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Q: PSA and Tumor Markers for Prostate Bone Metastasis?
This message pertains to the utility of Prostate Specific Antigen (PSA), for the treatment of Advanced Prostate Cancer. PSA writes Dr. John Lee (Harmone Balance for Men) is produced both within the Prostate Gland and the Breast Tissue. He further writes that the normal cells produce PSA, an anti angiogenesis defence when there are abnormally growing cells in the prostate. This seems to indicate that the PSA has no correlation with what is happening in the bone and anywhere outside prostate. Is this correct? There are further questions: (a) How do we monitor bone metastasis and other situations where the cancer has escaped out of prostate. (non-Bone Scan/MRI options) (b) Are there other prostate tumor markers that can tell us the tumor loads/tumor activity in non prostate areas such as the bones. (c) Will Acid Phosphatase levels inform us the status of prostate metastasis on bone. (d) Are Osteoblastic/Osteocystic/Osteocytic rates right parameters to track. Sam

A: There are a few misconceptions here. * PSA is manufactured almost exclusively by prostate cells. Although there are a few other cell types that can make minute quantities of it, their contribution is so small that PSA is indeed, for all practical purposes, a prostate-_specific_ marker. However, that doesn't mean it measures only cells that reside in the prostate gland. * In a person with normal prostatic health, prostate cells reside only in the prostate gland. But in a person with advanced prostate cancer, most of his prostate cells have traveled to areas outside the prostate, typically the bones and lungs. Therefore, for men with advanced prostate cancer, PSA is normally the single best way of tracking the cancer, since it correlates so well with the number of prostate cells in the body -- both within the gland (if it's still there) and outside the gland, and thus presumably cancerous. (a) To specifically find bone metastases, one would normally use an imaging technique, such as a bone scan, a CT scan, and/or a PET scan (preferably one that uses 11C-choline rather than 18F-FDG). It's unclear why someone would try to monitor bone metastasis without any attempt to image the bones, so I don't know what prompts the question. (Not all imaging techniques use radioactive tracers, for example. And if expense is an issue, then maybe consider simple X-rays.) (b) There are indeed other tumor markers, but none of them are specific to rogue prostate cells that are in the _bones_, as opposed to rogue prostate cells generally. Such tumor markers include: PSMA, PAP, NSE, CGA, and CEA. (c) Yes and no. PAP (prostatic acid phosphatase) is useful as a tumor marker, but no tumor marker, so far as I know, can possibly differentiate betwee bone and non-bone metastasis. (d) Yes and no. If you're focusing only on the bone, then you are interested in overall rates of bone-building (osteoblastic) and bone-resorption (osteoclastic) activity. But you won't know _where_ the activity is occurring. Most importantly: In a person has advanced prostate cancer, bone issues are one of the consequences. But it's much more important to tend to the cancer itself than to focus on only one of its consequences. If a car is heading downhill and its brakes are failing, one of the consequences will be tiretread left on the roadway. Rather than trying to measure and track the tiretread, it's more important to find a turnoff, or a soft ditch, or (best) an alternate braking system. Good luck! (BTW, I'm now also a member of the PCa tribe.)

Q: what happens when prostate cancer returns for the 3rd time knowing that the prostate has been removed?
the psa level is 8.21, and the doctor says the cancer is back but unsure where. How high can the psa level go

A: I’ve seen PSAs in the thousands. It can often elevate long before mets show up on imaging. Not knowing what treatment you have had other than a prostatectomy, your age, stage and grade of your cancer you are going to have to ask your urologist. For now he will probably continue to monitor you.

Q: My grandfather recently went to the doctor because he was feeling weak and they found that his PSA levels were?
26, does this indicate that he does have prostate cancer? He has painful and burning time using the bathroom and it's been hard for him to do either one. Does this mean it has spread to his bones? He goes to the doctor on December 30th I just wanted to be prepared. thanks He's 83 years old. He's been feeling really weak, painful to go to bathroom, getting up alot at night to go. Lost alot of weight.

