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PSA Recurrence
  1. #1
    Jim Hand Guest

    Default PSA Recurrence

    After 21 months of non-detectable PSA tests following prostatectomy in
    January, 2008 I tested 0.09 ng/ml in January. I had been anxious
    about a recurrence because the post-op pathology revealed microscopic
    positive margins. Since I've been told that that result is about
    halfway to biochemical recurrence, I was expecting to get an estimate
    of when I'd need to start radiation or hormone treatment from the test
    this month. Rather than increase, the result was back to non-
    detectable. Is there any way that can happen other than either the
    January or April test being in error?
    Jim

  2. #2
    I.P. Freely Guest

    Default Re: PSA Recurrence

    Jim Hand wrote:
    > Is there any way that can happen other than either the
    > January or April test being in error?


    My PSA has bounced around'n'around and up'n'down between <0.002 and
    0.053 for > 5 years now, all from the same test at the same lab. Error?
    Test accuracy limits? Real biochemical variations? Do we use those silly
    charts and trend lines the stock market technical analysts do to make
    sense of it?

    I don't know the answer, so I can't say "Oh, $#!+!" or "Don't worry;
    you'll be fine", but my academic and seasoned hands-on oncs are not
    excited about my variations, which are on the order of 60% of yours.

    I.P.

  3. #3
    Alan Meyer Guest

    Default Re: PSA Recurrence

    On 4/15/2010 10:58 AM, Jim Hand wrote:

    > After 21 months of non-detectable PSA tests following
    > prostatectomy in January, 2008 I tested 0.09 ng/ml in January.
    > I had been anxious about a recurrence because the post-op
    > pathology revealed microscopic positive margins. Since I've
    > been told that that result is about halfway to biochemical
    > recurrence, I was expecting to get an estimate of when I'd need
    > to start radiation or hormone treatment from the test this
    > month. Rather than increase, the result was back to non-
    > detectable. Is there any way that can happen other than either
    > the January or April test being in error?
    > Jim


    Jim,

    I'm not a doctor or any kind of expert, but I speculate that,
    yes, this can happen. Here's why:

    Cancer normally originates in a specific organ in the body, like
    the prostate gland. Prostate cells live in that particular
    glandular environment, dependent on the biochemical and
    physiological conditions in that environment. They stay there
    and can't survive elsewhere. That's why in healthy people there
    are no prostate cells in the lungs, brain, bones or other areas.

    Cancer cells start as normal cells but over generations of cell
    division, they gradually undergo mutations that make them
    different from normal cells. Their transformation from normal
    cells, to local cancer cells, and eventually to metastatic
    cancer cells capable of living in other places in the body, is
    gradual.

    When your prostate was intact, there were apparently small bits
    that extended outside the prostate, but were still very much
    connected to it. They (hopefully) weren't metastatic cells
    living unconnected from the prostate. They were still only
    living in a prostate environment, but that environment had
    expanded and penetrated through the normal basement membrane that
    separates the prostate from the rest of the body.

    If all that is right, and I don't know that it is, the cells
    outside the prostate may have languished and eventually died once
    they were no longer in contact with the rest of the prostate.
    The environment for them was not what they needed. They
    struggled on for some months but eventually couldn't hack it. In
    fact, when prostate cells are under stress the produce more PSA
    (which is why we shouldn't have sex before a PSA test) so the
    0.09 may have reflected a very small number of cells that were
    expressing more PSA than usual.

    Well, that's all speculation on my part. I am pretty sure that
    what I described is possible, but whether it applies in your
    case, I have no way to know or find out other than getting more
    PSA tests over time.

    Best of luck.

    Alan

  4. #4
    ron Guest

    Default Re: PSA Recurrence

    On Apr 15, 8:58*am, Jim Hand <jdh...@chartermi.net> wrote:
    > After 21 months of non-detectable PSA tests following prostatectomy in
    > January, 2008 I tested 0.09 ng/ml in January. *I had been anxious
    > about a recurrence because the post-op pathology revealed microscopic
    > positive margins. *Since I've been told that that result is about
    > halfway to biochemical recurrence, I was expecting to get an estimate
    > of when I'd need to start radiation or hormone treatment from the test
    > this month. *Rather than increase, the result was back to non-
    > detectable. *Is there any way that can happen other than either the
    > January or April test being in error?
    > Jim


