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Soon after I was diagnosed back in 1996 (when I was a young man!!) I came across a website where a man who called himself Lorenzo Q Squarf posted some very amusing, basic ideas about PCa. Here's part of his advice:
I am not a Luddite. Let me clarify my go/no-go criteria for hurling yourself into the great maw of urological mayhem:
If you are in your 50s, avoid biopsies until and unless you have negative urological symptoms which clearly indicated the need for a biopsy to determine what might be going on. If you have a suspicious DRE that does not clear up you fall into this catagory. If your PSAs are beginning to sequentially rocket upward you fall into this catagory. Absent these criteria, avoid urological procedures.
If you are in your 60s, the same criteria apply.
If you are in your 70s, ditto, but be *very* fussy about what constitutes negative symptoms. If they are not all that distressful consider treating the symptoms. Think amelioration of discomfort rather than aggressive intervention, but, if ordinary stuff can't supress your discomfort, why, discuss your particulars, and especially your personal values, with a urologist who listens carefully, and who seems to care more about you than his theories of aggressive intervention.
If you are in your 80s don't play the therapy game. Period. No. Don't do it. It will destroy the rest of your life. Ameliorate negative symptoms with medication. You can probably do this in an agreeable manner for a longer time than you might imagine. Smile. You have won.
I suppose I liked it, because it reflects my views - we always lke people who have the same outlook as we do!!
I can't give you any specific advice on what antibiotics might suit the condition, but I do know that bladder and prostate infections are very difficult to treat. One of my urologists said, when talking about the possibility of infection building up in my bladder from my BPH, said that when the bladder didn't drain it left behind a wonderful warm pool that was just what bacteria needed to breed and breed.
We saw the urologist today and he thought that all of his numbers from 2004 to now hadn't changed much at all so that is good.
He said he can't feel any nodules but his prostate is enlarged.
So he has put him on Avodart for 6 months to shrink the prostate in case there is something there he can't feel and then he is to get another psa test.
What is your thoughts on Avodart? good?? bad??
THanks
Nancy
Sorry for the delayed response, but as you probably know I was travelling - right down the West Coast of the US from Seattle, using tghe old Highway 1 wherever we could. Marvellous trip.
As to Avodart, well.....on balance there may be more positive than negatives to the use of the drug. It certainly can and does reduce the size of the prostate gland, so bear in mind that the previous PSA test results will be affected and you will have to start a new series to measure changes. It is sometimes said that the PSA is simple halved when Avodart is used, but it's not that simple - nothing is :-)
Gee, Nancy, that's one I can't answer - sorry. But why doesn't he get the PSA test done before the colonoscopy. The two week time gap would make no real difference.
As the first oncologist I ever consultred said, "You learn something new about this disease every day"
I have never heard of PSA having a measurable half-life and would be most interested in where you got this information - any studies etc - and how this conclusion was arrived at.
As far as I am concerned there is ample evidence that signficant variances can occur in PSA levels at periods that differe from 2.5 days
Check out tables 2 & 3 at the bottom of the article.
I know that the story relates to the decay of PSA following a prostatectomy, but if PSA leaves the blood at a certain rate, then that rate is the same whether you have a prostate or not. It is just that a man with a prostate tops up the PSA at the same rate that it is leaving his blood and his normal equilibrium PSA is maintained.
If the prostate is massaged by DRE or a bike ride, or is exercised by ejaculation and thereby produces an extra spurt of PSA, and if the half life is really 2.5 days, it will take a week for that extra PSA to decay to 14% of its initial value.
I have read how a DRE or ejaculation can elevate PSA by as much as 2 ng/mL. If that is true and the PSA half life is 2.5 days, then nearly 0.3 ng/mL of the PSA elevation will still be present after a full week of inactivity.
This surprises me due to the normal advice to refrain from certain activities for 48 hours prior to a PSA test.
This has particular relevance to me at the moment because I had a DRE late Friday arvo and am scheduled for a PSA test early Tuesday.
Thanks for that Brian – very interesting indeed, especially the reference to an earlier study (Eur Urol. 1998;33(3):251-4. Clearance of free and total serum PSA after prostatic surgery. Ravery V, Meulemans A, Boccon-Gibod L.) which concluded that the half-life of PSA after surgery was up to 3 days with a mean half-life of 2.43 +/- 0.688 days for total PSA.