A: Certainly 26 is a high number for the PSA. It doesn't necessarily mean cancer, because there are a lot of false positives even with high PSAs. The doctor will probably want to obtain a biopsy sample for lab analysis. Don't jump to any conclusions yet about cancer or the spread of cancer to other areas; wait until the doctor can make a proper diagnosis.

Q: Can you help with this question about prostate cancer and pomegranate juice?
I have a strong family history of prostate cancer (father & older brother). I am now over 65 and my PSA tests have remained at normal levels I have that test and a rectal exam by a urologist done annually. I've heard recently that pomegranate juice may be of value in treating men wiith prostate cancer whose cancer is still progressing despite radiation and/or hormonal therapy. What I'd like to know is this: (1) Is there any evidence that it might help in preventing or delaying onset of the disease? and (2) Is there any indication it could interfere with early diagnosis by skewing the PSA test? Cat Lover: Thank you for your kind remarks. Last year after reading an article that advised taking 4 times the usual recommended dose of Vitamin D3 I asked my urologist about it and he was able to tell me nothing. I think he would have no more information about pomegranate juice. I find that most doctors' knowledge of therapies is restricted to treatment of trauma, surgery, radiation, chemotherapy and the latest drugs the big pharmaceutical companies are pushing. They don't seem to know or even care about alternative therapies. I know, of course, there are exceptional doctors who do, but it's difficult to find them.

A: Why don't you ask your doctor? Most of the men (boys) who answer questions here are too young to even think of prostate cancer! They are more obsessed about sex! I think this pomegranate juice theory is relatively new, and no real studies have been done. Your best bet is to keep on having the PSA tests regularly. You are at the age where it is very important to do this. I have no idea whether the juice would interfere with the PSA test or not. Again, ask your doctor. And just because there has been a lot of prostate cancer in your family, doesn't guarantee you will get it. Just keep having those tests! If you should get it, treatment is so much better these days than it was years ago. Good luck!

Q: Information on prostate cancer?
DOES A LOW PSA LEVEL (BELOW 4) MEAN THAT PROSTATE CANCER HAS PROBABLY NOT SPREAD FROM THE PROSTATE?

A: How much a cancer has spread cannot be determined by the PSA level. How was this person diagnosed? A PSA below 4 is normal and a doctor would not likely do other tests. If he already had his prostate removed and his PSA is rising that is a different story.

Q: False positive and false negative probability question?
Approximately 25% of Canadian men in the 50's have prostate cancer. High level of PSA in the blood is used as a test for prostate cancer. Approximately 20% of men with prostate cancer have normal PSA levels and two out of three men without prostate cancer have high PSA levels. Calculate the probabilities that a PSA test on a Canadian man in his 50's will result in a) false positive b) false negative Thanks for the help :)

A: P(had) = 25% = 1/4 P(not) = 3/4 P(normallhad) = 20% = 1/5 P(highlnot) = 2/3 qa P(false positive) = P(positive but not) / P(positive) = P(highlnot)*P(not) / [P(highlnot)*P(not) + P(highlhad)*P(had)] = 2/3 * 3/4 / [2/3 * 3/4 + 4/5 * 1/4] = 1/2 / [1/2 + 1/5] = 5/7 qb P(false negative) = P(negative but had) / P(negative) = 1/5 * 1/4 / [1/5 * 1/4 + 1/3 * 3/4] = 1/20 / [1/20 + 1/4] = 1/6

Q: Hi my dad has prostate cancer which is terminal.His psa in oct 09 was 364 and now his latest test is 600.?
Also his GFR is 58 and his seren urea level is 6.7.They said he only had months in oct left to live but im confused into how many months.

