PSA

Has anyone been diagnosed with prostate cancer when their PSA was less than 3.0? If so, what was your PSA score that led to the biopsy?

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One may have prostate cancer even with PSA of 1.0. Either rise in PSA or abnormal DRE may lead to biopsy.

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Thank you for reponding. I realize this. However, I am would like to keep the conversation open because I am interested in the cases where it actually happens. Thank you again for your response.

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Yes, plenty of men have been diagnosed with PCa despite a PSA of <3.0. In almost no cases, however, was it the PSA score that led to a biopsy. For example, before the PSA test was invented, it was never the PSA score that led to a biopsy.

Nowadays, it could be one of several things other than a PSA that could would lead to a biopsy, such as positive DRE or suspicious imaging.

Also, many men undergo TURP for BPH. Unless done by laser, this usually provides tissue specimens from which cancer can be diagnosed -- again, irrespective of PSA.

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Hi newfriend, - About 15 to 20% of men diagnosed with Prostate Cancer (PCa) today have what was once (but no longer) considered "normal" PSA readings (<4.0). This is extremely significant because there is a form of particularly aggressive PCa that produces very little PSA and needs to be recognized regardless of low PSA results. Not ALL men with low PSA's have this relatively rare form of the disease but the possibility needs to be addressed if other diagnostic factors raise a suspicion of PCa presence. Why do you ask and do you have other specific questions? - John@newPCa.org (aka) az4peaks

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Like the others, I am wondering what is causing your Drs. to suggest prostate cancer.

A PSA alone has little meaning. An elevated PSA usually leads to treatment with antibiotics (useless in my view but boilerplate) and then if the PSA remains elevated you are put in the hands of an urologist who usually suggests a transrectal biopsy.

A PSA of 3 for many men is very normal.

Best, please tell us more, Scott

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Az4peaks and scott
Thanks for the info. Basically I am trying to educate myself. I am a 43 year old with incidentally found microscopic hematuria. I have been through the ringer for bladder and upper tract testing and no cause can be found during these last 18 months. I so by process of elimination I am told that the hematuria most be from my prostate. My PSA is 0.4 and my DRE finds no nodules. I had a DRE by 3 uros. However, my prostate seems to be mildly enlarged. None of my drs are worried. But dad had PCa. And so, I want to stay on top of things and know when it is time to have biopsy. My understanding is I should have a biopsy if my PSA is >2.5, or if it increase more than O.35 in one year, or a nodule is felt on DRE. I'm trying to do my home work so thart fall between the crackd

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There is a non-invaisive test called PCA-3. It is more commonly used in Europe than US but it is available here. It is a urine test, you first are subjected to a vigourous DRE and then immediately afterwards submit a urine sample. I would ask about this test.

Best. Scott

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Hi newfriend, - You said: "My understanding is I should have a biopsy if my PSA is >2.5, or if it increase more than O.35 in one year, or a nodule is felt on DRE."

The parameters you have set, would be reasonable thresholds for Biopsy consideration. Young men's PSA usually moves more slowly than older men and, therefore, the more traditional 0.75 ng/ml trigger for annual increase, needs to be adjusted downward. This is because Prostate Cancer (PCa) statistics, unless age differentiated, tend to be dominated by older men (over 65), who make up 75 to 85% of those diagnosed annually. Enlarged Prostate is often due to BPH (Benign Prostatic Hyperplasia), the natural growth of the Prostate, usually after 40 years of age, observed in most men to varying degrees. It has never been found to have any association with PCa.

A Study by Dr. Catalona, et al, (Northwestern University) showed a median PSA level (half above/half below) of 0.7 ng/ml in a cohort of men between 40 to 49 y/o which can be used as a guideline. Your PSA is certainly on the right side of that ratio and you have had repeated negative DRE's. Another Study found that only 6.6% of men with a PSA of less than 0.5 (<0.5 ng/ml) were found to have PCa. So all in all, your PCa likelihood is rather substantially in your favor, at this time.

As far as your micro-hematuria is concerned, there are several possibilities, along with the Prostate, as a source for such tiny amounts of blood in the Urine. Micro-hematuria is not that uncommon and certainly can originate from such sources as Kidney stones, Lower Urinary Tract infections, etc. Good luck to you and if you feel I can be of any help, don't hesitate to contact me. - John@newPCa.org (aka) az4peaks

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Your caution is called for, IMHO, especially with a family history. My PSA was rock-steady at 1.5 for 7 years; and my primary care doc performed annual DREs, declaring it was just BPH. Serious hematuria at age 62 led me to a urologist, who immediately upon performing a DRE declared, "Uh, oh. Bad prostate." Biopsy results: Gleason 8, 11 out of 12 cores >70% cancerous. Subsequent urethral biopsy found cancer at sphincter, resulting in T4 staging. My best friend has a "normal" PSA = 9. So, if you think I'm a bit cynical about relying solely on PSA numbers, you're right. (You can draw your own conclusions about DREs performed by primary care docs--at least mine.)

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PSA velocity, whether measured as an absolute increase (such as increasing by 0.35 or by 0.75 in one year) or as a doubling time (such as going from 0.11 to 0.22 to 0.44 in PSA testing every six months), is helpful but not as specific* or sensitive* as some other indicators.

Scott's suggestion about PCA3 is an excellent one. It's a urine test, but requires a vigorous prostate massage. It should be fairly easy to find a facility that provides this test.