This made me wonder why the ‘standard’ for PSA measurement was to wait three months after surgery. I have noticed that this has changed of late to a shorter period – usually about four weeks, but even that seems a long time in the light of these studies.
As you say, it seems that the current practice of recommending a 48 hour hiatus in sexual activity may be too short a time. Your reference to an increase as high as 2.0 ng/ml also clashes with the information I have read which refers to percentage increase in the base PSA level, so higher increases may occur.
There is another study (S Yox: "To Screen or Not to Screen? The Controversy Over Prostate Cancer." Laboratory Medicine V29, No 8. Aug/98) that suggests, among other things that Exercise on a bicycle can increase PSA levels up to threefold and that this may last a week; that prostate massage and ejaculation will produce variable results that can last up to six weeks in the former case and two days in the latter. I guess it is that finding that drives the current advice, although other studies come to different conclusions. There is a German study for example (Journal of Urology Volume 157, Issue 1, Pages 209-211 - January 1997 - The Influence of Ejaculation on Serum Levels of Prostate Specific Antigen) which concludes that for men under the age of 35 ejaculation does not affect serum PSA concentration in young men, and there seems to be no physiological relationship between ejaculation and PSA level.
I’ll certainly be making more enquiries to try and understand the half-life issue better. If I find anything, I’ll be posting it here and on the site.
I posted on this issue on a couple of other Lists and the answers, one of which referred to 10 half-days made me think ‘What the….!! What is this man talking about?????’ Ten half days?? How can that be????
And that’s when I realized that my (very non scientific) idea of what the term ‘half-life’ meant was seriously flawed. I reckon there might be more than one man on this list who might think that a half-life is half the life of the item under discussion and since we all know that two halves make a whole, twice the half life equals the full life. Therefore if PSA has a half life of 3 days it has a full life of six days i.e. after six days it is gone, surely????
But, impelled by your post I went to my good friend Wikipedia(that's the link for anyone else who shares my lack of knowledge) and all became more clear. The second half of a half life is a lot longer than the first half, and a lot longer than twice the number!! How you the people who understand science must laugh at such ignorance - but that comes from dropping out of school – warn your grandchildren/children!!
So now that I understand THAT a tad more, I can understand (and agree with)the minimum time to measure after RP (Radical Prostatectomy)being at least 30 days.
So, in terms of that knowledge, it would seem logical to say that the lingering remains of any elevated PSA that might come from DRE, or any of the other activities that are said to elevate PSA, might last longer too. Except that there is very little evidence that DRE DOES elevate the PSA significantly, especially in men with a PSA under 10 ng/ml. There are many published articles that refer to DRE elevating PSA, including this site, but very little evidence that it does.
Now I understand, the next part of a half life is longer than the first half by more than half? Terry if you ever tire of enlightening us about prostate cancer I think you could be a comedy writer.
Thank You for all your replies about my husband's colonoscopy. We were also assured by two dr's that it was ok. He has had the colonoscopy but has not got the results yet.
As my husbands next psa nears (Nov.8) my psa anxiety again has sky rocketed.
I am sorry to ask this but here is the question anyways.
My husband is now going to a massage therapist, for what the therapist thinks is a floating rib problem. The therapist is using hand manipulation plus a vibrator on his back.
Is there any way the vibrator can raise his psa level?
Hello:
To catch you all up on my hubbies PSA it is as follows:
Mar. 2010 6.3 Free 24.9
Nov 2010 3.5 been on Avodart for the past 6 months
May 2011 1.5 still on Avodart
Oct 2011 2.3 " " "
May 2012 2.5 " " " normal DRE
Nov 2012 3.1 hubby wants off Avodart dr. agrees
May 2013 2.0 still off Avodart
May 2014 4.2 " " "
Just wondering if anyone had any thoughts what is going on now?
He is to see the urologist next week.
Thanks
Given the conventional wisdom that PSA whilst on Avodart should be doubled to provide a comparison with non-Avodart readings, it may be that nothing is going on. Another DRE should provide reassurance - if not much comfort at the time!