A: Sam - Welcome to Answers. I'm sorry about your dad's serious condition. His PSA (Prostate Specific Antigen) level is very high and indicates his prostate cancer has spread elsewhere in the body. That's his like outlook is terminal. His GFR (Glomerular Filtration Rate) indicates his kidneys are working pretty well while his BUN (blood or serum urea nitrogen) level is okay. Sadly no physician or anyone else can given you any accurate forecast of how much remaining time he has. At best, it's an educated guess. Spend time with your dad, and let him know you love him, if at all possible. I pray you'll be pleasantly surprised as he continues to be with you.

Q: Prostate Cancer Help?
Hi all, thank you for reading my question. My dad was just diagonsed with prostate cancer last monday. The funny thing about this is that his PSA levels started at 7.6, when they told him he might have cancer, he changed his entire diet around, every two weeks he had to go for blood work. Everytime his PSA levels kept going down. The last PSA level he had was 4.2 and the doctor said, everything seem to be ok, but if he wanted to be 100% sure to get the biopsy done. Well he did get the biopsy, last monday the doctor told us they found very little cancer. My dad decided to get his prostate removed, we are going to talk to the doctor again on monday to give him the decision. My question here is, if anybody knows why his PSA levels would go down instead of up? and does this mean his cancer maybe hasn't spread? He has done a psa level for the past 2 or 3 years know, and this is teh first time cancer was diagnosed. He is 56 but very heatly otherwise. Anybody out there with experienc

A: PSA is produced by both normal prostate tissue and by cancerous tissue. The most common reason for a temporary rise of this magnetude is infection. It's also possible that he has BPH...benign enlargement...which is contributing to his PSA reading. With a reading of 7.6, I'm surprised they didn't have the biopsy done earlier. If his choice is radical therapy, he should take some time and research options and practitioners. It takes more than 10 years for PCa to kill, so he has some time to think this through. The consequences of prostate treatment can be quite serious, and he should come to terms with the potential consequences before finalizing his decision. If his choice is surgery, then he should consider robotic prostatectomy, which is rapidly becoming the preferred method, thanks to lower trauma and rapid recovery. It's important that his surgeon have a great deal of experience. A surgeon who has done 1000 prostatectomies would be a much better choice than one who has done 50. Although every urologist can perform this surgery, there are a small number of "artists", who are considered both by peers and patients to be more capable than average. He needs to find one of these surgeons. The probability of permanent impotence following surgery is anywhere from 20-70%, with the choice of surgeon being the key variable. And he will probably be incontinent for a period of time, with a small chance that this will be a lifetime condition.

Q: What are the odds of surviving Gleason 9 prostate cancer at age 56?
A friend of mine, who is 56 years old, was just diagnosed with prostate cancer. He has a pretty advanced case, gleason grade 9 and I think a PSA under 10. His dad died of prostate cancer. The doctors are worried because a year ago, he was tested and had extremely low PSA levels, but now they are much higher. This could be a sign of aggression. They don't know if it has spread yet. His doctor has recommended surgery in Seattle. Has anyone gone through this? Can anyone tell me what the likelihood is that he will be OK? Oh, just found out the PSA last year was 2 and now is 5.

A: The Gleason score "grades" tumors on the basis of how abnormal they look when the tissue is examined under a microscope. The more abnormal they look, the more likely they are to grow fast and to spread to other parts of the body. A grade of less than 4 generally means that cancer cells look similar to normal cells. Grades 5 to 7 fall under the intermediate range. Grades 8 to 10 indicate aggressive growth. survival rate is an average of 5 years.i would have a second opinion,and maybe some more tests such as a cat scan,bone scan(this shows what is called (hot spots) to show advancement and a biopsy to examine types.the grading can get complicated what you do need to ask is what his T-score is or TNM this tells basically if a primary Tumor Localized) n is for spread into lymph Nodes (regional)and M Metastatic into other bones(stage 4) or organs.then life expectancy is calculated for each stage. let me know what his Tscore is and email me with any other facts or test results. the best thing you can do is support your friend on his choices and through his recovery.

Q: Are there insurance companies for those over 60 and have had cancer of the prostate but is under control?
no further treatment for the cancer and approximately 1.5 years since the surgery and treatment. PSA levels are under 2

A: I used to offer life insurance, they like to see a five year cancer free time period. Go to an independant agent who has access to numerous companies. Each life insurance company has different underwriting guidlines.

