PSA "Noise"
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From: Pops on 16 Nov 2005 09:59 There are a lot of people posting here regarding PSA levels with resolutions equal to or less than 0.01. My urologist and oncologist both agree that, quantitatively speaking, absolute readings below 0.1 are relatively meaningless, They are "in the noise" so to speak (no matter what resolution test is used). I asked why, of course... A: Prostate cells are not the only ones that produce PSA. Other contributors may be present and signficant below levels of 0.1 A: All prostate cells, malignant or not, produce PSA. Malignant cells simply produce more. At these low levels there is really no way to differentiate, and that's assuming that there are really prostate cells present. A: Many psychological and physiological factors contribute to PSA level variations, usually swamping resolutions below 0.1 (even in patients treated with RP or radiation) They were both quick to say that confirmed precision readings may be qualitatively significant (things like PSA acceleration and doubling times) but must be combined with significant absolute readings (above 0.1 for post therapy patients and above 0.4 for pre-therapy patients) before any further diagnostic/curative action should be contemplated. Of course there are exception even to these "rules" (like an abnormal DRE or significant symptoms). Anywho, I'm due for my next PSA test, three months after the last and 10 months after LRP. My initial post-op PSA test were cause for concern. Taken at monthly intervals beginning 3 months after surgery they were 0.24, undetectable, 0.12, undetectable, udetectable. I am of course concerned.... concerned enough to put off making winter vacation reservations until after the PSA test for fear that readings above 0.1 would trigger further regular tests and prep for EBRT (and of course my max out-of-pocket resets Jan 1). I've also quietly watched developments in this NG regarding the use of hormonal therapies. It is my understanding that the only possible "curative" treatments are surgery and radiation. It is my understanding that hormonal therapy is a "slow down the beast" treatment, that it will eventually become ineffective and that there may be significant SE's. If that is the case then EBRT is my last "silver bullet", one that I want to fire at exactly the right time. Further, since HT is not curative and has a finite "half-life", if and when the EBRT proves not to have worked, I will wait until the last possible monent before Invoking HT, if at all. Can anyone here comment on the "PSA noise" issue, and/or on my diatribe regarding post LRP treatment? To all of you, who have been my salvation through this whole horrible experience, have the happiest of possible Turkey Days, and may it find you and yours healthy, safe and warm!
From: Buttercup's Dad on 16 Nov 2005 11:01 When I was diagnosed in April 2003 I did a lot of reading on the subject, so at this point I cannot remember where I read this. But, as I recall, the adrenal gland produces PSA also. I have never read anything that indicates the significance or measurability of the PSA produced by the adrenal gland, but it would seem to me that it could be a factor in the ultra sensitive tests. Of course, women have adrenal glands, so in that case they too can have PSA. Or so I read 2+ years ago. Anyone else familiar with this? "Pops" <pvanden1(a)rochester.rr.com> wrote in message news:1132153148.117854.314630(a)g44g2000cwa.googlegroups.com... > There are a lot of people posting here regarding PSA levels with > resolutions equal to or less than 0.01. > > My urologist and oncologist both agree that, quantitatively speaking, > absolute readings below 0.1 are relatively meaningless, They are "in > the noise" so to speak (no matter what resolution test is used). > > I asked why, of course... > > A: Prostate cells are not the only ones that produce PSA. Other > contributors may be present and signficant below levels of 0.1 > > A: All prostate cells, malignant or not, produce PSA. Malignant cells > simply produce more. At these low levels there is really no way to > differentiate, and that's assuming that there are really prostate cells > present. > > A: Many psychological and physiological factors contribute to PSA level > variations, usually swamping resolutions below 0.1 (even in patients > treated with RP or radiation) > > They were both quick to say that confirmed precision readings may be > qualitatively significant (things like PSA acceleration and doubling > times) but must be combined with significant absolute readings (above > 0.1 for post therapy patients and above 0.4 for pre-therapy patients) > before any further diagnostic/curative action should be contemplated. > Of course there are exception even to these "rules" (like an abnormal > DRE or significant symptoms). > > Anywho, I'm due for my next PSA test, three months after the last and > 10 months after LRP. My initial post-op PSA test were cause for > concern. Taken at monthly intervals beginning 3 months after surgery > they were 0.24, undetectable, 0.12, undetectable, udetectable. > > I am of course concerned.... concerned enough to put off making winter > vacation reservations until after the PSA test for fear that readings > above 0.1 would trigger further regular tests and prep for EBRT (and of > course my max out-of-pocket resets Jan 1). > > I've also quietly