    Hi Jim...A lab error is always a possibility. It seems unlikely that
    calibration errors could be so large as to account for your results,
    but certainly a sample mix-up is a possibility. Did you have other
    PSA tests between your Jan '08 surgery and the Jan '09 reading of
    0.09? If so what were those results and what was the lower detection
    limit of the test that was used? In about 5-10% of men treated
    surgically, enough residual prostate tissue remains after surgery to
    generate a PSA that is low and slowly increasing with time (doubling
    time > 5 years); sometimes the amount of tissue left behind is not
    enough to sustain itelf and it eventually dies. Also, many other
    organs produce very small amounts of PSA (that's why PSA can be
    detected in women, in fact one study has shown that 1.5% of women have
    a PSA >= 0.10 ng/ml). It would seem possible, that if one of these
    organs became infected then PSA levels could temporarily spike...Best
    wishes and good health, ron

  5. #5
    Jim Hand Guest

    Default Re: PSA Recurrence

    On Apr 15, 12:07*pm, ron <oit...@yahoo.com> wrote:
    > On Apr 15, 8:58*am, Jim Hand <jdh...@chartermi.net> wrote:
    >
    > > After 21 months of non-detectable PSA tests following prostatectomy in
    > > January, 2008 I tested 0.09 ng/ml in January. *I had been anxious
    > > about a recurrence because the post-op pathology revealed microscopic
    > > positive margins. *Since I've been told that that result is about
    > > halfway to biochemical recurrence, I was expecting to get an estimate
    > > of when I'd need to start radiation or hormone treatment from the test
    > > this month. *Rather than increase, the result was back to non-
    > > detectable. *Is there any way that can happen other than either the
    > > January or April test being in error?
    > > Jim

    >
    > Hi Jim...A lab error is always a possibility. *It seems unlikely that
    > calibration errors could be so large as to account for your results,
    > but certainly a sample mix-up is a possibility. *Did you have other
    > PSA tests between your Jan '08 surgery and the Jan '09 reading of
    > 0.09? *If so what were those results and what was the lower detection
    > limit of the test that was used? *In about 5-10% of men treated
    > surgically, enough residual prostate tissue remains after surgery to
    > generate a PSA that is low and slowly increasing with time (doubling
    > time > 5 years); sometimes the amount of tissue left behind is not
    > enough to sustain itelf and it eventually dies. *Also, many other
    > organs produce very small amounts of PSA (that's why PSA can be
    > detected in women, in fact one study has shown that 1.5% of women have
    > a PSA >= 0.10 ng/ml). *It would seem possible, that if one of these
    > organs became infected then PSA levels could temporarily spike...Best
    > wishes and good health, ron


    Ron,
    Thanks for the reply. Yes, I had PSA tests virtually every 3 months
    for the 21 months after surgery, which was in January, 2008. All were
    all non-detectable (<0.01 ng/ml) until January, 2010 which is when I
    got the 0.09. The result in April, 2010 was back to <0.01. I get to
    talk with the folks at the clinic next week so I'll get their take on
    this then.

    I.P. and Alan, thanks for your input too.
    Jim

  6. #6
    Alan Meyer Guest

    Default Re: PSA Recurrence

    On 4/15/2010 1:17 PM, Jim Hand wrote:

    > Ron,
    > Thanks for the reply. Yes, I had PSA tests virtually every 3 months
    > for the 21 months after surgery, which was in January, 2008. All were
    > all non-detectable (<0.01 ng/ml) until January, 2010 which is when I
    > got the 0.09. The result in April, 2010 was back to<0.01. I get to
    > talk with the folks at the clinic next week so I'll get their take on
    > this then.
    >
    > I.P. and Alan, thanks for your input too.
    > Jim


    Ah!

    I see I misread your original posting. I was imagining you had 0.09 for
    months, then went to undetectable. Hence my odd response to your posting.

    Sorry for the confusion.

