when to test. They say
> "The half-life of serum PSA was determined by Stamey et al.
> [31] using the Yang
> assay to be 2.2 +/- 0.8 days, and by Oesterling et al. [39]
> using the Hybritech assay to be 3.2 +/- 0.1 days. These
> determinations of PSA clearance were made from data obtained
> from patients in the postoperative period after radical
> prostatectomy. Clearance of PSA from the serum follows an
> exponential decay pattern characteristic of first-order
> elimination kinetics, as indicated by the straight line
> obtained when the natural logs of serum PSA values are
> plotted as a function of time. Because of the relatively
> long half-life of PSA, coupled with slow resolution of
> inflammation following biopsy or prostatitis, it may take
> several months for serum PSA to reach its baseline after
> transurethral prostatic resection (TURP), biopsy, or
> infection. ...

Sometimes I read things like this and think, Whoa, wait
a minute, is that right? And I read it again, and then
again.

In this particular case, no matter how often I read it I can't
seem to get it stand up straight.

The author shows a worst case PSA half life of 3.3 days.
Then he says that there is an "exponential decay pattern
characterisitic of first-order elimination kinetics". I take that
to mean that half the PSA disappears in the first 3.3 day
period, then half again in the next, and so on. This gives us
the "straight line obtained when the natural logs ... are
plotted as a function of time."

Okay. I've got that part standing up straight. But then comes
the wiggly part: it "may take several months for serum PSA
to reach its baseline..."

How can that be? If several means, say, three, or around
90 days, then there are 27 3.3 day half-life periods in that
time. PSA should drop to less than 1/1000th of it's pre-
treatment level in only 33 days.

Am I missing something?

Alan

Bill wrote:
> Thanks, Ron; that report is the reason I asked the radiologist about
> it, and when I went in to get my scans Tues. I left a copy for him.
> It's really frustrating to constantly be more up on developments than
> doctors in practice. Of course, they don't have this forum or the time
> to monitor it.

Because they *do* have access to this forum but most of them poo-poo the
internet and any other source of data we offer including research
literature, I attribute their reticence to accept contrary patient input
to arrogance, find a different doctor, and, if blatant, report their
uppity asses. I've even seen their attitudes put them in personal,
physical danger in street situations where their MD degree and
experience meant zilch (think their scrubs mean squat to an angry
redneck in the woods?).

I.P.

"Alan Meyer" <ameyer2@yahoo.com> wrote in message
news:fu6dnaFyUr2t54vbnZ2dnUVZ_g-dnZ2d@comcast.com...
> ... PSA should drop to less than 1/1000th of it's pre-
> treatment level in only 33 days.

I didn't phrase that quite right. If the treatment is a radical
prostatectomy PSA should drop to 1/1000th of the
pre-treatment level in 33 days.

If the treatment is something else that cures some other
condition - infection, inflammation, etc., then the PSA
due to that condition should drop to 1/1000th of the
pre-treatment level in 33 days, if the condition is
100% cured. PSA should return to baseline + 1/1000th
of the increase caused by the condition.

I shouldn't criticize others for sloppy writing!

Alan

On Apr 5, 1:27?pm, "Steve Kramer" <skra...@cinci.rr.com> wrote:
> "Bill" <zeros...@midsouth.rr.com> wrote in message
>
> news:1175782559.913174.280130@q75g2000hsh.googlegr oups.com...
>
> > Does anyone have any experience w/ these? I am going to a new med-onc
> > at Dana Farber in a few weeks and he wanted a bone scan and CT, which
> > I had Tues. I happened to be touring the hospital last week and asked
> > a radiologist about the 18F Flouride PET/CT scan. He conferred w/ "the
> > guru" and said a bone scan was sufficient. Looking at the scan and
> > talking w/ the tech, it looked like there had been no change in the
> > last 3 years when my PSA went from .37 to 1.6. I hate to think it was
> > just another worthless test when something better was available.
>

Good friend of mine is a young radiologist. Iasked him about PET scans
for Pca and this is his response.

