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Re: 3.79 psa

Thanks

Re: 3.79 psa

Mine went from 1.5 in 2003 to 3.35 in 2012. Dx with 3 out 14 cores, all G6. The trend is not your friend in this case.
Perhaps, add other tests to the PSA before biopsy?

Re: 3.79 psa

I guess at this point the question is what are the odds. About a month or two from now the odds may not be as important.

I suppose at age 55 any man has a 55% chance of having cancer of prostate? Did I read that right? Not that it would be detected by PSA test, or worth treating but those are the odds? Maybe I misread that or the site I saw that on was not the best.

I guess a better stat is 25%

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What is Prostate Cancer?
If you're a 50 year old male, you have a 25% chance of having at least some cancerous cells in your prostate gland -- and that risk grows as you age, making regular prostate exams a wise choice for health maintenence.
- prostate cancer information center.

Not sure I am thinking clearly at the moment - sorry.

Re: 3.79 psa

Don,

I think you are getting to grips with some of the key issues very well. It is difficult to think very clearly when faced with so much data and opinions, much of it apparently contradictory. As I say in the Introduction to my booklet A Strange Place :

The late Robert Young was diagnosed in the latter part of 1999 with a PSA of over 1,000 ng/ml. He compared a prostate cancer diagnosis to being dropped, without your consent, into a new country. A country where the language, customs, terrain, roads and rules are all foreign. You are in a Strange Place, and it's frightening.

You are still trying to learn the language, customs, terrain, roads and rules – and also finding out that there are in fact no Rules, no certainty. All we can ever do is to gather suitable information which will help us to choose the path that we feel is best for us and our family based on our particular circumstances. So press on, ask questions, get information. Here is a little more that may help.

You pose the question What is Prostate Cancer? it seems from the way you have posted, this is clipped from a website, but it is a useful question to start from, at least for me, because that was a question I asked myself. My reason for doing that was that I had a growth removed from my chest many years before I was diagnosed. I was told that it was a Basal Cell Carcinoma and knowing that carcinoma was cancer and that skin cancer was deadly and that my Mother had died of cancer…..well, you can imagine the feelings. BUT….I had a very good doctor who explained that there was a substantial difference between Basal Cell Carcinoma which rarely metastasizes or kills and Melanoma which is the most aggressive of the many skin cancers, most likely to spread and, if untreated, to become fatal.

Against that background I wanted to know if there was any similar differentiation as far as prostate cancer was concerned. One of the pieces I came across in my search shone some light on this question was a speech given three years before my diagnosis which said in essence:

One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.

(You can read the entire piece at Presentation
By Dr. Christopher Logothetis, M.D.


Many other medical people have made the same point. Perhaps the most influential has been Dr Jonathon Oppenheimer. In February 2008 he published on a blog Prostatic Tubular Neogenesis - A letter to colleagues where he says in part:

It is time to reconcile the discrepancy of the term that pathologists assign to a microscopic finding to the historical and practical significance of that term. The most common significant finding made by contemporary pathologists on prostate biopsies cannot be adequately described by “tumor” (Greek: swelling), “cancer” (from the crab-like extension), or “malignant” (threatening to life or tending to metastasize). I propose the terms “prostatic tubular neogenesis” (creation of new epithelial tubes or acini) and “potentially malignant” to better describe the microscopic findings that we have in the past labeled “adenocarcinoma” “cancer” “tumor” and “malignant.”

Although this suggestion has not yet been taken up by his colleagues, they have agreed that many of the ‘prostate cancers’ diagnosed in the past by way of needle biopsy procedures should no longer be labelled as cancer – I refer to the samples where the Gleason Score was 5 or lower. Samples were previously labelled adenocarcinoma and graded using five grades giving Gleason Scores from 2 to 10 with a median of 6. Now they are scored using three grades, giving a minimum Grade of 3+3=6. In other words, if the scores of either focus are less than 3, the man is not said to have adenocarcinoma.

So there have been a number of discussion regarding the definition of prostate cancer and, just to add a little more confusion, there are a number of other conditions which inexpert pathologists can mistake for adenocarcinoma.

Against that background it is difficult to try to estimate what proportion of men are likely to have prostate cancer – if you cannot define the disease adequately how can you measure the incidence. Perhaps when there is a greater understanding of the genetics of prostate cancer we may have a better idea, that seems a long way off despite the upbeat tone of this article The Prostate Cancer Quandary

Broadly speaking as you say, there is a view that the percentage of men with prostate cancer correlates with their age – so yes in term of this belief, about 55% of men aged 55 will have prostate cancer cells in their prostate. These numbers are based on so-called cadaver autopsies. The prostate glands of men of all ages who died of something other than prostate cancer were examined. The distinction is sometimes made, when discussing these figures between clinically observable cancer and microscopic observations. The point being made that only the men with clinically observable cancers can be said to have cancer. I have never been sure that the distinction is much value. The statistics in the SEER data base also demonstrate graphically that the incidence of prostate cancer rises with age.

There is one study, pretty well ignored by many, which does throw a bit of light on the other issue you raise Not that it would be detected by PSA test, or worth treating but those are the odds? Maybe I misread that or the site I saw that on was not the best. I guess a better stat is 25%... This study is Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level ≤4.0 ng per Millilitre and it concludes Biopsy-detected prostate cancer, including high-grade cancers, is not rare among men with PSA levels of 4.0 ng per milliliter or less — levels generally thought to be in the normal range. The study found that about 16% of men in the study were found to have what was defined as prostate cancer at that time even though their PSA never rose above 4.00 ng/ml.

I don’t know if this post will add to your confusion or help you in understanding some of the issues. Please post more questions – never stop asking.

Good luck along your way
Terry in Australia

Re: 3.79 psa

Update - Urology appointment today

(spoiler alert - I am probably obsessing a bit about almost nothing - but want to get any advice that may be relevant)

Dr. prescribed cipro to try to treat or rule out possible prostate infection. Urine being cultured as well.

I return in one month for followup PSA and if cipro changed nothing (infection ruled out as cause of elevated PSA) then maybe a biopsy to try to rule out cancer.

Sounds reasonable since I was having some symptoms of infection - some pain and stiffness in hip and lower back areas.

I have two friends who were recently diagnosed with prostate cancer. One had surgery before it spread and mostly had to deal with surgery side effects - which are better now. The other had stage four PC and tried lupron and then lupron and casodex, then radiation for one tumor that was causing pain. Now just on lupron and feeling pretty good, PSA dropping. Doctor doesn't know why, might just be temporary.

All that to say I am not exactly worried yet since I don't even have a diagnosis. I have walked down this road a bit with two others. And doctor said another month to try to puzzle it out most likely wouldn't hurt any since PSA so low. Concerned but not worried yet.

Thanks

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