watched developments in this NG regarding the use of > hormonal therapies. It is my understanding that the only possible > "curative" treatments are surgery and radiation. It is my understanding > that hormonal therapy is a "slow down the beast" treatment, that it > will eventually become ineffective and that there may be significant > SE's. If that is the case then EBRT is my last "silver bullet", one > that I want to fire at exactly the right time. Further, since HT is not > curative and has a finite "half-life", if and when the EBRT proves not > to have worked, I will wait until the last possible monent before > Invoking HT, if at all. > > Can anyone here comment on the "PSA noise" issue, and/or on my diatribe > regarding post LRP treatment? > > To all of you, who have been my salvation through this whole horrible > experience, have the happiest of possible Turkey Days, and may it find > you and yours healthy, safe and warm! >
From: ron on 16 Nov 2005 12:02 Buttercup's Dad wrote...snip... > as I recall, the > adrenal gland produces PSA also. I have never read anything that indicates > the significance or measurability of the PSA produced by the adrenal gland, > but it would seem to me that it could be a factor in the ultra sensitive > tests. Of course, women have adrenal glands, so in that case they too can > have PSA. Or so I read 2+ years ago. Anyone else familiar with this? > That's right, some other organs in the body produce very small amounts of PSA. For example, psa has been found to be present in very low levels in pituitary tissue and adrenal tissue. It is found in many tumors (e.g. lung). It has also been found in women (breast and ovarian tissue). PSA in women can occasionally exceed 0.1 ng/ml depending upon BCa status, age, time in the menstrual cycle, etc...Best wishes and good health, Ron
From: DonC on 16 Nov 2005 12:27 What I remember reading is that the adrenal glands produce testosterone -- not PSA. But then again, that's just from memory : ) "Buttercup's Dad" <Buttercupsdad(a)dog.net> wrote in message news:dlfkno$84g$1(a)gargoyle.oit.duke.edu... > When I was diagnosed in April 2003 I did a lot of reading on the subject, > so > at this point I cannot remember where I read this. But, as I recall, the > adrenal gland produces PSA also. I have never read anything that > indicates > the significance or measurability of the PSA produced by the adrenal > gland, > but it would seem to me that it could be a factor in the ultra sensitive > tests. Of course, women have adrenal glands, so in that case they too can > have PSA. Or so I read 2+ years ago. Anyone else familiar with this?
From: I. P. Freely on 16 Nov 2005 13:10
"Pops" wrote > I am of course concerned.... concerned enough to put off making winter > vacation reservations until after the PSA test for fear that readings > above 0.1 would trigger further regular tests and prep for EBRT (and of > course my max out-of-pocket resets Jan 1). I'm not putting my life on hold for ANYTHING diapers or Tylenol will solve. PC's not going anywhere in the span of one lousy vacation, and I've got only 10-15 years left anyway unless I blow the statistics out of the water. IOW, your PC will never know you took that vacation, but YOU will certainly know if you abandon it. Who's more important . . . YOU, or your PC? > It is my understanding that the only possible "curative" treatments > are surgery and radiation. It is my understanding > that hormonal therapy is a "slow down the beast" treatment, that it > will eventually become ineffective and that there may be significant > SE's. If that is the case . . . If you're still at the "understanding" (i.e., not certain) stage, you haven't done enough research to make decisions regarding adjuvant treatment. The "understandings" you present here are certain, with one exception: ADT (aka HT) virtually WILL, not "may", produce significant SEs, according to trials, authors, and a poll of this forum. The odds of escaping them are extremely low . . . down in that noise. > then EBRT is my last "silver bullet" Yup. > one I want to fire at exactly the right time. IF one is going to fire it, isn't the best time NOW, before the PC can spread any more? I'd think (and I've not researched this yet because my PSA is definitely in the noise) the real question is the IF, not the timing. > I will wait until the last possible moment before invoking HT, if at all. You and me both. The therapeutic ratio statistics, and many patients and authors, don't support anything else, IMO, BASED ON MY PERSONAL PRIORITIES. > To all of you, who have been my salvation through this whole horrible > experience I'm sorry to hear your experience was horrible. Mine has merely been a couple weeks of major discomfort, a lingering minor nuisance, the wasted expense of a huge pile of new boxer shorts (they were on sale) I'll apparently now never use, and being reminded that I'm not invincible. The REAL impact has been the man-months of time spent on the research, but that, in turn, has freed me from doubts about my treatment choices, so it wasn't wasted. What's relatively horrible to me -- and I'm not joking -- is that my windsurfing season has probably ended, and I haven't found a place worth traveling to for a whole winter of good windsurfing. I'll reserve the "H" word for when I hit intractable clinical failure and am forced to choose between different unacceptable alternatives. I.P. |