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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Hi saros and welcome to the Board!

We are not physicians, and we have different views. Here is mine.

That drop in PSA from 15 to 10 is great news in the context of your very large prostate (75cc). :) PSA does not decrease with either BPH (gradual increasing pattern) or prostate cancer (a steady exponential increase as cells split). Therefore, this pretty much nails down that you have an infection. Take a look at our thread on “Benign Prostate Enlargement (BPH), PSA and Prostate Cancer: When to Biopsy?” Basically, it gives sources for information that about 1 unit of PSA is produced for every 10 cc of benign prostate tissue (so 75 X .1 = 7.5 expected PSA), with one respected, senior urologist stating that up to 50% more than that value can be considered normal, which could give you an upper bound of 11.5, even without continuing infection, and it seems reasonable that some of that current value of 10 is due to infection.

Furthermore, while a free PSA value of 14% is approaching the worrisome zone, free PSA, like PSA, is reduced by infection, so that percentage may not be a caution light for prostate cancer as your free PSA if uninfluenced by infection would likely be higher. I've learned that free PSAs in that midzone percentage range are not very helpful as indications of either cancer or freedom from cancer.

Going on finasteride looks sound to me. It will reduce the size of your prostate and also reduce blood flow to the prostate, a good thing if cancer is involved. Some research indicates that finasteride can eliminate at least some prostate cancer up to Gleason score of 6 if it is there. Finasteride reduces “noise” from BPH in the PSA signal for cancer or infection. Once you hit your low point on finasteride, any PSA increase, if not due to infection, is likely due to cancer. :cool: (I have been on finasteride or dutasteride continuously since the fall of 2000.)

You may have a mild form of prostate cancer that is best either not found or managed with active surveillance. It seems unlikely, in view of your workups and history, that you have a dangerous form of prostate cancer.

As biopsies are much less sensitive than mpMRIs, your urologists reluctance to do a biopsy at this time is understandable; he doesn’t want to search for a very small needle in the proverbial haystack. As for the statistics noted earlier, my understanding is that they do not account for BPH or infection.

There is some risk in this business, but I think your case is being well managed and that you can be confident.

Jim :wave:

[SIZE="1"]- - - - - - - - - - - - - - - - - - - - - - - -
Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. [/SIZE]

1. [U]No longer necessary to double the PSA to interpret trend[/U]: Once the PSA low point ("nadir") has been achieved, the amount of BPH that the that these drugs are capable of eliminating has been eliminated. That resets the PSA baseline. It is no longer necessary to double the PSA (which, doubling, is an approximation of a range of results anyway) to interpret changes in PSA level; I have heard experts advise this. Any significant increase needs investigation to determine whether it is due to infection, cancer, or both.[/SIZE][/QUOTE]

If on Finasteride you already know the trend. It is rising and not returning to normal levels and urinary and ED symptoms are revealing themselves.

Doubling the PSA to approximate its value if not on the drug allows you to track the progression of the cancer against study data. An unaffected value of 10 or 20 or higher still means something. Values eventually reach a height that are not the possible result of BPH or infection. Eventually, a PSA gets so high it can only be cancer, and it's not a very high number.

Rarely is an infection a serious consideration in the prostate cancer conversation.

Finasteride is a stop gap, buy some time and relief, but not a cure for what can kill you.

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