Fred

PET scans for Prostate cancer are not often done, and as far as I
know are not generally approved by Medicare and 3rd party payers
(insurance companies). 1 of the major reasons is that to detect local
recurrence you need to be able to see the pelvis well. FDG (the
radioactive agent used in PET scanning) is excreted by the kidneys and
therefore collects in the urinary bladder. This makes evaluation of
things in the pelvis dicey at best. Another problem is that PET scans
detect elevated metabolic activity (which most cancers show), but
Prostate Cancer metastasis generally have low metabolic activity and
are slow growing. This decreases detectability. The primary site for
Prostate mets is the bone, and standard whole body bone scans are very
good at detection of these. There have been reported cases in the
literature of PET scans detecting spread to nodes before they can be
anatomically detected on a standard CT scan, but the research for this
is ongoing as far as I know. There is another nuclear medicine agent
called Prostascint, which is more specifc to cells of prostate origin,
but I have no experience in using it.

On Apr 6, 12:48 pm, "Alan Meyer" <amey...@yahoo.com> wrote:
> "A. Black" <xuv...@gmail.com> wrote in message
>
> news:1175865173.629391.180740@y80g2000hsf.googlegr oups.com...
>
>
>
>
>
> > ...
> > This 1996 article, Gleave et al indicates that inflammation
> > as well as half-life are determining factors when to test. They say
> > "The half-life of serum PSA was determined by Stamey et al.
> > [31] using the Yang
> > assay to be 2.2 +/- 0.8 days, and by Oesterling et al. [39]
> > using the Hybritech assay to be 3.2 +/- 0.1 days. These
> > determinations of PSA clearance were made from data obtained
> > from patients in the postoperative period after radical
> > prostatectomy. Clearance of PSA from the serum follows an
> > exponential decay pattern characteristic of first-order
> > elimination kinetics, as indicated by the straight line
> > obtained when the natural logs of serum PSA values are
> > plotted as a function of time. Because of the relatively
> > long half-life of PSA, coupled with slow resolution of
> > inflammation following biopsy or prostatitis, it may take
> > several months for serum PSA to reach its baseline after
> > transurethral prostatic resection (TURP), biopsy, or
> > infection. ...
>
> Sometimes I read things like this and think, Whoa, wait
> a minute, is that right? And I read it again, and then
> again.
>
> In this particular case, no matter how often I read it I can't
> seem to get it stand up straight.
>
> The author shows a worst case PSA half life of 3.3 days.
> Then he says that there is an "exponential decay pattern
> characterisitic of first-order elimination kinetics". I take that
> to mean that half the PSA disappears in the first 3.3 day
> period, then half again in the next, and so on. This gives us
> the "straight line obtained when the natural logs ... are
> plotted as a function of time."
>
> Okay. I've got that part standing up straight. But then comes
> the wiggly part: it "may take several months for serum PSA
> to reach its baseline..."
>
> How can that be? If several means, say, three, or around
> 90 days, then there are 27 3.3 day half-life periods in that
> time. PSA should drop to less than 1/1000th of it's pre-
> treatment level in only 33 days.
>
> Am I missing something?

The part about "slow resolution of inflammation".

---
The Palpable Prostate
http://palpable-prostate.blogspot.com

Alan,
I think the quote is missing "after transurethral prostatic resection
(TURP), biopsy, or infection." The PSA kinetics are different after
radical prostatectomy.

Looked at all the references cited by Swanson (the ones I could find)
and over all with the exception of the Haab F et al citation all
report a half-life that would render Mike's PSA to be UD after 6
weeks. Haab reported a half-life of almost 14 days which could fit
Mike's results. A range of 1.2 days to almost 14 days seems extreme...

I don't know if Mike is reading this thread, but a retest is in order
ASAP to eliminate the possibility of an analytical error.

RalphV
pcainaz>org/phpbb

Source:

Bjork T et al.
Removal of the prostate resulted in a rapid, biexponential elimination
of PSA-F from serum, corresponding to a mean initial (alpha) half-life
of 0.81 hours and a mean terminal (beta) half-life of 13.9 hours.
Serum PSA-ACT concentrations decreased by 20% to 40% immediately after
removal of the gland; the elimination after surgery was slow and
nonexponential, corresponding to a mean rate of 0.8 ng/mL/day.