    Alan

  7. #7
    ron Guest

    Default Re: PSA Recurrence

    On Apr 15, 11:17*am, Jim Hand <jdh...@chartermi.net> wrote:
    > On Apr 15, 12:07*pm, ron <oit...@yahoo.com> wrote:
    >
    >
    >
    >
    >
    > > On Apr 15, 8:58*am, Jim Hand <jdh...@chartermi.net> wrote:

    >
    > > > After 21 months of non-detectable PSA tests following prostatectomy in
    > > > January, 2008 I tested 0.09 ng/ml in January. *I had been anxious
    > > > about a recurrence because the post-op pathology revealed microscopic
    > > > positive margins. *Since I've been told that that result is about
    > > > halfway to biochemical recurrence, I was expecting to get an estimate
    > > > of when I'd need to start radiation or hormone treatment from the test
    > > > this month. *Rather than increase, the result was back to non-
    > > > detectable. *Is there any way that can happen other than either the
    > > > January or April test being in error?
    > > > Jim

    >
    > > Hi Jim...A lab error is always a possibility. *It seems unlikely that
    > > calibration errors could be so large as to account for your results,
    > > but certainly a sample mix-up is a possibility. *Did you have other
    > > PSA tests between your Jan '08 surgery and the Jan '09 reading of
    > > 0.09? *If so what were those results and what was the lower detection
    > > limit of the test that was used? *In about 5-10% of men treated
    > > surgically, enough residual prostate tissue remains after surgery to
    > > generate a PSA that is low and slowly increasing with time (doubling
    > > time > 5 years); sometimes the amount of tissue left behind is not
    > > enough to sustain itelf and it eventually dies. *Also, many other
    > > organs produce very small amounts of PSA (that's why PSA can be
    > > detected in women, in fact one study has shown that 1.5% of women have
    > > a PSA >= 0.10 ng/ml). *It would seem possible, that if one of these
    > > organs became infected then PSA levels could temporarily spike...Best
    > > wishes and good health, ron

    >
    > Ron,
    > Thanks for the reply. *Yes, I had PSA tests virtually every 3 months
    > for the 21 months after surgery, which was in January, 2008. *All were
    > all non-detectable (<0.01 ng/ml) until January, 2010 which is when I
    > got the 0.09. *The result in April, 2010 was back to <0.01. *I get to
    > talk with the folks at the clinic next week so I'll get their take on
    > this then.
    >
    > I.P. and Alan, thanks for your input too.
    > Jim- Hide quoted text -
    >
    > - Show quoted text -


    Jim...Your data would seem to rule out the "residual tissue"
    hypothesis. I'd be curious to hear what the folks at the clinic
    think...ron

  8. #8
    Steve Kramer Guest

    Default Re: PSA Recurrence

    "Jim Hand" <[email protected]> wrote in message
    news:[email protected]...
    > After 21 months of non-detectable PSA tests following prostatectomy in
    > January, 2008 I tested 0.09 ng/ml in January. I had been anxious
    > about a recurrence because the post-op pathology revealed microscopic
    > positive margins. Since I've been told that that result is about
    > halfway to biochemical recurrence, I was expecting to get an estimate
    > of when I'd need to start radiation or hormone treatment from the test
    > this month. Rather than increase, the result was back to non-
    > detectable. Is there any way that can happen other than either the
    > January or April test being in error?
    > Jim


    What was the actual number they quoted you in April?

    I suspect that if you were 0.01 from April 2008 through September 2009 (as I
    understand is the case) and are again 0.01 in April 2010, then there was
    probably a mistake made in January 2010.

    That said, I have often opined that testing below 0.10 for a surgery patient
    has no potential for benefit and lots of potential for apprehension.



    --
    skramer remarks
    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 0.56 years
    Lupron 07/03 (1 mo) 8/03 and every 4 months there after
    PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
    Casodex added daily 07/06
    PSA undetectable since. Next Assay 10/10/10
    Illegitimati non carborundum



  9. #9
    Steve Kramer Guest

    Default Re: PSA Recurrence

    "Jim Hand" <[email protected]> wrote in message
    news:[email protected]...

    The result in April, 2010 was back to <0.01.

    ==> Disregard my previous question.



  10. #10
    tarhoosier7 Guest

    Default Re: PSA Recurrence

    On Apr 15, 10:58*am, Jim Hand <jdh...@chartermi.net> wrote:
    > After 21 months of non-detectable PSA tests following prostatectomy in
    > January, 2008 I tested 0.09 ng/ml in January. *I had been anxious
    > about a recurrence because the post-op pathology revealed microscopic
    > positive margins. *Since I've been told that that result is about
    > halfway to biochemical recurrence, I was expecting to get an estimate
    > of when I'd need to start radiation or hormone treatment from the test
    > this month. *Rather than increase, the result was back to non-
    > detectable. *Is there any way that can happen other than either the
    > January or April test being in error?
    > Jim