Even better (according to a study published at http://www.ncbi.nlm.nih.gov/pubmed/21600800) is a three-marker test that includes PSA, PCA3, and TMPRSS2:ERG. The study's abstract indicates that: PCA3 had the highest sensitivity* in predicting prostate cancer diagnosis (93 percent); and TMPRSS2:ERG had the highest specificity* in predicting prostate cancer diagnosis (87 percent), as well as the greatest discriminatory value.

The authors concluded that a clinical algorithm combining the three markers was better at predicting cancer than any single biomarker alone. The algorithm they suggested was this: Check PSA first; if PSA=10 or higher, biopsy; if PSA<10, check PCA3 and TMPRSS2:ERG in post-DRE urine and then biopsy only if either of the other two markers is found.
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* Sensitivity = correctly identifying positives (thus not misidentifying sick people as healthy)
* Specificity = correctly identifying negatives (thus not misidentifying healthy people as sick)

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I was having moderate urinary symptoms for 1 1/2 years, with minimal relief from flomax and uroxatral. I was referred to a local urologist, who noted a slight irregularity on my prostate during a DRE, and, after several flow tests and a cystoscopy (normal), he suggested a biopsy. The results shows 20% of one of 16 cores as adenocarcinoma. My psa has never been higher than 2.8--63 years old now--and the cancer, according to my Dr., is too small to be palpated.
So, I am either lucky or unlucky, depending on your perspective. I'm still having urinary symptoms--taking no meds--I have an enlarged prostate and low psa, but I have confirmed PC. Am I better off not knowing? Will my psa ever rise? Is the cancer a threat?

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'hematuria' ... (blood in urine?)
could be another health related issues... hum?
PSA of over 4 is 'getting up' in the 'cause for concern' range... perhaps.

Look up closer study about getting prostate tissue biopsied - not piece of cake to me!

BTW:
I also did NOT get the PCA-3 (?) urine test, etc. but we certainly still ALL
need badly ... a "concise & respected / valid" new "MARKER" for us guys with pCa! IMHO.

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I was diagnosed at 3.0. Yes, it was a rise from 1.2. Low grade-low volume . . . < 1% of 1 of 12 samples. nothing detected thru DRE. Curiously (and gratefully) have made some lifestyle changes as part of active surveillance it has steadily declined back to 1.22 in the past 18 months. So by extension - I am 1.22 with PCa.

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Hi Newfriend I have been on flowmax and Advodart for 10 years when my Uro believed he felt something on the DRE.
My PSA was 0.3 at the time; PSA was 0.5 6 months before.
The biopsy show 10% of 1 core out of 12 with 3 + 4, Gleason 7
None of the second opinions from other Uros assessed their DREs as a problem and would probably not ordered a biopsy!
Get a second opinion on your slides from a lab that has a national reputation.
Have an endo-rectal MRI and get the results back from the lab before you make any treatment decision.
I did not because I did not know any better!
I will never know if I am at risk for a recurrence now because of bulge the MRI might have picked up.
Also. I might not have had cancer at all if I had had another lab read the results.
I was treated with about 100 to 120 greys of radiation using the para-rectal technique from Koutrovellis 9 weeks after being diagnosed
I do not know anyone that has had as low a PSA when diagnosed.
Good luck

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PaulC2
Do you know where in the northeast PCA3 and TMPRSS2:ERG are available? I would imagine it would need to be in a center that is used to these tests?

az4peaks,
You mention a particularly aggressive PCa that produces very little PSA and is relatively rare. My questions on the aforemtioned form of PCa are (1) what percentage of PCa diagnosis is this particular form? (2) Are there any particularly different risk factors form of PCs that produces very little PSA? (3) What is the best way to catch this particular form of PCa?

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I was diagnosed with a PSA of 2.3. Cancer in 2 of 12 samples with less than 5% involvement. Gleason score of 3+3. While shopping around different treatment plans, my urologist put me on Proscar. Finally decided this week to go with brachytherapy and had some bloodwork done prior to the procedure. Nurse called today to say my PSA is .9. Now I am wondering if I should hold off on the seed implant or go ahead. I know the Proscar was responsible for the decrease but doesn't that indicate that it is successfully retarding the growth of the cancer or did I misinterpret the results? Anyone else find themselves in a similar situation?

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My PSA was 0.61. My doctor on a exam felt a nodule.

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To rapearce. That's the problem with proscar. Why did the doc put you on it?
PSA (regardless of my case and research - still consider myself a layman), rises due to growth. Growth either caused by natural aging or tumor growth. I have some confidence in my declining PSA (3 . . . 1.67 . . . 1.87 . . . 1.27 . . . 1.22) as it is without any BPH medication. For me it indicates no growth of any kind, particularly PCa). I would think it's very difficult/impossible for you to know.

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You cannot rely on PSA, it is only a part of the puzzle.

You should not have blood in your urine.

Wherever you are there are good urologists nearby.

See one.

Best. Scott

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Hi newfriend,

YOU POSTED, in response to my previous answer:

"az4peaks, - You mention a particularly aggressive PCa that produces very little PSA and is relatively rare. My questions on the aforemtioned form of PCa are (1) what percentage of PCa diagnosis is this particular form? (2) Are there any particularly different risk factors form of PCs that produces very little PSA? (3) What is the best way to catch this particular form of PCa?"

MY RESPONSE: (1) There may be others, but Small Cell Prostate Cancer (SCPCa) is one. It is EXTREMELY rare, and usually very aggressive. It can already have metastases at PSA levels of 1.0 ng/ml. It is consequently extremely difficult to diagnose and can evolve from common adenocarcinoma PCa or appear spontaneously. (2) Not to my Knowledge (3) If by "catch", you mean diagnose, I would say Monitoring and Biopsy. - John@newPCa.org (aka) az4peaks

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