Q: Concerns prior to scheduled Prostate Cancer Biopsy and I am hoping someone (perferrably a urologist) can?
assist me in making an informed decision. I am scheduled to have Prostate Cancer Biopsy on 05/24/07. Here is a brief history of events up till now: Vital statistics and hx are as follows: Age: 38; Sex: Male; Ht: 5' 5"; Wt: 162 lbs; Father: recently passed away at the age of 73 2ndry Prostate Cancer which got metastasized and as a result he had bone cancer as well; Mother: has diabetes and previously has had benign tumor removed; Older Brother: Healthy; Race: Asian-Indian. On 04/23/07 blood test done and the results indicated PSA level of 3.5, subsequent to this FreePSA test done on 05/04/07 and PSA level: 3.68. The normal range is 0-2.5. Based on some some chart scoring had a value of 8 indicative that I probably have a 24% chance of having prostate cancer. Visited Urologist on 05/16/07 and DRE was conducted and was normal. Should I wait 8 weeks and have another PSA test or go for Biopsy as suggested by the Urologist? Don't want to be sliced & diced but also want peace of mind!

A: The above answer has the right conclusion, although all the facts are wrong. While PCa at your age is rare, it's hardly unknown. You have an significantly elevated risk due to the fact that your father had it. PSA is not an indication of cancerous tissue, it's produced by both normal and diseased prostate tissue. The absolute number turns out to be fairly meaningless, as "normal" could be anywhere from .5 to 8, mostly depending on the size of your prostate and general health. It's best to have regular PSA tests, and to keep a chart of your results. A rapid increase in PSA is more concerning than a high absolute number. Free PSA is the percent of PSA which isn't attached to protein. If it's very low, there is a higher chance that your PSA reading is caused by cancer. A DRE can only detect cancer when it's extensive enough to be palpable. In parts of Europe, adoption of PSA testing has been slower than in the US, and DRE is still a preferred detection technique. But DRE will miss cancer in it's earliest, most treatable stage. In the US, the overwhelming majority of men are diagnosed with biopsy following abnormal PSA readings, and never reach the stage of having a positive DRE. If I were in your place, I would take the biopsy. Although biopsy isn't the most pleasant experience, it's the only way to find peace of mind. If it's negative, I would continue being vigilant, and have PSA tests every six months, charting the results. Given your family history, it pays not to take chances. What you can expect from the biopsy is a few minutes of discomfort, followed by a month of bleeding. It's not the worst thing that can happen to you.

Q: question for prostate cancer survivors?
I found out two weeks ago that I have prostate cancer. My wife and I have talked with the Dr and gone over the different form of treatment possible. I have had one hormone therapy shoot and and on a strict diet to lose as much weight as possible so I can have surgery in about 6 months. I would like to know from prostate cancer survivors what type of treatment you has and what were the side effects. Was incontinence a problem? I am thinking about having the radioactive seeds implanted in the prostate and if anyone has had this I would like to know how it went and what were any side effects you had. Other than being a bit overweight I am healthy. The cancer came as a surprise and was found after my PSA level rose to 4.3 The urologist did a biopsy and the cancer was found. I am curious to hear from other men who have survived prostate cancer. I didn't ask how to lose weight I asked about the side effects of the treatment

A: The good news is your PSA indicates you have discovered the cancer in the early stages. Mine was 12.7 but After taking antibiotics for two weeks it went down to 9.3 -- then I had a biopsy that showed a Gleason score of 6. I went through the radioactive seeding procedure followed by 7 weeks of external radiation at the RCOG clinic in Atlanta, GA. You ought to go on to their internet site and you can find all the information about the different treatments and the cure rates for each type of treatment. Just go to www.rcog.net. They'll send you a booklet explaining everything you need to know. The seeding alone without any further external radiation treatment is not nearly as effective as having both performed. I never had any side affects from the radiation except for one instance of radiation prostatitis which only affects a small number of patients.It's very similar to a regular prostate infection except antibiotics won't cure it but it goes away in a week or so.