    Jim:
    I vote for error at lab or perhaps in the clinic or office, or both.
    For men who achieve a result after surgery of <0.01 the chance for
    recurrence is ~3%.
    See here:
    http://palpable-prostate.blogspot.co...ecurrence.html

  11. #11
    fred Guest

    Default Re: PSA Recurrence

    On Apr 17, 8:56*am, tarhoosier7 <tarhoos...@carolina.rr.com> wrote:


    > I vote for error at lab or perhaps in the clinic or office, or both.
    > For men who achieve a result after surgery of <0.01 the chance for
    > recurrence is ~3%.
    > See here:http://palpable-prostate.blogspot.co...al-psa-recurre...


    With respect, I don't think that's quite accurate.

    The study that I think you are referencing is talking about 3%
    recurrence WITHIN 2 YEARS of surgery. After 5 or 10 years, the
    recurrence rate may be much higher than 3%.

    Fred

  12. #12
    Steve Kramer Guest

    Default Re: PSA Recurrence

    "fred" <[email protected]> wrote in message
    news:[email protected]...


    The study that I think you are referencing is talking about 3%
    recurrence WITHIN 2 YEARS of surgery. After 5 or 10 years, the
    recurrence rate may be much higher than 3%.

    ==> Speaking of which, Fred, you are one who had failure after two years,
    and success with SRT for at least two years, but I don't recall your having
    reported your success since 2008. How are you doing?


    --
    skramer remarks
    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 0.56 years
    Lupron 07/03 (1 mo) 8/03 and every 4 months there after
    PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
    Casodex added daily 07/06
    PSA undetectable since. Next Assay 10/10/10
    Illegitimati non carborundum



  13. #13
    fred Guest

    Default Re: PSA Recurrence

    On Apr 21, 6:02*am, "Steve Kramer" <skra...@cinci.rr.com> wrote:

    > ==> *Speaking of which, Fred, you are one who had failure after twoyears,
    > and success with SRT for at least two years, but I don't recall your having
    > reported your success since 2008. *How are you doing?


    Steve: complete record below, for your files.

    Post SRT nadir of 0.008 in September 2007, which everyone thought was
    outstanding. But after 7 consecutive PSA rises, I assume I'm headed
    for an official recurrence at some point in the not too distant
    future. As yet no symptoms, enjoying life, PSA still low, and I'm
    almost 7 years out from original diagnosis.

    I have consulted with an oncologist who seems to have lots of
    experience in PCa; he says it's too soon to consider any HT or other
    follow up treatment. He refuses to be pinned down on when HT should
    start, rather like Dr Myer's response previously posted; wait and see
    seems to be his watchword, and for now, I'm comfortable with that. He
    has also made the point to me that he feels that new treatments will
    be available in the next few years that will have fewer risks/SEs than
    HT; so his opinion is that it's better to postpone start of HT for as
    long as reasonable possible.

    Any comments/suggestions from the group are always appreciated.

    And thanks for your diligence in your record-keeping!

    Fred

    4/99 PSA 1.5
    10/01 PSA 1.68
    9/02 PSA 2.7
    10/03 PSA 3.8
    11/03 needle biopsy. Positive for Gleasons 6 on left side.
    12/03 Radical Prostatectomy performed at the Cleveland Clinic.
    Gleasons 3+4 = 7, clear surgical margins, extracapsular extension
    established. SVI: negative. Perineural invasion: positive. No LN
    sampling.
    3/17/04 PSA 0.003
    4/27/04 PSA 0.003
    7/22/04 PSA <0.1 (not 3rd generation test)
    11/10/04 PSA <0.1 (not 3rd generation test)
    5/10/05 PSA <0.1 (not 3rd generation test)
    10/19/05 PSA 0.050
    2/3/06 PSA 0.082
    3/23/06 PSA 0.110
    3/06-6/06 IMRT SRT
    9/06 PSA 0.044
    12/06 PSA 0.025
    3/07 PSA 0.019
    6/07 PSA 0.013
    9/07 PSA 0.008
    12/07 PSA 0.011
    3/08 PSA 0.012
    9/08 PSA 0.029
    2/09 PSA 0.043
    6/09 PSA 0.053
    10/09 PSA 0.090
    2/10 PSA 0.105

  14. #14
    Steve Kramer Guest

    Default Re: PSA Recurrence

    "fred" <[email protected]> wrote in message
    news:[email protected]...

