Recently diagnosed

Hi MalCG I hope that you don't mind me popping over from.another thread. Welcome to the forum. I had cause to be discussing exactly this last week with the lead for our Community Buddies at local level. It seems that a psa test is as you say it seems to be the holy grail. However, I checked on the guidelines available and none exist for scotland but not sure of anywhere else. As far as I can see psa testing can throw up false positives which can result in lots of anxiety. I'm tempted to suggest that a false positive would trigger further tests to rule out or rule in but that's just my thoughts. I'm also reliably informed that lots of different things can alter the level of psa and I'm sure someone will be better able to let you know what these are. Personally in the absence of any other testing for Prostate Cancer then a PSA is what we have. I have also heard of people being refused PSA testing and again we are locally trying to ascertain why that is happening in the absence of anything else? Hope that's been helpful and I hope i have not gone off on a tangent. Best wishes for now..

After reading a lot of stuff on this forum, and reviewing my own experience during my recent diagnosis, it seems to me that we should regard PSA as an indicator.

So, my recent experience:

• Elevated PSA - refer to Urology.
• Urology - DRE - nothing suspicious but we will have an MRI
• MRI - that's cancer and it looks like its getting away. Biopsy and 2 scans.
• Bonescan - nothing seen.
• CT Scan - it is getting away , but not far, so we can give ita good whack.
• Biopsy - that is high risk, we'll give it a bigger whack.

The PSA reading is an indicator, especially at a lower level. if it gets very high it turns from an amber light to a read one

At the start of indicates that you should have other investigations to see what exactly is happening. 

After treatment is complete, then again it is an indicator. If it goes up, then let's find out what is going on.

 Mal CG , my understanding (and I am not medical) is that PSA is the best indicator we have, but in itself isn’t totally reliable.  All sorts of factors come into play like age and some cancers are low secreters. So a low score isn’t very reliable on its own.  On the other hand, some people naturally have a high PSA, so that again isn’t good to check, but is the best we currently have to make an initial diagnosis.  That’s why, scans and biopsies then confirm (or reject) an initial diagnosis.

Once PCa is confirmed, then a change to a baseline figure is highly indicative (usually over a few months) to indicate if the PCa is being held (lower readings) or increasing to spread (higher readings).

Hope this makes sense.  Best wishes, David

Excellent posts from the others who have covered well why the PSA is only an indication of something happening with the prostate. My understanding is that once you have been diagnosed with prostate cancer then this becomes more important as your base number which, along with all the other tests, should help determine the treatment pathway. If you decide on active surveillance then it is used as an indicator that the cancer remains slow growing so they will look for the rate at which it increases every year, no more than 0.7 annually, but it is important to have the other checks as well on a regular basis to ensure that nothing has changed. Most men have a form of prostate cancer which can be monitored by PSA so the initial PSA at diagnosis becomes relevant to the choices given and the likelihood of the long term success of that treatment in terms of likelihood of biochemical recurrence e.g. someone with an initial PSA below 10 is less likely to have a biochemical recurrence compared to if it is above 10. Some men are low secreters which means that the PSA is not a good indicator of their disease state so they should be monitored with scans after treatment but invariably their initial PSA at diagnosis is below 5 and yet they have cancer which has already spread out the prostate and metastasised. As a general rule, once prostate cancer has been diagnosed then the higher the PSA is the greater the disease burden.

After treatment then the PSA is used as a monitoring tool to check that things are still under control. Most treatments should remove the cancer from the prostate area. Surgery takes some or all of the prostate away plus adjoining areas if necessary so it is expected that the PSA after treatment should be negligible. Any PSA rise above 0.2, or 3 consecutive rises, would indicate that something has escaped so further investigation and treatment would be advised. With the different forms of radiotherapy the prostate area is turned to mush and the cancer is killed off over a longer period of time so the PSA is followed for up to 3 years to ensure that it continues to drop to its lowest level (nadir). Once this is reached then three consecutive rises in PSA, or a PSA rise of 2 units above the nadir is indicative that further investigation and treatment might be necessary. For those on hormone therapy it is hoped that the PSA will rapidly drop to very low levels and stay there - the level to which it drops can indicate the likelihood of recurrence in the future. 

Thought I better qualify about low secreters. Only 1-2% of men are low secreters. For most men having a low PSA, if above the norm for your age, is good and can indicate a benign condition where the prostate is just bigger than normal. If this is ruled out by further tests then it usually refers to a lower cancer burden which is either monitored or treated.

Morning a great read at this time off the morning,it has taken my mind of my body for a wee while which is aching this morning

My first psa was private off Internet Randox health which gave 2 readings total psa plus free psa ?this recommended seeing the doc who said she would need a nhs psa but asked if I would jump on bed for finger test .she went quiet and said she would refer me anyway ,I asked how test went ?she said P was enlarged and she could feel hard skin on bottom this was end of February. 

Her PSA test was 5 higher than mine at 31,

It then took until end of June for mri bone and pet scans 

Started on tablets end of June zoladex at start of July. 

My question is how and how much do they know  My psa as dropped if my last PSA test was February and and I didn't start treatment until end of June ?

Hi Mal CG, you gave no mention of a biopsy which provides the most information about your PCa,I hope it was just an omission as to have one now would not only be unusual, as your on HT, it would incorrectly give more favourable results, the only way to monitor your PSA is with the blood test, you would normally have follow up tests every three months, for you that would be early June, Mal I arrange my own PSA blood tests through my GP, so to answer your question without a blood test no one knows your PSA.

Eddie

My biopsy was 4+5 =9 initially diagnosed stage 3 by urologist 

Changed to stage 4 by oncologist 

What I mean is psa initially was 31 in February  but ht started end of June but no psa was done then so next psa is on August 29th .so they are calculating on February psa .would that have been much higher by end of June?