Q: Serious question. Hope Dr. sees this. I have prostate cancer?
i was diagnoised with Prostate cancer 18 months ago. i had an biopsy done and out of 12 biops only 1 cancer cell showed up. I have recentely lost my urologist due to insurance. He explained everything too me and for forty-five minutes I listened along with two of my children. After all was said and done I decided on the "wait & watch". He said something else may kill me before my prostate cancer. He said if a male lives long enough he will have "prostate cancer". Now to the new Doctor, a Navy Dr. that I am not thrilled about. First of he does not believe in the "Wait & watch" theory. In December he wants to do another biopsy regardless what my PSA level reads. My PSA was 5.2 last examination, and anything over 4.0 you should have a biopsy. This Navy Doctor does not believe in the "watch & wait". He wants to do another biopsy regardless what my PSA level is Should I go see my original Urologist even though I want be covered with Insurace; i.e. just for a second opinion.

A: I didn't understand your question, however frequent PSA is recommended for close follow up of your case.....

Q: Question regarding prostate cancer?
My dad was diagnosed with prostate cancer April of 2007. July 2007 he had the Da Vinci Robot remove his prostate. Now he goes in for regular checkups.....when he was diagnosed his PSA level was 4....now he just had the PSA again and it's .3. I know it's not nearly as high as what it was before .3 is a long ways from 4....but what does the .3 mean? The doctor didn't seem concerned....and my dad is going to go back for a bunch of opinions. Just wondering if anyone can help me undestand what the .3 means. Can those cells be killed off with working out and eating well (which he already does)...or will he prb need radiation or hormone therapy?

A: I had prostate cancer in 2005. I had Proton Radiation treatments at Loma Linda University Medical Center in Loma Linda Calif. Proton Radiation has no side effects to speak of and a 90% cure rate.. When I was there there were several people there who had surgery, harmone implants and the lupron that did not or was not working... and they were gettin Proton Radiation to get rid of their cancer. They didnt know about Proton Radiation at the time they had the other treatments.. I think it is the very best treatment available for prostate cancer today.. Id say your dad would be fine if he could have Proton Radiation. It is very different from conventional radiation. With Proton 90% of the treatment energy is directed exactly to the point being treated... there fore surrounding tissue and organs are not damanged and the treatment energy is delivered where needed in a concentrated from. There is a website called Proton Bob that tells about Proton Radiation and prostate cancer.. If you go there be sure and read the Patient Testimonial section and you will see how other former patients are as sold on it as I am..you can probably find a testimonial or two from some who had other treatments that didnt work but later took proton and are just fine now.. Also there is a book recently out called YOU CAN BEAT PROSTATE CANCER, written by Robert J. Marckini, a prostate cancer survivor. It is great. It tells all about prostate cancer and then tells all about all of the various types of treatments available today plus the pros and cons and side effects of each type treatment.. It can be purchased at barnes and noble and other book stores or on line at the Proton Bob website.. Its just my opinion, but from my experience with prostate cancer and the treatments.. I think your father would be fine if he could get proton radiation for the prostate cancer... Hope this helps

Q: Can you help !!!!!?
I need to know more about prostate cancer and PSA levels. My dad has been having problems recently and went to the GP were they done a blood test. The test results showed his PSA level was 22 ! He has since had an ultrasound and we are waiting on the results. Does anyone know more about this psa is the hormone level they chack for in the blood - an average man his age has a level of 4 - his level was 22

A: Hello there, PSA is a substance normally found in the cells of the prostate gland. If the gland is damaged somehow, PSA gets out into the blood. That is what is measured when the test it done. Lots of things can raise the level, infection, cancer, riding a bicycle and sex. If the level is high, it means the chance of cancer is higher, but it doesn't prove anything. Try not to worry too much. Good luck.