Haab F et al
After radical prostatectomy: 11/18 patients (61%) showed a one-
component exponential decrease in PSA with a half-life of 2.5 +/- 1.33
days (range 0.97-4.6 days), and 7/18 showed a two-component
exponential decrease with a first half-life of 0.94 +/- 0.8 days and a
second of 7.62 +/- 6.35 days); 100% of the patients reached
undetectable serum PSA by day 28 in the first group compared to 14.2%
of the patients with a two component exponential decrease (P < 0.01).
There was no difference between these groups as far as preoperative
PSA levels and specimen pathology were concerned.

Lein M et al
Could not find at Pubmed


Partin AW et al
Serum free and total PSA are cleared from the circulation following a
"two-compartment" model with an initial constant "infusion." The
constant "infusion" is most likely a consequence of surgical
manipulation. The initial half-life estimates are < 2 hr for both free
and total PSA, and later increase to 22 and 33 hr, respectively.

Ravery V et al
RESULTS: Group I-the mean half-life was 1.416 +/- 0.723 days for free
PSA and 2.43 +/- 0.688 days for total PSA. After prostate removal,
free PSA showed a marked increase. Group II-the mean half-life of free
PSA was 2.157 +/- 1.792 days and 3.391 +/- 2.337 days for total PSA

Richardson TD et al,
CONCLUSIONS: Unlike PSA, which has a half life of 2-3 days, the half-
life of serum free PSA is 110 minutes (1.83 hours).

Rathert P et al
When PSA serum half-life was calculated solely in potentially cured
patients, we found a half-life of 1.6 days, which is considerably
shorter than in previous reports based on patient populations
regardless of the outcome of disease in the follow-up. To elucidate
the route of PSA elimination, serial urine PSA levels were determined
before and after radical prostatectomy, revealing strong evidence for
the assumption that PSA is not eliminated by the kidneys in its
unchanged form.

de Reijke TM et al
Could not find at PubMed

On Apr 6, 9:48 am, "Alan Meyer" <amey...@yahoo.com> wrote:
> "A. Black" <xuv...@gmail.com> wrote in message
>
> news:1175865173.629391.180740@y80g2000hsf.googlegr oups.com...
>
>
>
> > ...
> > This 1996 article, Gleave et al indicates that inflammation
> > as well as half-life are determining factors when to test. They say
> > "The half-life of serum PSA was determined by Stamey et al.
> > [31] using the Yang
> > assay to be 2.2 +/- 0.8 days, and by Oesterling et al. [39]
> > using the Hybritech assay to be 3.2 +/- 0.1 days. These
> > determinations of PSA clearance were made from data obtained
> > from patients in the postoperative period after radical
> > prostatectomy. Clearance of PSA from the serum follows an
> > exponential decay pattern characteristic of first-order
> > elimination kinetics, as indicated by the straight line
> > obtained when the natural logs of serum PSA values are
> > plotted as a function of time. Because of the relatively
> > long half-life of PSA, coupled with slow resolution of
> > inflammation following biopsy or prostatitis, it may take
> > several months for serum PSA to reach its baseline after
> > transurethral prostatic resection (TURP), biopsy, or
> > infection. ...
>
> Sometimes I read things like this and think, Whoa, wait
> a minute, is that right? And I read it again, and then
> again.
>
> In this particular case, no matter how often I read it I can't
> seem to get it stand up straight.
>
> The author shows a worst case PSA half life of 3.3 days.
> Then he says that there is an "exponential decay pattern
> characterisitic of first-order elimination kinetics". I take that
> to mean that half the PSA disappears in the first 3.3 day
> period, then half again in the next, and so on. This gives us
> the "straight line obtained when the natural logs ... are
> plotted as a function of time."
>
> Okay. I've got that part standing up straight. But then comes
> the wiggly part: it "may take several months for serum PSA
> to reach its baseline..."
>
> How can that be? If several means, say, three, or around
> 90 days, then there are 27 3.3 day half-life periods in that
> time. PSA should drop to less than 1/1000th of it's pre-
> treatment level in only 33 days.
>
> Am I missing something?
>
> Alan

"A. Black" <xuvt99@gmail.com> wrote in message
news:1175882449.947022.166990@w1g2000hsg.googlegro ups.com...

>> Am I missing something?
>
> The part about "slow resolution of inflammation".

Ah yes. Got it. Thanks.

Alan