    Post SRT nadir of 0.008 in September 2007, which everyone thought was
    outstanding. But after 7 consecutive PSA rises, I assume I'm headed
    for an official recurrence at some point in the not too distant
    future.

    ==> As much as anyone can rely on lab results of less than 0.1, I would
    agree. You have the most stable sub- 0.1 results I think I have ever seen.
    Even your doubling times on your last three tests seem predictably stable: 9
    months, 8 months, 8 months. That's based on my eyeball rather than a
    nomogram. The nomogram I use doesn't even allow sub- 0.1 entries.


    I have consulted with an oncologist who seems to have lots of
    experience in PCa; he says it's too soon to consider any HT or other
    follow up treatment.

    ==> I agree. If you had the standard assays all this while, you wouldn't
    even have been concerned until February 2010.


    He refuses to be pinned down on when HT should
    start, rather like Dr Myer's response previously posted; wait and see
    seems to be his watchword, and for now, I'm comfortable with that.

    ==> Keep in mind one caviat. Dr. Myers said that he would be working on a
    treatment plan customized to you; not just waiting for an arbitrary number
    to be reached. I had the feeling that if he could treat you with Vitamin D
    and Celbrex to level off your PSA, that's what he would do. And that would
    stave off ADT, not some hope for better future meds.


    He
    has also made the point to me that he feels that new treatments will
    be available in the next few years that will have fewer risks/SEs than
    HT; so his opinion is that it's better to postpone start of HT for as
    long as reasonable possible.

    ==> Two birds in the bush? :-)


    Any comments/suggestions from the group are always appreciated.

    ==> I can only give you my decision based on my stats. When I decided to
    go on ADT, my PSA was 0.21. If your pattern continues, that's where you'll
    be in October. My PSAD was about 7 months; yours has been 8. I was 48
    hoped to live long enough to retire at 55. You're about 60, I think.
    However, in 2003, I thought I was at least a decade from seeing something
    better than ADT.



    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 0.56 years
    Lupron 07/03 (1 mo) 8/03 and every 4 months there after
    PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.40 years
    Casodex added daily 07/06
    PSA undetectable since. Next Assay 10/10/10
    Illegitimati non carborundum



  15. #15
    Alan Meyer Guest

    Default Re: PSA Recurrence

    On 4/21/2010 8:59 PM, fred wrote:
    > ...
    > Any comments/suggestions from the group are always appreciated.
    > ...
    > 9/07 PSA 0.008
    > ...
    > 2/10 PSA 0.105


    Fred,

    One of the things Dr. Myers does is try to stabilize PSA using
    non-medical means, i.e., over the counter supplements. He told a a
    friend of mine who was one of his patients to try 5 x 200 mg capsules of
    pomegranate extract a day, and some amount of resveratrol, I don't
    remember how much. My friend had a very bad case and the supplements
    didn't do much for him. He died last year so I can't ask him what else
    Dr. Myers tried.

    I don't have a lot of confidence in supplements, but if they can work
    for anyone, I would think they might work best for someone like you with
    a very low and slowly rising PSA.

    Good luck.

    Alan


  16. #16
    fred Guest

    Default Re: PSA Recurrence

    On Apr 22, 10:00*am, Alan Meyer <amey...@yahoo.com> wrote:

    > Fred,
    >
    > One of the things Dr. Myers does is try to stabilize PSA using
    > non-medical means, i.e., over the counter supplements. *
    >
    > I don't have a lot of confidence in supplements, but if they can work
    > for anyone, I would think they might work best for someone like you with
    > a very low and slowly rising PSA.
    >
    > Good luck.
    >
    > * * *Alan


    Alan:

    Thanks for the suggestion. Like you, I'm fairly skeptical about
    supplements/herbal meds, but Myers seems like a serious med doc, and
    his approach of trying to slow PCa by other methods before HT seems
    reasonable, and having little downside. So I've ordered his book.

    Does anyone have any experience with Dr Myer's recommendations, or
    been a patient?

    Fred

  17. #17
    I.P. Freely Guest

    Default Re: PSA Recurrence

    fred wrote
    > his approach of trying to slow PCa by other methods before HT seems
    > reasonable, and having little downside.


    Unless it suppresses PSA without suppressing the underlying cancer.

    I.P

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